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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
Q

Why does the pump fail and what is activated?

A

● 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
Q

If pump NOT working with more volume to push w/ RAAS activated, then?

A

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
Q

What does the SNS do to the heart?

A

○ 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
Q

Person has DM and HTN what route may happen where l/t progressive LV dilation?

A

globular/expanded heart
systolic dysfunction
mitral regurgitation,
symptomatic heart failure

29
Q

Person has DM and HTN what route may happen with hypertrophic pathway?

A

response to chronic pressure overload,
concentric LVH associated with normal cavity size
stiff ventricle
diastolic dysfunction- diastolic HF

30
Q

Is SOB always related to pulmonary edema?

A

NO

31
Q

What does positioning in ROS have to do with CP of CHF?

A 
○ 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
Q

What are swelling CP of CHF?

A

○ Edema

○ Abdominal distention/bloating? RUQ tenderness?

33
Q

What are 4 indicative CP of decreased CO?

A 
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
Q

What are CV findings on PE?

A

● 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
Q

Where will edema be on PE on person with CHF?

A

Abdomen: ascites
Extremities- flank, sacral if in bed
Anasrca

36
Q

What are finding in CHF hallmarks in CBC?

A

Anemia
INfx
Pancytopenia-deficency of all blood components, RBC,WBC, platelets

37
Q

What are findings in CHF on chem 7?

A 
Renal
Electrolytes Ca++
K
Mg
Hyponatremia
38
Q

What are hallmarks of CHF on LFT?

A

Liver damage due to hepatic congesion

39
Q

What other labs?

A

TSH

LIpid-atherscleroiss

40
Q

What can be useful in diagnosing, and tracking medical therapies, establishing prognosis or
disease severity in chronic HF

A

BNP
NT-proBNP
Troponin
CK-MB

41
Q

What findings are seen on EKG?

A

arrhythmias,
LVH,
LAE​ (left atrial enlargement)​,
widened QRS complex.

42
Q

What is a Transthoracic Echocardiogram goal?

A 
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
Q

What are thin linear pulmonary opacities on CXR? What are causes? What is the TX?

A

“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
Q

What is defined as Major HF diagnosis?

A 
Yes to PND, orthopnea
Elevated JVP
Rales
S3 
CXR Cardiomegaly and Pulmonary edeam
45
Q

What is defined as Minor HF diagnosis based of Framinham criteria?

A 
Bilateral edeam
Nocturnal cough
DOE
hepatomegaly
Pleural effusion
Tachycardia>120
46
Q

What is rarely done for workup of CHF

A

Cardiac MRI-Aneurysmal LV, Restrictive CMP vs. Pericarditis

Endomyocardial biopsy

47
Q

What are other workups for CHF

A

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
Q

Who goes to ICU w/ CHF?

A 
● ICU Admit: Invasive hemodynamic monitoring for
People with: 
respiratory distress, 
renal decline, 
low BP’s,
require parenteral agents
49
Q

What is treatment for CHF to improve symptoms?

A

○ Diuretics (water pills)-Filters sodium+fluid from the blood to reduce workload, dec preload

○ Digoxin -Slows HR, improves ejection fraction

50
Q

What is treatment for CHF to improve survival?

A

○ 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
Q

What are non pharmolocig methods? How do they affect the heart?

A

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
Q

Pt has risk of HF. PHM DM, HTN, obese but w/o structural damage or symptoms. What stage and TX is best for them?

A

STAGE A
TX-lifestyle mods
ACEI/ARB
Statins

53
Q

Pt has LVH structural damage, but NO symptoms. What stage and TX is best for them?

A

STAGE B
ACEI/ARB
BB

54
Q

Pt has prev. MI WITH symptoms. What stage and TX is best for them?

A

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
Q

Pt has SOB, edema, Orthopna at rest, in and out of ICU. What stage and TX is best for them?

A

STAGE D Refractory HF

TX- trasplatn, care, iontropes, surgery, Pallative

56
Q

What devices are used for STAGE C to prevent SCD or pt w/ <35 EF?

A

ICD -Implantable cardiac defibrillator​

CRT- cardiac resynchronization therapy

57
Q

Ms. Cardia feel her heart beating fast to a quiver and collapses ? What is DX

A 
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
Q

What other devices can be used ford Class III/STAGE C?

A

LVAS- left ventricular assist system

CardioMEMs

59
Q

Pt has thick LV muscle that doesnt relax and results in no filling normal. BP 118/100? What is DX and treatment?

A

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

SUMMED2 (38 decks)

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