279 Heart Failure: Pathophysiology and Diagnosis Flashcards

1
Q

It is a 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, edema and rales

A

Heart Failure

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2
Q

Etiologies of Heart Failure with Depressed EF (<40%)

A

Coronary artery disease
Myocardial infarction
Myocardial ischemia

Chronic pressure overload
Hypertension
Obstructive valvular diseasea

Chronic volume overload 
  Regurgitant valvular disease
  Intracardiac (left-to-right)       shunting
  Extracardiac shunting
Chronic lung disease
  Cor pulmonale
  Pulmonary vascular disorders 

Nonischemic dilated cardiomyopathy
Familial/genetic disorders
Infiltrative disorders

Toxic/drug-induced damage
Metabolic disordera
Viral

Chagas’ Disease

Disorders of rate and rhythm
Chronic bradyarrhythmias
Chronic tachyarrhythmias

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3
Q

Etiologies of Heart Failure with Preserved EF (>40%)-50%

A

Pathologic hypertrophy
Primary hypertrophic cardiomyopathies
Secondary hypertension
Aging

Restrictive cardiomyopathy
  Infiltrative disorders (amyloidosis, sarcoidosis)
  Storage diseases (hemochromatosis)

Fibrosis

Endomyocardial disorders

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4
Q

Etiologies of Heart Failure High Output States

A

Metabolic Disorders
Thyrotoxicosis

Nutritional disorders (beriberi)

Excessive blood flow requirements
Systemic arteriovenous shunting
Chronic anemia

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5
Q

Myocyte Changes during LV Remodeling

A

Myocyte loss
Necrosis
Apoptosis
Autophagy

Alterations in extracellular matrix
Matrix degradation
Myocardial fibrosis

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6
Q

Alterations in Myocyte Biology during LV Remodeling

A

Excitation-contraction coupling

Myosin heavy chain (fetal) gene expression

β-Adrenergic desensitization

Hypertrophy

Myocytolysis

Cytoskeletal proteins

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7
Q

Alterations in LV Chamber Geometry during LV Remodeling

A

Left ventricular (LV) dilation

Increased LV sphericity

LV wall thinning

Mitral valve incompetence

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8
Q

It refers to the changes in LV mass, volume, and shape and the composition of the heart that occur after cardiac injury and/or abnormal hemodynamic loading conditions

A

Ventricular Remodeling

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9
Q

Cardinal Symptoms of HF

A

Fatigue

Shortness of breath

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10
Q

It is defined as dyspnea occurring in the recumbent position, is usually a later manifestation of HF than is exertional dyspnea

A

Orthopnea

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11
Q

It results from redistribution of fluid from the splanchnic circulation and lower extremities into the central circulation during recumbency, with a resultant increase in pulmonary capillary pressure

A

Orthopnea

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12
Q

It refers to acute episodes of severe shortness of breath and coughing that generally occur at night and awaken the patient from sleep, usually 1–3 h after the patient retires

A

PND

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13
Q

Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain.

A

NYHA Class III

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14
Q

Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.

A

NYHA Class IV

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15
Q

Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activ- ity does not cause undue fatigue, palpitations, dys- pnea, or anginal pain.

A

NYHA Class I

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16
Q

Patients with cardiac disease resulting in slight limita- tion of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpita- tion, dyspnea, or anginal pain.

A

NYHA Class II

17
Q

It is also referred to as periodic respiration or cyclic respiration.

It is caused by an increased sensitivity of the respiratory center to arterial PCO2

A

Cheyne-Stokes Respiration

18
Q

Pulmonary examination in HF

A

Pulmonary crackles

Pleural effusion

19
Q

Cardiac examination in HF

A

Cardiomegaly- displaced PMI

S3- volume overload who have tachycardia and tachypnea

S4- diastolic dysfunction

MR and TR

20
Q

Abdominal examination in HF

A

Hepatomegaly
Ascites
Jaundice

21
Q

Diagnostic work-up in HF

A

CBC, Electrolytes, BUN, Serum Creatinine, FBS, OGTT, Lipid Profile, TSH, 12-lead ECG, chest x-ray, 2d echo with DS, MRI, Biomarkers (BNP and NT-proBNP), Exercise testing

22
Q

It provides a comprehensive analysis of cardiac anatomy and function and is now the gold standard for assessing LV mass and volumes

A

MRI

23
Q

It is the most useful index of LV function

A

EF

24
Q

It is often referred to as pulmonary heart disease

A

Cor pulmonale

25
Q

It can be defined as altered RV structure and/or function in the context of chronic lung disease and is triggered by the onset of pulmonary hypertension

A

Cor pulmonale

26
Q

It is the common pathophysiologic mechanism of cor pulmonale

A

Pulmonary hypertension

27
Q

Etiology of Chronic Cor Pulmonale

A

Diseases of the Lung Parenchyma

Disorders of Chronic (Alveolar) Hypoxia

Diseases of the Pulmonary Vasculature

28
Q

It is the most common symptom of cor pulmonale

A

Dyspnea

29
Q

It is the increase in intensity of the holosystolic murmur of tricuspid regurgitation with inspiration

A

Carvallo’s sign

30
Q

It is the most common cause of right HF

A

Left HF

31
Q

ECG in severe pulmonary hypertension

A

P pulmonale
Right axis deviation
RV hypertrophy

32
Q

Chest x-ray findings in cor pulmonale

A

Enlargement of the main central pulmonary arteries and hilar vessels