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AS - N932 Advanced Pathology > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Heart Failure Classification

A

New York Heart Association Functional Classification of Breathlessness (for heart failure patients)

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2
Q

NYHA Class I

A

No symptoms and no limitation in ordinary physical activity i.e. SOB when walking, climbing stairs, etc.

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3
Q

NYHA Class II

A

Mild symptoms (SOB and/or angina) and slight limitation during ordinary activity

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4
Q

NYHA Class III

A

Marked limitation in activity d/t symptoms even during less-than-ordinary activity i.e. walking short distances (20-100m)
Comfortable at rest

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5
Q

NYHA Class IV

A

Severe limitations
Experiences symptoms even while at rest
Mostly bedbound patients

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6
Q

Heart Failure Causes

A

Volume overload
Pressure overload
Myocardial contractile impairment d/t ischemia or infarct
Restrictive filling (constrictive pericarditis, cardiac tamponade, restrictive myocarditis)
Idiopathic remodeling - cardiomyopathy
Myocardial inflammation

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7
Q

Left-Sided HF Causes

A 
↑LVEDP
Hypertension
CAD
Valvular disease
MI
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8
Q

Right-Sided HF Causes

A

↑RVEDP
Most common cause L-sided HF
Pulmonary arterial hypertension
R ventricle MI

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9
Q

Low Output HF Causes

A 
Result from FILLING or EMPTYING problem
CAD
Chronic HTN
Cardiomyopathy
Valvular disease
Pericardial disease
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10
Q

High Output HF Causes

A

↑ metabolic demand
Anemia
Septicemia
Hyperthyroidism

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11
Q

Volume Overload

A 
SHF
↓LVEF
↑LV chamber size 
S3 gallop
Compliant
ECCENTRIC remodeling
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12
Q

Pressure Overload

A 
DHF
Normal LVEF
↓LV chamber size
S4 gallop
↓ compliance
CONCENTRIC remodeling
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13
Q

Eccentric

A

New sarcomeres in series
Hypertrophy
↑radius (chamber size)
EMPTYING problem

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14
Q

Concentric

A 
New sarcomeres in parallel
Hypertrophy
↓chamber radius
Cardiomyocyte thickening
FILLING problem
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15
Q

Heart Failure Physiological Compensations

A

↑SNS
Arterial VSMC vasoconstriction ↑SVR ↑afterload
↑venomotor tone ↑VR
Frank-Starling mechanism engagement
SA node ↑HR
Myocardium ↑inotropy ↓catecholamine sensitivity
Adrenal gland ↑circulating catecholamines
RAAS activation d/t ↓renal blood flow
Cardiac remodeling

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16
Q

Neural Compensations

A

Atrial & arterial baroreceptors trigger catecholamine release & ↑vasopressin
Catecholamines → cardiotoxicity (apoptosis & necrosis) promotes cardiac remodeling
Vasopressin ↑SVR ↑Na+/H2O retention

17
Q

Local Compensations

A

↓renal blood flow → RAAS activation promotes remodeling
Ischemic cardiomyocytes release inflammatory mediations (cytokines) that trigger cardiac remodeling
Ischemic endothelial cells release endothelin
Stretched atrial & ventricular cells release ANP/BNP (cardioprotective)
ANP promoted diuresis, natriuresis, inhibits RAAS & SNS, anti-inflammatory, inhibits remodeling

18
Q

Systolic Heart Failure

A

Emptying problem occurs in the L ventricle > R ventricle

Triggered by volume overload → eccentric remodeling

19
Q

Diastolic Heart Failure

A

Filling problem occurs in the L ventricle > R ventricle

Triggered by pressure overload → concentric remodeling

20
Q

Acute Heart Failure

Anesthetic Implications

A

Immediate goal ↑CO ↓LVEDP
End organ perfusion
Tools include inotropes, vasodilators, diuretics, Ca2+ sensitizers, BNP, NO inhibitors, & mechanical devices

21
Q

Chronic Heart Failure

Anesthetic Implications

A

Goal to prevent acute heart failure episode
Hemodynamic stability
Full preop workup
Check medications, complete cardiac history, hepatic/renal/electrolyte panels, recent EKG or Echo

22
Q

FILLING

A 
DHF
Restrictive cardiomyopathy
Hypertrophic cardiomyopathy
Constrictive pericarditis
Cardiac tamponade
Hypotension
Mitral valve stenosis (L ventricle)
Tricuspid valve stenosis (R ventricle)
23
Q

EMPTYING

A 
SHF
Dilated cardiomyopathy
Hypertrophic cardiomyopathy w/ LVOTO
Myocardial infarction
Aortic valve stenosis (L ventricle)
Pulmonary valve stenosis (R ventricle)
24
Q

Volume Overload

A 
Aortic regurgitation (L ventricle)
Mitral regurgitation (L atrium)
25
Q

SHF or DCM Considerations

A

EMPTYING problem
Heart rate - maintain NSR (atrial kick) ↓HR ↑filling time ↓CO
Preload - maximize Frank-Starling & prevent fluid volume overload or pulmonary congestion
Afterload - ↓SVR ↑CO (ΔP) w/o hypotension (maintain BP) ↓BP ↓CorrPP
Contractility/inotropy - admin inotropes to help improve forward flow
Ischemia - monitor to prevent

26
Q

DHF or RCM

Considerations

A

FILLING problem
Heart rate - maintain NSR ↑HR ↓filling time SV limited
Preload - maximize Frank-Starling & prevent fluid volume overload
Afterload - maintain ↓SVR → SNS activation ↑HR
Contractility/inotropy - maintain (not an emptying problem) ↑contractility ↑MVO2
Ischemia - avoid ↑LVEDP

27
Q

HCM w/ LVOTO

Considerations

A

FILLING & EMPTYING problem
Heart rate - avoid ↑HR ↓filling time
Preload - maintain w/o fluid volume overload
Afterload - do NOT ↓afterload (worsens LVOTO d/t Venturi effect)
Contractility/inotropy - ↑contractility worsens LVOTO
Ischemia - HIGH risk

28
Q

Aortic Valve Stenosis

Considerations

A

L ventricle EMPTYING problem
Heart rate - maintain NSR (atrial kick) SV limited ↑HR ↑demand ↓supply ↓HR → L ventricle overdistension
Preload - maintain w/o fluid volume overload
Afterload - do NOT ↓afterload (unable to compensate to maintain BP)
Contractility/inotropy - maintain or ↑contractility ↑CO
Ischemia - HIGH risk

29
Q

Pulmonic Valve Stenosis Considerations

A

R ventricle EMPTYING problem
Heart rate - maintain NSR ↓HR → volume overload
Preload - maintain w/o fluid volume overload
Afterload - minimal impact ↑SVR to maintain CO
Contractility/inotropy - maintain or ↑contractility
Ischemia - monitor ↑MVO2
Prevent ↑PVR → worsens R ventricle congestion & cardiac demand

30
Q

Aortic & Mitral Valve Regurgitation Considerations

A

VOLUME overload
Heart rate - AVOID bradycardia >80bpm ↓filling time
Preload - maintain w/o fluid volume overload
Afterload - avoid ↑SVR ↓SVR as tolerated (ΔP) but maintain adequate perfusion
Contractility/inotropy - maintain & admin inotropes as needed to promote forward flow
Ischemia - ↑LVEDP ↓CorrPP

AS - N932 Advanced Pathology (8 decks)

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