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Echo 2 > C5: CHF > Flashcards

C5: CHF Flashcards

1
Q

define heart failure

A

a state in which the heart is unable to meet the oxygen and metabolic demands of the body

symptoms may be present in a rest state or w/ exertion

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2
Q

define heart function

A

producing a cardiac output sufficient enough to meet all physiological needs and to generate arterial press sufficient to profuse all organs (under low pressure)

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3
Q

do compensatory mechanisms for heart failure help or hurt?

A

hurt

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4
Q

can we diagnose CHF on echo?

A

no, its diagnosed clinically based on signs and symptoms, we look for cause and grading

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5
Q

1 year mortality rate for severe, moderate and mild CHF

A

S: 50-60%
Mod: 15-30%
Mild: 10%

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6
Q

3 general causes left heart failure

A

diseases of:
the myocardium
valves
coronary arteries

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7
Q

what causes right heart failure

A

Lft heart faliure

diseases of:
the lung parenchyma (COPD, emphysema)
lung vascularity (emboli, HTN)
cor pulmonale

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8
Q

most common cause of right heart failure

A

left heart failure, due to rising pressures, R heart fails b/c it cant handle the high afterload

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9
Q

describe some causes of decreased myocardial function that cause LHF

A

decreased myocardial function - CAD, CMO, myocarditis, infitrative diseases (hemochromatosis, amyloidosis, sarcoidosis), vascular diseases, medicatins, radiation therapy

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10
Q

describe some causes of increased myocardial workload that cause LHF

A

HTN
valvular diseases (severe regurg/stenosis)
increase preload/afterload

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11
Q

does LHF eventually cause RHF

A

yes

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12
Q

2 types of heart faliure

A

systolic/forward HF

diastolic/backwards HF

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13
Q

another term for systolic/forward HF and diastolic/backwards HF

A

S/F: Heart Failure reduced EF (HFrEF)

D/B: Heart Failure normal EF (HFnEF)

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14
Q

which type of HF is reversible to some extent?

A

diastolic…. systolic is not reversible

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15
Q

can LHF be both systolic or diastolic

A

yes, often there is an element of both in one patient

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16
Q

can diastolic HF be isolated? (w/o systolic HF)

A

yes, diastolic HF can be isolated

w/ systolic HF there will ALWAYS be a component of diastolic HF

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17
Q

what is the EF w/ SHF

how will CO be effected

A

<40%

CO will also be decreases

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18
Q

what is the EF w/ DHF

how will CO be effected

A

> 55%

CO will be normal

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19
Q

what causes SHF

what is the most common cause

A

impaired ventricular contraction - most CHF are this type (50-60%)

ischemic heart disease

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20
Q

what causes DHF

what is the most common cause

A

impaired ventricular relaxation
40-50% of CHF cases

HTN and LVH

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21
Q

causes of impaired ventricular relaxation of the LV

A

reduced compliance and possibly LVH….

…infiltrative myocardial disease, LVH by AS, high BP, advanced age

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22
Q

describe the physiology of DHF of the LV

A

reduced compliance of the LV leads to increased LVEDP and LA filling pressures (Gr 2/3 DD), which translates into higher pressure backing up in the PVs , lungs and eventually to the R heart

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23
Q

symptoms of both types of LV CHF

A

dyspnea due to pulm. congestion

orthopnea - diff breathing laying down

parxysmal nocturnal dyspnea - diff breathing at night
acute pulnomary edema
chronic fatigue
palpitations

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24
Q

what is the most common palpitation/arrhythmia to experience w/ CHF

A

afib

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25
Q

signs of both types of LV CHF

A

cardiomegaly
ventricular heave - LV pushes against chest wall
3rd and 4th heart sound
rales or crackles when breathing
cheyne-stokes respiration - w/ end stage CHF - starting and stopping breathing
tachycardia to compensate for low volume output

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26
Q

what causes the 3rd and 4th heart sound

A

3rd - early filling

4th - decreases compliance

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27
Q

signs of RHF

A 
signs related to underlying disease
RV hypertrophy
murmur due to pulm. or TV regurg
wheezing and SOB
elevated jugular venous pulse (JVP)
pitting edema, ascites, cyanosis
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28
Q

symptoms of RHF

A 
main symp. related to systemic venous congestion (JVP or leg edema)
fatigue when CO is reduced
dependent edema
liver enlargement/RUQ pain
anorexia or bloating
29
Q

whats the gold standard for measuring pulmonary pressure

what is its downside

A

pulmonary capillary wedge pressure

its invasive, where as echo is not, but we canonly estimate LAP

30
Q

how is pulmonary capillary wedge pressure measures

A

catheter is inserted into the R heart through the femoral vein or wrist and advanced into the RA, RV, RVOT, PA and then into a smaller pulmonary vessel

31
Q

another term for LAP

A

PWCP - pulmonary wedge capillary pressure

32
Q

norm LAP

an LAP over what value is considered hypertension

A

3-12 mmHg

> 18 mmHg

33
Q

NYHA functional CHF categories

A

Grade I - no symp and no limitations w/ norm activity

Grade II - mild symp or some limitations, can engage in low levels of excercise and comfortable at rest

Grade III - marked limitations w/ activity but comfortable at rest

Grade IV - severe limitations w/ symptoms are rest

34
Q

review pressure/volume loops for SHF and DHF

A

pg 18 and 19 of PP

35
Q

how does SHF and DHF effect frank starling law

A

FSL is lost in both SHF and DHF b/c of the lack of compliance

36
Q

what does the term left heart venous return refer to

A

pulmonary venous return

37
Q

3 things that effect venous return

A 
blood volume (obesity, preg, blood loss)
venous press (related to volume, venous constriction and temp)
intrathoracic press
38
Q

does expiration increase or decrease venous return fro the lower extremities

A

increases

39
Q

how does high after load reduce stroke volume

A

by increasing the end systolic volume in the LV

40
Q

the parasympathetic nervous sys stimulates which areas of the heart

what pathway does it use

A

SA node and AV node (decreased HR)

vagus nerve

41
Q

the sympathetic nervous sys stimulates which areas of the heart

what pathway does it use

A

SA node, AV node and purkinje fibers (increases HR)

cardiac fibers/nerves

42
Q

how does the parasympathetic nervous sys slow HR

A

by moving the resting membrane potential to a more negative state… sympathetic does the opposite

43
Q

what determines HR

A

steepness of phase 4 slope

44
Q

as BP drops, what happens to HR, contractility and blood vessles

A

increased HR
increased contractility
systemic vasoconstriction

45
Q

relationship b/w vasoconstriction and BP

A

inversely related

46
Q

why do compensatory mechanisms kick in w/ CHF

are they helpful

A

to counter act a drop in EF and BP, they are helpful in the short term but eventually make CHF worse

47
Q

how does sodum and h20 retension effect contractility of the heart

A

makes it harder for the heart to contract

48
Q

which hormones are released in order to counter act the compensatory mechanisms

what are the effects of these hormones

A

atrial natriuretic peptide
B-type natriuretic peptide (tested to see if someone is in CHF)

water excresion and vasodilation

49
Q

which specific parameters are we assessing when scanning a patient in CHF

A 
underlying etiology
chamber sizes and LV/RV mass
systolic function
diastolic filling press
R side heart pressure
valve function
50
Q

concentric LVH is seen more often with which type of CHF

A

backward

concentric is thick walls, norm chamber size

51
Q

eccentric LVH is seen more often with which type of CHF

A

fowards

eccentric is normal wall thickness, dilated chamber

52
Q

what do we need to determine RAP

A

IVC sniff test

TR jet

53
Q

how do we find RVSP

A

4(v)^2 + RAP

54
Q

how can moderate or severe regurg OR stenosis cause heart failure

A

it alters preload and afterload significant;y which puts stress on the heart

55
Q

treatment for CHF

A

depends on causes and symptoms

lifestyle
medication
pacemakers

56
Q

goal of medical treatments for CHF

A

mitigate symptoms to improve quality of life and improve the patients NYHA classification if possible…
… also to balance the effects of the compensatory mechanisms

57
Q

how do diuretics work

how do they help w/ CHF

A

-promote urination to decrease blood volume

  • decrease preload and afterload
  • relieves pulmonary congestion/pedal edema
  • also to treat high BP by decreasing blood volume
58
Q

what are inotropic agents

when are they used

A

improve contractility of the heart

used for those w/ reduced EF to increase SV and stimulated viable wall segments to contract

59
Q

will necrotic heart tissue respond to inotropic agents

A

no

60
Q

examples of inotropic agents

A

digitalis, digoxin

61
Q

describe ACE inhibitors

what is there effect

A

angiotension converting enzyme blocker

-used for arterial and venous vasodilation effects… this drug would increase BP
…. look for drugs ending in “pril” (enalopril, captopril)

62
Q

describe beta blockers

when would they be used

A

slow the force of contractions and HR

used in patients w/ diastolic HF…. controversial in patients w/ low EF since they can decrease SV futher

63
Q

do beta blockers increase the hearts filling time

A

yes

64
Q

examples of beta blockers

A

propranolol, atenolol, metoprolol…. names ending in olol

65
Q

drugs used for arrhythmias

A

anti-arrhythmias like calcium channel blockers, lidocaine, beta blockers

prophylactic anticoagulation for a fib - to reduce risk of clots

66
Q

which arrhythmia is common in CHF

describe its effects

A

a fib, it decreases SV and leads to a risk of clot formation and ventricular arrhythmias.

67
Q

non medical anti-arrhythmic treatments

A
  • pacemakers -biventricular pacing
  • implantable cardioverter/defibrillators (ICD) - stops v fib and v tachycardia
  • LV assist device (LVAD) - can be temporary of permanent w/ internal or external pumps
68
Q

LVADs are good for which type of HF

A

forward/SHF

Echo 2 (15 decks)

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