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SUMPHYS2 > CARDIO-CHF > Flashcards

CARDIO-CHF Flashcards

1
Q

Define CHF and MCC?

A

Decrease Cardiac output. CO cannot keep up with systemic demand. Impaired CO. DM and CAD, HTN, valve dz.

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2
Q

What is pathology of CHF?

A

CHF from 1. Elevated SBP ⇾pressure overload afterload. 2. INC EDV ⇾ vol. overload. 3. Injury to myocardium cell.

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3
Q

What does the body do in CHF?

A

Compensates to restores CO but damaging LTC. 2. Decompensates- Body fails to maintain CO

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4
Q

How does elevated SBP lead to features of hypertrophy?

A

D/T Elevatd SBP= INC afterload. Thickened ventricles. First: MSK stretches ⇾strong contraction⇾INC CO. BUT chronically will L/T floppy cardiac MSK⇾ weak contraction⇾ DEC CO. OVERALL ventricles thicken, chambers get smaller.

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5
Q

What are effects of hypertrophy overtime?

A

OVERTIME: 1. contraction slowed 2. Delay in time and max tension. 3. INC need of O2 consumption d/t size⇾ ischemia⇾loss of myocardial cells

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6
Q

Describe Features of SNS activity in CHF?

A

SNS INC to maintain perfusion (blood flow) via B-andrenegic receptors in heart: 1. INC HR and contractility improve CO via INC EF and Stroke volume. 2. Sterling⇾SNS vasocontriction (alpha)venous retrun INC CO. 3. Pools blood from resiovirs to inc. venus volume return

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7
Q

Name two LT effects of SNS activity on CHF

A

OVERTIME: 1. INC HR, contractility, Vasocontriction- DEC diastolic filling time⇾DEC CO. 2. INC TPR and viens resistance limits CO, key w/ exertion, INC pressue on aorta 3. INC work on heart

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8
Q

What are effects of fluid retention on CHF?

A

RAAS L/T 1. INC vasoconstriction⇾DEC CO⇾ DEC blood flow to kidney 2. INC NA, H2O ⇾ periperal edema⇾ vol. overload. 3. Heart dfx cant pump extra BV⇾venous P INC⇾edema in periphery, ascites, liver, pulmonary

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9
Q

What hormone inc vascular contrition, Na rentenion and cardiac remodeling?

A

Angeiotensin II

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10
Q

What hormone is release in response to volume overload that tries to overcome the volume issue in compensation of low CO?

A

Heart release Atrial Natruetic Peptide- vasodilates. 2. Brain- relese naturetic peptide. BOTH promote diuresis- acts on other organs

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11
Q

These Underlying health problems should be considered when leading to CHF?

A
  1. DM 2. HTN 3. PMH MI 4. Genetic cardiomyopathy 3. Infx myocarditis 5. Valve dz
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12
Q

Events that can cause acute decompensation of CHF. Precipatating factors?

A
  1. Acute Infx PNA 2. Trauma, surgery 3. Afib, Supravent Tachy, Bradycardia, AV blk 4. Excess exertion 5. Excess Salt 6. PE 7. Anemia ⇾INC HR to get O2 to tissue 8. Thyrotoxidosis 9. Pregnancy- Double BV short and rapid time 10. ETOH, chemo 11. Excess IV fluid, tranfusion- go slow get EKG prior prn
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13
Q

What is impaired ejection?

A

Systolic HF D/T DEC myocardial contractiliy. EF <40%

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14
Q

What is diagnostic finding of systolic HF?

A

LV dialted BUT CO still DEC regardless of volume

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15
Q

Aortic Stenois, Uncontrolled HTN are what type of systolic HF?

A

Pressure Afterload. Strain created

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16
Q

Name a type of imparied contractily related to systolic HF?

A
  1. MI and Ischemia/CAD. 2. Volume overload-MR-reduce EF, AR- backs up
17
Q

Which type of HF has a high or normal EF, BUT still abnormal CO?

A

Diastolic HF- stiffness/compliance dfx. INC DBP. D/T scar, hypertrophy, Acute ischemia

18
Q

What type of cardiomyopathy are related to Diastolc HF?

A
  1. Hypertrophic 2. Restrictive: fibrosis infiltration 3. Ventricular Hypertropy
19
Q

What other types of Heart dz are related to Diastolc HF?

A

Transient Ischemia, Obstruction of LV filling: Mitral stenosis, Pericardial constriction

20
Q

What is cardiac tamponande?

A

Pericardial fills w/ blood. Trauma ⇾heart moves, aorta doesn’t, shear tear, obstruct filling

21
Q

Which side of HF is related to pulmonary edema, orthopnea, Acute MI, PND, DOE?

A

Left Heart Failure: fluid goes upstream to Pulmonary veins/LA. 1. Basilar crackles Lungs heavy filled with fluid at base. 2. Pulmonary Venous pressure INC b/c smaller than systemic venous system

22
Q

Which side of HF is related to JVD, fatigue, PHM COPD, Peripheral edema, ascites, hepatomegaly, GI upset and cyanosis?

A

Right Heart Failure. PE, AN as well

23
Q

What is the MCC of RHF?

A

Left Heart failure, often Pt have both… chronic

24
Q

Failure related to vasocontriction. S/S: 1. cold, clammy, pale extremity. 2. oliguria 3. Low pulse pressure <40 think HF. 4. O2 diff btwn aa and vv.

A

Low output failure

25
Q

What conditions are related to MC low output failure?

A
  1. Ischemia dz 2. HTN 3. dialated CMP 4. Valve Dz 5. pericardial
26
Q

What conditions are related to high output failure?

A

HYPERACTIVE SYSTEM-1. Anemia-INC HR, 2. Thyrotoxicosis 3. Pregnancy 4. Paget dz bone 5. AV fistula 6. underlying heart dz.

27
Q

If a Pt has warm skin, HTN, bounding pulse, AVO2 is normal, then what is condition?

A

High output failure. VASODIALTION. CO INC

28
Q

What is difference in forward vs backward HF?

A

Forward- Poor CO-confused, weak, edema. Backward-pulmonary HTN backward to venous system, RV failure

29
Q

What are PE findings of CHF

A
  1. Dyspnea, Hypoxia 2. JVD 3. Tachy, S3 gallop, +/- S4 (pathologic LV not compliance 4. PMI displace laterally d/t enlarge LV 5. Lung basilar crackles. 6. Hepatomeglay, ascites 7. Periph edema +/- anasarca
30
Q

What are CBC finding in CHF?

A
  1. Elevaed BNP 2. Hypoxemia ABG low 3. Respitory acidiosis- INC CO2, DEC PH, 4. BMP- hyponatremia 5. INC LFTS- AST for congestion
31
Q

What are specific findings on ECG R/T CHF?

A
  1. Sinus tachy 2. Conduction delays LBBB 3. LAE- P-wave wide 4. LVH or RVH height of QRS, V5, V6
32
Q

What is never used to diagnosis CHF?

A

Chest Xray- 1. only see anatomy 2. Cephalization-Upper lung vessesls 3. Interstitial fluid(pulmonary edema)- Kerley B lines 5. Pleural effusion (pooling)

33
Q

What are pertinent Pt symptoms of CHF?

A
  1. DOE, DOR, Orthopnea, PND, cough 2. Fatigue weak 3. Confusion, HA 4. Nocturia, Oliguria, Color 5. Abdominal pain 6. PV edema
34
Q

What are the NYHA staging of HF

A

Class I- Heart dz, BUT W/O limitatin in physical activity. Class II- Slight limit in actvity, SX on INC exerction-EASy to miss Class III- Marked limits of activity during ordinary task W/SX- seen. Class IV- Symptoms at rest- Death soon, NO TX. Classes help w/ prognosis

35
Q

Mr. Fair has c/c of fatigue, SOB w/ stairs. What is the most important diagnositc test for CHF?

A

Echocardiogram: ONLY test for EF%. Gold standard CHF 1. cardiomyopathy 2. valve dz, intracardia shunts 3. EF measurement

36
Q

What life threateing condition is caused by hypoperfusion systemically?

A

Shock- cardiogenic-Low CO, hypovolemic-bleeds, anaphalactic-DEC BP bc vasodilation, septic- DEC BP

SUMPHYS2 (27 decks)

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