CARDIO-CHF Flashcards by JHope .

Define CHF and MCC?

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

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What is pathology of CHF?

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

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What does the body do in CHF?

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

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How does elevated SBP lead to features of hypertrophy?

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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What are effects of hypertrophy overtime?

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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Describe Features of SNS activity in CHF?

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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Name two LT effects of SNS activity on CHF

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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What are effects of fluid retention on CHF?

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

Angeiotensin II

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

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

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

DM 2. HTN 3. PMH MI 4. Genetic cardiomyopathy 3. Infx myocarditis 5. Valve dz

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

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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What is impaired ejection?

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

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What is diagnostic finding of systolic HF?

LV dialted BUT CO still DEC regardless of volume

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

Pressure Afterload. Strain created

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Name a type of imparied contractily related to systolic HF?

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

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

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

What type of cardiomyopathy are related to Diastolc HF?

Hypertrophic 2. Restrictive: fibrosis infiltration 3. Ventricular Hypertropy

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

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

What is cardiac tamponande?

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

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

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

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

Right Heart Failure. PE, AN as well

What is the MCC of RHF?

Left Heart failure, often Pt have both… chronic

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.

Low output failure

What conditions are related to MC low output failure?

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

What conditions are related to high output failure?

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

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

High output failure. VASODIALTION. CO INC

What is difference in forward vs backward HF?

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

What are PE findings of CHF

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

What are CBC finding in CHF?

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

What are specific findings on ECG R/T CHF?

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

What is never used to diagnosis CHF?

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

What are pertinent Pt symptoms of CHF?

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

What are the NYHA staging of HF

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

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

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

What life threateing condition is caused by hypoperfusion systemically?

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