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CPR Exam 1 > Cardiac Clinical Med 3 (Miller) > Flashcards

Cardiac Clinical Med 3 (Miller) Flashcards

1
Q

What is HF with preserved ejection fraction defined as?

A
  • LVEF >50%
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2
Q

What is HF with reduced ejection fraction defined as?

A
  • LVEF < 40%
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3
Q

How does HFrEF occur?

A
  • Begins with direct injury to myocardium or a disease state that leads to reduced contraction of the ventricles
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4
Q

What are some CV etiologies that can cause HFrEF?

A
  • CAD
  • Cardiomyopathies
  • Myocarditis
  • Valvular diseases
  • Cardiac infections
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5
Q

What are some non-cardiac causes of HFrEF?

A
  • Endocrine (thyroid disorders)
  • Systemic diseases
  • High intake of alcohol and other illicit drugs
  • Following chemotherapy for cancer
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6
Q

What are the shared risks of HF?

A
  • Age
  • DM
  • Smoking
  • HTN
  • Atherosclerosis
  • Obesity
  • Metabolic syndrome
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7
Q

What are some risk factors specifically for HFrEF?

A
  • Male
  • LVH
  • Bundle branch block
  • Previous MI
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8
Q

What are some risk factors specifically for HFpEF?

A
  • Older age
  • Female
  • HTN
  • A fib
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9
Q

What are some symptoms of congestion in HF?

A
  • Dyspnea on exertion
  • Paroxysmal nocturnal dyspnea
  • Orthopnea
  • Nocturnal cough
  • Weight fluctuations
  • Edema
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10
Q

What are some symptoms of hypoperfusion?

A
  • Exercise intolerance
  • Fatigue
  • Decreased mentation
  • Cold intolerance
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11
Q

What do we look for in the medical history to help make a diagnosis of heart failure?

A
  • Identify risk factors, existing precipitating factors, comorbid conditions
  • Identify family history of sudden cardiac death or clinical HF
  • Assess medications
  • Identify exacerbating conditions
  • Assess diet
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12
Q

What is the goal in diagnosis of HF?

A
  • Identify the etiology of HF
  • Identify prognostic factors
  • Provide information about patient management
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13
Q

What devices can we use to help diagnose HF?

A
  • EKG
  • CXR
  • Labs (assess renal function, serum potassium)
  • Echocardiography
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14
Q

What do the labs help us look at when diagnosing HF?

A
  • Look at renal funciton and serum potassium

- Cardiac biomarkers like BNP and NT BNP

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15
Q

What will be found on echocardiography in someone with HF?

A
  • Reduced LVEF
  • Atrial and ventricular chamber dilation or hypertrophy
  • Valvular dysfunction
  • Pericardial pathology
  • Elevated ventricular filling pressures
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16
Q

What are the objectives of treating and managing HF?

A
  • Improve symptoms
  • Improve quality and duration of life
  • Prevent hospital admission
17
Q

What is a way to improve the symptoms of HF?

A
  • Give diuretics
18
Q

What is a way to prevent remodeling of the heart in order to improve the quality and duration of life?

A
  • Treat patient with ACEi or B-blocker

- If still symptomatic, give MR antagonist

19
Q

What treatment option gives the best overall quality of life in those with HFrEF?

A
  • Cardiac transplantation
20
Q

How do we treat individuals with HFpEF?

A
  • Without HTN, there is no evidence in giving any medications except diuretics
  • Identify and treat comorbidities because that is what kills people (not the HF)
21
Q

How does Cor Pulmonale develop?

A
  • In response to pulmonary HTN
22
Q

What is the common mechanism in cor pulmonale?

A
  • Pulmonary HTN and increased RV afterload are sufficient to alter RV structure and function
23
Q

What are the symptoms of cor pulmonale?

A
  • Generally related to underlying lung disorder

- Leads to systemic congestion like LE swelling or ascites

24
Q

How is cor pulmonale diagnosed?

A
  • EKG (signs of pulmonary HTN: right axis and RV hypertrophy)
  • CXR (show enlargement of pulmonary arteries
  • 2D TTE
25
Q

What is the treatment and management of cor pulmonale?

A
  • Maintain oxygen delivery to tissues (keep SaO2 above 90%)
  • Optimize volume status (diuretics, fluid, Na restriction)
  • Provide hemodynamic support
  • Manage arrhythmias
  • Activity restriction
  • Palliative care
26
Q

How is HF prevented?

A
  • Identify, treat, and prevent conditions that lead to HF like HTN, hyperlipidemia, DM, obesity, smoking
27
Q

What is stage A of HF prevention?

A
  • Prevent the development of CV disease and ventricular structural abnormalities
  • Counselling for appropriate dietary and exercise modifications
28
Q

What is stage B of HF prevention?

A
  • Prevent the development of further cardiac remodeling and symptomatic HF through the appropriate initiation of heart failure specific therapies

CPR Exam 1 (21 decks)

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