252 HF Patho Flashcards
In industrialized countries, predominant causs and responsible for 60-70% of heart failure
CAD
Major cause if HF in Africa and Asia
Rheumatic heart disease
NYHA classification: marked limitation of physic activity. Fatigue, dyspnea on less than ordinary activity
Class III
Refers to changes in LV mass, volume, and shape and the composition of the heart that occur after cardiac injury
Ventricular remodeling
Most common symptom of cor pulmonale
Dyspnea
Pleural effusion. Ascites. Edema. What’s the diagnosis?
Emphysema with cor pulmonale
complex clinical
syndrome that results from structural or functional impairment of
ventricular filling or ejection of blood, which in turn leads to the
cardinal clinical symptoms of dyspnea and fatigue
Heart failure
True or false. approximately one-half of patients who develop HF have a normal or preserved EF (EF ≥50%).
True.
considered as having a borderline or mid-range EF
Patients with a LV EF between 40 and 50%
responsible for 60–75% of cases of HF in industrialized countries
coronary artery disease (CAD
remains a major cause of HF in Africa and Asia, especially in the young.
Rheumatic heart disease
still a major cause of HF in South America
Chagas’ disease
True or false. Despite recent advances in the management of HF, the development of symptomatic HF still carries a poor prognosis
True.
NYHA class. Patients with cardiac disease but without resulting limitation of physical activity
Class I
NYHA class. Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at res
Class II
NYHA class. Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest
Class III
NYHA class. Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort.
Class IV
reasons why patients with LV dysfunction may remain asymptomatic
(1) activation of the renin-angiotensin-aldosterone system (RAAS) and the adrenergic nervous system (2) increased myocardial contractility
series of adaptive changes within the myocardium collectively referred to as
LV re modelling
The cardinal symptoms of HF
fatigue and shortness of breath
Important mechanism of dyspnea in HF
pulmonary congestion with accumulation of interstitial or intra-alveolar fluid, which activates juxtacapillary J receptors, which in turn stimulate the rapid, shallow breathing characteristic of cardiac dyspnea.
True or false Dyspnea may become less frequent with the onset of right ventricular
(RV) failure and tricuspid regurgitation.
True.
defined as dyspnea occurring in the recumbent position
Orthopnea
True or false. Orthopnea is usually a later manifestation of HF than is exertional dyspnea
True.
Common manifestation of orthopnea
Nocturnal cough
refers to acute episodes of severe shortness of breath and coughing that generally occur at night and awaken the patient from sleep
Paroxysmal nocturnal dyspnea
When does paroxysmal nocturnal dyspnea occur
usually 1–3 h after the patient retires
True or false Cheyne-Stokes respiration is present in 40% of patients with advanced HF and usually is associated with low cardiac output
True.
referred to as periodic respiration or cyclic respiration
Cheyne-Stokes respiration
a nonspecific sign caused by increased adrenergic activity
Sinus tachycardia
Examination of the jugular veins provides an estimation of
right atrial pressure
The jugular venous pressure is best appreciated with the patient lying recumbent, with
head tilted at 45°.
Normal jugular venous pressure
normal ≤8 cm
True or false pleural effusions occur most commonly with biventricular failure.
True.
Although pleural effusions are often bilateral in HF, when they are unilateral, they occur more frequently in
the right pleural space.
Cardiac examination most commonly present in patients with volume overload who have tachycardia and tachypnea, and it often signifies severe hemodynamic compromise.
An S3 (or protodiastolic gallop)
The most useful index of LV function
EF (stroke volume divided by end diastolic volume)
released from the failing heart, are relatively sensitive markers for the presence of HF with depressed EF
Both B-type natriuretic peptide (BNP) and N terminal pro-BNP (NT-proBNP)
Peak oxygen uptake associated with a relatively poor prognosis.
peak oxygen uptake (vo2) <14 mL/kg per min is associated with a relatively poor prognosis.
cardinal manifestation of HF
Peripheral edema
referred to as pulmonary heart disease, is broadly defined by altered RV structure and/or function in the context of chronic lung disease and is triggered by the presence of pulmonary hypertension.
Cor pulmonale
an important sequela of HFpEF and HFrEF
RV dysfunction
True or false Although RV dysfunction is an important sequela of HFpEF and HFrEF, this is not considered as cor pulmonale.
True.
Common pathophysiologic mechanism in cor pulmonale
pulmonary hypertension and increased RV afterload sufficient to alter RV structure
mean pulmonary artery pressure
only ~15 mmHg
True or false Anatomically, the RV is a thin-walled, compliant chamber better suited to handle volume overload than pressure overload
True.
True or false. Cyanosis is a late finding in cor pulmonale
True.
The ECG in severe pulmonary hypertension shows
P pulmonale, right axis deviation, and RV hypertrophy
True or false BNP and N-terminal BNP levels are elevated in patients with cor pulmonale secondary to RV myocardial stretch
True.
remains best suited for diagnosing chronic thromboembolic disease
ventilation-perfusion scan
