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OMSII BECOM Exam 2 > Acute and Chronic heart failure I&II - Adje > Flashcards

Acute and Chronic heart failure I&II - Adje Flashcards

1
Q

ejection fraction

A

EF = SV / EDV

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2
Q

stroke volume

A

SV = LVEDV - LVESV

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3
Q

increase in sympathetic activity to heart

A

increase contractility and HR

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4
Q

increase in contractility

A

increase SV and preload back to heart

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5
Q

increase preload

A

increase force of contraction

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6
Q

increase afterload

A

increase contractility

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7
Q

increase HR

A

increase contractility

  • Pos chronotropes –> increase HR (ex. NE) –> bind to beta 1
  • Neg chronotropes –> decrease HR (ex. Ach) –> bind to M2
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8
Q

during exercise***

A

-strenuous exercise –> muscles take up 85% of CO (effects of local vasodilators)

  • SNS –> increases HR, increases SV (due to increase in preload and contractility)
  • decrease afterload (decrease PVR and increase perfusion to muscles)
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9
Q

HFrEF vs. HFpEF***

A
  1. HFrEF –> systolic heart failure (EF <40%)
    - CAD > chronic pressure/volume overload
  2. HFpEF –> diastolic heart failure (EF >40%)
    - pathologic hypertrophy, restrictive cardiomyopathy, aging, fibrosis

heart failure = heart can’t fill, heart can’t pump

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10
Q

2 main causes of depressed EF (HFrEF)*****

A

structural heart disease**

  1. older person –> CAD or atherosclerosis
  2. younger –> viral myocarditis
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11
Q

pathogenesis of HFrEF**

A

decline in pumping capacity –> compensatory mechanisms activated to prevent end organ damage

  1. adrenergic nervous system –> to maintain CO
  2. RAAS –> Na+ and H20 retention***
  3. cytokine storm

LV remodeling over time

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12
Q

cardinal symptoms of heart failure***

A
  • fatigue and SOB (dyspnea)***

- pulmonary congestion due to accumulation of fluid –> activate J receptors –> rapid, shallow breathing

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13
Q

orthopnea

A
  • SOB in recumbent (increased pulmonary capillary pressure)
  • nocturnal cough
  • relieved with sitting up
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14
Q

paroxysmal nocturnal dyspnea (PND)***

A

-acute episodes of severe SOB and coughing at NIGHT and awaken from sleep

  • 1-3hr after falling asleep
  • increased pressure in bronchial arteries –> airway obstruction –> airway resistance

-differentiate from cardiac asthma* (wheezing secondary to bronchospasm)

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15
Q

Cheyen-stokes respiration

A
  • periodic respiration
  • due to increase sensitivity of respiratory center to arterial PCO2**
  • apneic phase (drop O2, rise in CO2) –> stimulate respiratory center –> hyperventilation and hypocapnia
  • differentiate from sleep apnea*
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16
Q

New York Heart classification*****

A
  1. class I - NO limitation of physical activity
  2. class II - SLIGHT limitation
    - ordinary physical activity brings on symptoms
  3. class III - MARKED limitation
    - less than ordinary activity
  4. class IV - even at REST
    symptoms: fatigue, palpitation, dyspnea, anginal pain
17
Q

Jugular Veins**

A
  • estimation of RA pressure
  • head tilted 45 degrees
  • normal JVP = 8cm of water*****
  • add 5cm
  • measuring height above sternal angle
18
Q

what are specific for heart failure?***

A
  • RALES** on pulmonary exam (fluid in alveoli)

- S3** gallop (protodiastolic gallop) on cardiac exam from volume overload

19
Q

CHF**

A
  • rales
  • JVP >10
  • S3
  • peripheral edema (hepatomegaly, ascites, jaundice)
20
Q

what lab test is most helpful i heart failure?***

A

-BNP or Pro-BNP**

21
Q

what is the only test that will help you differentiate b/w HFrEF and HFpEF?*****

A
  • ECHO** (assesses LV function)
  • EF is normal (>/=50%)
  • EF depressed (<30-40%)
  • chest Xray used to diagnose cardiomegaly
22
Q

what biomarker is diagnostic for heart failure?***

A
  • Brain Natriuretic peptide (BNP)**
  • released from heart ventricles
  • high BNP –> fluid retention

-Dyspnea –> high BNP or NT-proBNP = diagnosis of HF***

23
Q

acute pulmonary edema symptoms*****

A
  • dyspnea at rest
  • tachypnea
  • tachycardia
  • severe hypoxemia
  • crackles and wheezing from alveolar flooding and bronchial compression
  • release catecholamines –> HTN
24
Q

cor pulmonale

A
  • altered RV structure and function (right side heart failure) in chronic lung disease from pulmonary HTN (or any lung disease)
  • dyspnea most common symptom
  • COPD and chronic bronchitis responsible for 50% of cases

physical exam

  • Auscultation –> LOUD P2***** in pulmonary HTN
  • TR murmur
  • high JVP
  • hepatomegaly
  • ascites
  • lower extremity edema
  • cyanosis
25
Q

myocarditis

A

-primary myocarditis caused by acute viral infection or post viral immune response

infectious causes
-viruses (most common)*

noninfectious causes

  • chemo drugs
  • autoimmune diseases
  • hypersensitivity rxns

diagnosis

  • high WBC, ESR, CRP, troponin, BNP
  • need biopsy and histologic evidence
26
Q

what can lead to cardiotoxicity in noninfectious myocarditis?**

A
  • COCAINE**
  • causes coronary spasm, MI, arrhythmias, myocarditis
  • inhibits NE reuptake by sympathetic nerves

OMSII BECOM Exam 2 (24 decks)

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