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SUMMED2 > CARDIO- CHF > Flashcards

CARDIO- CHF Flashcards

1
Q

What is the level of stretch in relaxed muscle b4 it contracts?

A 
PRELOAD
vol. of blood at end of diastole
INC w/ HYPERVOLEMIA
REgurgitation
CHF
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2
Q

The force that the muscle must generate during contraction or the resistance the LV must overcome
to circulate blood is called?

A

AFTERLOAD
resistance left ventricle must overcome to ciruclate blood
INC: HTN, VAsconstrction

INC AL=INC Cardiac work

INC AL= INC PL

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3
Q

Stroke volume x HR

A

Cardiac output- amount of blood pumped by each ventricle/ min 5.25L/min (4-8)

SV- amount of blood ejected w/ each contraction- 70mL

HR- beats per min-60-100

Low CO= s/s fatigiue, weaknes, SOB!

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4
Q

What is stoke volume dependent on?

A

Venous return
IF VR INC, then SV increase more blood to pump out

SV= EDV -ESV

Components- contractily, preload, afterload

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5
Q

IF more blood is left in ventricle, then

A

added to preload

activates Starling mech

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6
Q

What is max blood in the ventricle before emptying?

A

End diastolic volume​

65-240ml (120)

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7
Q

WHat is the blood left in the ventricle after it’s squeezed all it can?

A

● End systolic volume​
Doesn’t get to 0 b/c it’s a
closed liquid circuit

50-100ml

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8
Q

Name the mech, to determine if there is LV dysfunction?

A

Ejection fraction​
N=70-50%. percentage of blood
that is pumped out w/ each beat

impaired filling- diastolic

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9
Q

What does mean if LVEPD are high?

A

In a heart with LV dysfunction, higher LVEDP’s are required to increase CO with little yield, up to a point where the increasing pressure.

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10
Q

What curve/mech shows the ability of the heart to change its force of contraction, thus stroke volume, in response to changes in venous return? ​

A

Frank-Starling law/mechanism​.
Curve shift right mean-increase in contractility and after load

Curve shifts down= decreases n contractility and after load

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11
Q

How do you identify HF?

A

measure the percentage of blood that is pumped out
CHF= <40%

echocardiogram​

TTE-​transthoracic echo​

TEE -​transesophageal echo​
or Nuclear test

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12
Q

What are dysfunctional ranges of Ejection fraction?

A

● Hyperdynamic = LVEF > 70%

● Normal = LVEF 50% to 70% (midpoint 60%)

● Mild dysfunction = LVEF 40% to 49% (midpoint 45%)

● Moderate dysfunction = LVEF 30% to 39% (midpoint 35%)

● Severe dysfunction = LVEF < 30%

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13
Q

What is the one way valve circuit?

A

Veins →IVC/SC_ RA_EV_Right Heart →PA_ Lungs →PV_ LA_LV Left Heart → Aorta Body

Closed circuit- starts and ends somewhere else uninterrupted

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14
Q

What happens of LV fails?

A

increased fluid pressure_ transferred
back through the lungs,
ultimately damaging the heart’s right side.

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15
Q

What happens when RV loses pumping power?

A

blood backs up in the body veins.
swelling or congestion :
legs, ankles
abdomen: GI tract and liver, ascites

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16
Q

Progressive​ ​CHRONIC ​condition in which the heart has lost the ability to pump enough* blood to body’s tissues, bc poor contraction or poor relaxation is called

A

Chroni Heart failure

NO sx of volume overload= Heart Failure

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17
Q

How do you differentiate L CHF systole vs diastole?

A

HFpEF​ -preserved EF - diastolic- Filling defect
thick LV muscle, doesnt relax, no fillin normal
INC DBP

HFrEF​ -reduced EF - systolic- pump defect
LV cannot contract normal, dec force capacity

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18
Q

What is MC cause of RHF?

A 
LHF!
Rare to see RHF on it’s own.​ ​IF- Think LUNGS
Cor pulmonae- INC pressure, hypertrophy
1. PE
2, COPD
3. CF
  1. Pulmonaoyr HTN-sarcoidosis
  2. Fibrotic Lung Dz

Symptoms of RHF – Edema, ascites, JVD.

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19
Q

How many die with CHF?

A

1/2 die w/in 5 yrs
20% of ED >65 CHF
Men 60+ high prevalence

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20
Q

Pt has RV SP elevated heart filling pressures on echo w/o pulmonary congestion?

A

Right Hear failure

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21
Q

What cause acute and chronic conditions HF?

A

MI
viral-coxsackie, HIV, Sepsis
Valvular heart disease○ Rheumatic Fever

Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy

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22
Q

What are other risk factors for HF?

A 
smoking
CAD- RF**
HTN
Obese
DM
CKD

ACUTE onset
Pregnancy ​(volume overload)
Hyper/hypothyroidism
New onset arrhythmias (A. Fib)
PE
Anemia
Alcohol, NSAIDS
Idipathic
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23
Q

What ingested agents lead to CHF?

A

Alcohol, Cocaine, Cancer chemotherapeutics.

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24
Q

What occurs after myocardial injury?

A

Pathologic remodeling
Low ejection- death, pump failure
Neurohormonal stimulation

SX- dyspnea, fatigue, edema

25
Why does the pump fail and what is activated?
● Neurohormonal Stimulation- RAAS system ○ Renal hypoperfusion → release of renin → produces angiotensin I → produces angiotensin II ○ causes BP increase & release of aldosterone → causes Na & H20 retention = increase preload/ volume. stimulates cardiac cell growth/hypertrophy.
26
If pump NOT working with more volume to push w/ RAAS activated, then?
HEART does less → decrease cardiac output! RAAS not great for CHF Reason for drugs!! Kidneys Unhappy → Causes Water Retention + Vasoconstriction → Ventricular Hypertrophy => Heart Failure
27
What does the SNS do to the heart?
○ INIC HR and iontropy/force via norepinephrine β1-adrenoreceptors EX. Ventricular hypertrophy, arrhythmias, etc ● Peripheral vascular constriction ○ Norepinephrine via α1-adrenorecptors cause vasoconstriction EX- Arterial vasoconstriction maintains BP but,INC afterload. EX -Venous vasoconstriction INC venous return (preload) maintain SV. BUT pulmonary edema
28
Person has DM and HTN what route may happen where l/t progressive LV dilation?
globular/expanded heart systolic dysfunction mitral regurgitation, symptomatic heart failure
29
Person has DM and HTN what route may happen with hypertrophic pathway?
response to chronic pressure overload, concentric LVH associated with normal cavity size stiff ventricle diastolic dysfunction- diastolic HF
30
Is SOB always related to pulmonary edema?
NO
31
What does positioning in ROS have to do with CP of CHF?
``` ○ Orthopnea : Sleeping in a chair/ or on multiple pillows ○ PND (paroxysmal nocturnal dyspnea)- waking night to catch breath ○ SOB / DOE ○ Fatigue ○ CP ○ Palpitations ○ Insomnia ○ Change in Exercise capacity ○ Poor appetite or recent weight gain ? ○ Sudden Cardiac Death​ ```
32
What are swelling CP of CHF?
○ Edema | ○ Abdominal distention/bloating? RUQ tenderness?
33
What are 4 indicative CP of decreased CO?
``` Resting sinus tachycardia Narrow pulse pressure ​(120/90) Diaphoresis or edematous Peripheral vasoconstriction *Pulsus alternans- strong+weak- BIG preload heat, big squeeze systolic, weak fill ```
34
What are CV findings on PE?
● Precordial palpation: Displaced PMI, Diffuse or focal, Lift, Heave, Double tap ● Heart Sounds: S3 gallop (“Ken-tuc-ky”), Murmurs, Diminished S1, rubs, ● Neck veins: JVD, Hepatojugular Reflux?
35
Where will edema be on PE on person with CHF?
Abdomen: ascites Extremities- flank, sacral if in bed Anasrca
36
What are finding in CHF hallmarks in CBC?
Anemia INfx Pancytopenia-deficency of all blood components, RBC,WBC, platelets
37
What are findings in CHF on chem 7?
``` Renal Electrolytes Ca++ K Mg Hyponatremia ```
38
What are hallmarks of CHF on LFT?
Liver damage due to hepatic congesion
39
What other labs?
TSH | LIpid-atherscleroiss
40
What can be useful in diagnosing, and tracking medical therapies, establishing prognosis or disease severity in chronic HF
BNP NT-proBNP Troponin CK-MB
41
What findings are seen on EKG?
arrhythmias, LVH, LAE​ (left atrial enlargement)​, widened QRS complex.
42
What is a Transthoracic Echocardiogram goal?
``` Echo (TTE)-Ultrasound of heart Ventricular function = Ejection fraction wall motion wall thickness, valve function, Regurgitation Size LV, LA IVC dialation R ventricular systolic pressure ```
43
What are thin linear pulmonary opacities on CXR? What are causes? What is the TX?
"KERLEY B LINES" caused by fluid or cellular infiltration into the interstitium of the lungs d/t pulmonary congestion Diuretics. Other CXR: cardiomegaly, pulmonary edema​, pulmonary vascular congestion, enlarged hila, pleural effusions,
44
What is defined as Major HF diagnosis?
``` Yes to PND, orthopnea Elevated JVP Rales S3 CXR Cardiomegaly and Pulmonary edeam ```
45
What is defined as Minor HF diagnosis based of Framinham criteria?
``` Bilateral edeam Nocturnal cough DOE hepatomegaly Pleural effusion Tachycardia>120 ```
46
What is rarely done for workup of CHF
Cardiac MRI-Aneurysmal LV, Restrictive CMP vs. Pericarditis | Endomyocardial biopsy
47
What are other workups for CHF
Labs: hemochromatosis, HIV, pheochromocytoma, scleroderma, amyloidosis, Sarcoidosis ● Stress testing: Stress echo, Nuclear (Adenosine or Lexiscan) testing. ● Cardiac cath/ Angiogram: Strong suspicion of MI/ Ischemia
48
Who goes to ICU w/ CHF?
``` ● ICU Admit: Invasive hemodynamic monitoring for People with: respiratory distress, renal decline, low BP’s, require parenteral agents ```
49
What is treatment for CHF to improve symptoms?
○ Diuretics (water pills)-Filters sodium+fluid from the blood to reduce workload, dec preload ○ Digoxin -Slows HR, improves ejection fraction
50
What is treatment for CHF to improve survival?
○ Beta blockers-Reduces action of stress hormones, slows HR ○ ACEI/ARB- expands vessels, lowers BP, neurohormonal blockade ○ Aldosterone blockers- blocks neurohormonal activation, controlds vol.
51
What are non pharmolocig methods? How do they affect the heart?
Sodium- bad for HTN, causes fluid retention Extra weight- strain on the heart Exercise-reduce stress and BP Alcohol and caffeine- weakens a damaged heart Smoking- damage blood vessels and inc HR
52
Pt has risk of HF. PHM DM, HTN, obese but w/o structural damage or symptoms. What stage and TX is best for them?
STAGE A TX-lifestyle mods ACEI/ARB Statins
53
Pt has LVH structural damage, but NO symptoms. What stage and TX is best for them?
STAGE B ACEI/ARB BB
54
Pt has prev. MI WITH symptoms. What stage and TX is best for them?
STAGE C HFpEF- Diastolic heart failure with preserved ejection fraction; TX- Diuretics, guidelin for HTN HFrEF- Systolic heart failure with reduced ejection fraction TX- Diuretics, ACEI/ARB, BB, ALDO ANT ICDs, CRT
55
Pt has SOB, edema, Orthopna at rest, in and out of ICU. What stage and TX is best for them?
STAGE D Refractory HF | TX- trasplatn, care, iontropes, surgery, Pallative
56
What devices are used for STAGE C to prevent SCD or pt w/ <35 EF?
ICD -Implantable cardiac defibrillator​ CRT- cardiac resynchronization therapy
57
Ms. Cardia feel her heart beating fast to a quiver and collapses ? What is DX
``` Sudden Cardia Arrest chaotic rhythm and stops pumping blood ● Caused by an “electrical” problem d/t a pumping problem NOT a MI w/o warning an no symptoms ● # 1 of death in the U.S ```
58
What other devices can be used ford Class III/STAGE C?
LVAS- left ventricular assist system | CardioMEMs
59
Pt has thick LV muscle that doesnt relax and results in no filling normal. BP 118/100? What is DX and treatment?
DX-HFpEF​ -preserved EF Diastolic HF ongoing studies ● BP controlled according to HTN guidelines- DOC ARBs. BB, or ACE-I ● Control their HR ● Diuretics​ relief of symptoms due to volume overload ● Coronary revascularization w/ symptomatic CAD or demonstrable myocardial ischemia ● Manage AF preferably rhythm control > rate control

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