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Sp: Coexisting I > 7. Heart Failure/Cardiomyopathy > Flashcards

7. Heart Failure/Cardiomyopathy Flashcards

1
Q

contributing factors of SV

A
  1. preload
  2. afterload
  3. contractility
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2
Q

contractility is independent of

A

preload and afterload

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3
Q

estimate afterload

A

MAP
SBP

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4
Q

afterload impact on CO

A

inversely related

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5
Q

preload estimateion

A

LVEDP estimated by PAWP

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6
Q

all forms of heart disease have

A

high ventricular end diastolic pressure

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7
Q

does LVEDV increase with LVEDP

A

not necessarily

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8
Q

estimate for LVEDP

A

PAWP

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9
Q

estimate LVEDV

A

LVEDV ~ CO = HR*SV

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10
Q

Cardiac index

A

CI= CO/BSA

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11
Q

normal CI

A

2.5-4.2L/min/m2

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12
Q

Systolic heart failure

A

decr EF
chronic LV systolic dysfunction

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13
Q

systolic HF compensatory mechanism

A

tachycardia to incr CO

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14
Q

diastolic HF

A

inadequate relaxation of heart
improper filling

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15
Q

diastolic HF compensatory mechanism

A

tachycardia will decr CO

  • better to be bradycardic to allow for adequate filling
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16
Q

general HF compensatory mechs

A

decr Vmax
incr afterload
incr sympathetics
incr vascular tone

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17
Q

frank starling HF compensation

A

fluid retention/resuscitation

higher filling pressures needed to achieve similar SV/CO

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18
Q

incr afterload causes

A

heart needs to work harder

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19
Q

myocardial remodeling processing

A

hypertrophy
dilation
wall thining
incr collagen
myocardial fibrosis
scar formation
myocyte death

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20
Q

compensatory mechanism for pressure overlad

A

myocardial hypertrophy

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21
Q

myocardial hypertrophy is a _____ state

A

lower inotropic state

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22
Q

compensatory mechanism for fluid overload

A

dilation

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23
Q

most common cause of myocardial remodeling

A

ischemic injury

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24
Q

treatment for myocardial remodeling

A

ACE inhibitors
aldosterone inhibitors

25
Q
A

cardiomegaly

26
Q
A

alveolar edema
(pulm venous congestion severity level 3)

27
Q
A

pulmonary edema

28
Q
A

pleural effusion

29
Q
A

pericardial effusion

30
Q

acute HF management

A

loop diuretics
vasodilators
- NTG
- nipride
inotropes
- epi/Ne
- dobutamine
- milrinone
BNP
balloon pump
PVAD

31
Q

balloon pump: systole

A

deflates
suction incr EF

32
Q

balloon pump: diastole

A

inflates
incr CPP

33
Q

causes of RHF

A

Left ventricular failure
pulmonary HTN
right heart MI

34
Q

most common cause of RHF

A

left ventricular failure

35
Q

causes of LHF

A

left heart MI (LAD)
chronic HTN
acute HTN crisis
aortic/mitral valve disease

36
Q

high output HF

A

normal cardiac function
unable to provide adequate perfusion

37
Q

high output HF diagnostic values

A

CO > 8L/min
CI > 4L/min2

38
Q

causes of high output HF

A

hyperthyroid
sepsis
beriberi
lung disease
arteriole/capillary bypass
severe anemia
pregnancy

39
Q

HR: 65
BP: 80/45
SVR: 1400
CI: 1.5
PA: 40/20

Treatment?

A

milrinone
- incr inotropy
- decr PAP

40
Q

HR: 65
BP: 80/45
SVR: 650
CI: 3.0
PA: 20/10

Treatment?

A

NE
- incr SVR

41
Q

HRL 50
BP: 80/45
SVR: 650
CI: 1.0
PA: 20/10

Treatment?

A

Epi
- incr HR
- incr inotropy
- incr SVR

42
Q

post heart transplant

A

immunocompromised
need direct acting beta agonists (Phenylephrine)
pre-load dependent
avoid fluid overload

43
Q

HR: 60
BP: 80/45
SVR: 1200
CR: 1.0
PA: 20/10
Treatment?

A

dobutamine
- incr inotropy

44
Q

hypertrophic cardiomyopathy anatomic changes

A

septum hypertrophy
absence of cardiac disease
LVOT

45
Q

factors that worsen LVOT

A

incr contractility
- beta stimulation
decr preload
- hypovolemia
- vasodilators
- tachycardia
- PPV
decr afterload
- hypotension
- vasodilators
PPV

46
Q

factors that improve LVOT

A

decr contractility
- beta blockers
- VA
- CCB
incr preload
- hypervolemia
- bradycardia
incr afterload
- HTN
- alpha adrenergics

47
Q

goals for HCM

A

decr LVOT
minimize ischemia
avoid arrythmias

48
Q

anesthetic managment for HCM

A

beta blockers
CCB
euvolemia
mx SVR
mx sinus
avoid contractilioty changes

49
Q

what drugs worsen LVOT

A

ephedrine
dobutamine
epi

50
Q

HCM pregnancy management

A

epidurals
hypotension: fluid+phenylephrine
labor worsens LVOT

51
Q

dilated cardiomyopathy anatomic changes

A

LV dilation
regional wall abnormalities
valvular abnormalities

52
Q

DCM anesthetic management

A

treat like HF
give anticoag

regional if not on anticoag

53
Q

peripartum cardiomyopathy treatment

A

diuretics
vasodilators

54
Q

peripartum cardiomyopathy is ______

A

dilated cardiomyopathy

55
Q

restrictive cardiomyopathy characteristic

A

severe diastolic dysfunction
incr stiffness of myocardium

56
Q

restrictic cardiomyopathy management

A

sinus
avoid bradycardia
mx venous return
euvolemia
ketamine induction
avoid PPV

57
Q

cor pulmonale

A

right ventricular enlargement (hypertrophy and/or dilation)
may progress to RHF

58
Q

causes of Cor pulomonale

A

COPD
restrictive lung disease
pulm artery HTN

59
Q

cor pulmonale management

A

euvolemia
ABG
avoid hypoxia
avoid hypercarbia
avoid overnarcs

Sp: Coexisting I (11 decks)

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