Cardio Flashcards
Heart failure
IC: Sindrome que resulta de ___ ventricular; sobrecarga de ____ ou ____; combinados ou ____
disfuncao; volume; pressao; isolados
Heart output proportional to its:
Filling volume
Heart output inversely proportional to:
Resistance against wich it pumps
Systemic oxigen transport is calculated as…
Product of cardiac output and systemic o2 content
Cardiac output is calculated as…
Product of heart rate and stroke volume
Stroke volume dependes on…
PRE-load; AFTER-load; contractility
High-output heart hailure is…
Mantained or increased cardiac output with decreased systemic O2 content or increased demands
Increased sympathetic tone increases secretion of…
epinephrine and noradrenaline; in turn this increases cardiac output
Wich receptors increases HR and myocardical contractility?
B-adrenergic receptors
A-adrenergic receptors causes vaso____
constriction
Chronic exposure to catecholamines leads to…
a decrease in B-adrenergic receptors; Downeregulation
Edema is very frequent in infants with HF (T/F)
False; generally absent; may be passed off as normal weight gain
Many children may pressent abdominal symptoms of HF (T/F)
True; abd pain;nausea; anorexia can be quite common
Cardiomegaly is invariably noted in HF (T/F)
True
Measured on a PA chest x-ray
0.42-0.50 NV
Common rhythm in HF
Gallop (S3)
Holosystolic murmur might signal
advanced dilation; mitral and/or tricuspid regurgitation
Large left to right shunts may have ______ at the X-ray
Exaggeration of the pulmonary arterial vessels
Fluffy perihialr purmonary markings indicate:
Venous congestion
Standard technique for assessing ventricular function:
Ecocardiography
Ventricular function can be quantitated by meassuring: (USG)(2)
Fractional shortening and ejection fraction
Fractional shortening:
[(End-Diastolic - End-Systolic)/End-Diastolic]*100; Normal 28-42
Normal Ejection fraction:
55-65%
Usefulness of magnetic resonance angiography in HF: (5)
Quantifying L&R V function; volume; mass; coronary anatomy; valvular regurgitatino
Hyponatremia in HF is often the result of…
renal water retention
Increased ventricular tension causes the release of…
B-type natriuretic peptide; it might indicate HF or volume overload
Pulmonary embolism or hypertension can cause BNP release (T/F)
TRUE
Noncardiac causes of elevated BNP (10)
Isquemic or hemorragic brain lesion; renal; liver; paraneo; COPD; Sepsis; Burns; Anemia; Metabolic and hormonal abnormalities
Possitive pressure ventilation may be required in:
Pulmonary edema; reduces o2 consuption by eliminating work of breathing
Infants with HF fail to trhive due to:
increased metabolic demands and decreased caloric intake
Caloric density above 0.8cal/ml may cause:
Diarreia or renal overload
Gastroesophageal reflux may appear in…
Cardiac enlargement
Low sodium formulas for infants are routinely used (TF)
False; there preparations are often poorly tolerated and may cause hyponatremia
First mode of therapy for congestive HF
Diuretics
Most commonly used diuretic in pediatric HF
Furosemide
Diuretic that inhibits reabsorption of Na and CL in the “distal” tubules and the “loop”
Furosemide
Diuretic that inhibits aldosterone
Spironolactone; enhances K retention; 2mg/kg/24h BID
Diuretic with favorable effect on cardiac fibrosis
Spironolactone
Children with cardiomyopathy may benefit more from ___load reducers
“AFTER”load; ACEI and ARB’s
Children with mitral or aortic insufficiency may benefit more from ___load reducers
“AFTER”load; ACEI and ARB’s
Adults with dilated cardiomyopathy in use of ACEI have reduced:
Mortality and morbidity; may have effects on cardiac remodeling
Main effect of nitroprusside
Peripheral arterial vasodilation and afterload reduction; some venodilation
High doses of nitroprusside may cause intoxication due to:
Thiocyanate poisoning; Cyanide is a byproduct of hepatic metabolization
ACEIs may cause ___kalemia
“HYPER”
Digoxin may reduce death among infants with _____ heart disease
Single-ventricle.
Dopamine is a “predominantly _____ receptor agonist
B-adrenergic; it also has A-adrenergic effect at “higher” doses >15µ/kg/min
Dopamine is more arrhytmogenic than pure B-agonists like Isoproterenol (T/F)
False; its also less chronotropic
Fenoldopam is a ____ receptor agonist
Dopamine DA1; increases renal blood flow and urine output
Dobutamine is a derivative of ____
Dopamine
Main effects of Dobutamine (2)
Inotropic effect and moderate reduction in peripheral vascular resistance
Isoproterenol is a pure _____ receptor agonist
B-adrenergic; marked chronotropic effect; effective in patients with slow HR. Often used after heart transplants.
Epinephrine is a ____ receptor agonist
Mixed A-B adrenergic; usually reserver for patientes with cardiogenic shock and low BP
Epinephrine increases afterload by:
increasing systemic vascular resistance; also increases risk of arrhytmia
Milrinone is a ______ Inhibitor
Phosphodiesterase
Milrinone is useful in patients with _____ cardiac output
Low; used mostly after open heart surgery
Milirinone has ___tropic effect and ____ vasodilatory effects
“INO”; peripheral
Carvelidol is a ____ receptor bloquer
A-B adrenergic; metoprolol is B-adrenergic selective
B-blockers should be adminestered in acute fase of HF (T/F)
False; increases mortality
Ivabradine lowers HR without _______ miocardial _____
Lowering; contractility
Leading cause of sudden death in severe cardiomyopathy
Arrhytmias
Main causes of cardiogenic shock (8)
Cardiac dysfunction before or after surgery; septicemia; severe burns; anaphylaxis; cardiomyopathy; infarction; CNS disorders
Cardiogenic shock is characterized by:
low cardiac output that results in inadequate tissue perfusion
Hight HR may reduce cardiac output by:
decreasing time for diastolic filling and increasing myocardial o2 demand
Use of digoxin should be ____ during acute low cardiac output states
“Avoided”
Milrinone combined with a B-adrenergic agonists has a _____ effect
synergistic
Most common short term modality to support circulatory failure in children
ECMO
Tools for preload meassurement(4)
CVP; PCWP; Left Atrial Pressure; Cardiac chamber size (USG)
Parameters that measure contractility (4)
Cardiac output; BP; fractional shortening or EF (USG) mixed venous sato2
Parameters that measure afterload (3)
BP; periferal perfusion; SVR (calculated from cardiac output and meanBP)
