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clin med > cardio day 2 PP2 > Flashcards

cardio day 2 PP2 Flashcards

1
Q

bnp

A

Secreted by cardiomyocytes when they stretch
Decreases resistance, increases natriuresis, increases EF
Indicates CHF, but can also go up with things such as exercise

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2
Q

CHF ?

A

Heart isn’t pumping enough to meet the body’s needs
Structural and functional changes
Impaired systolic and diastolic function

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3
Q

CHF patho

A

Excessive activation of SNS and RAAS causing LV remodeling

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4
Q

CHF sx

A

Exertional dyspnea, orthopnea, PND, edema, fatigue, weight gail, abd distension, chest congestion, cyanosis
Rales and edema do not always = HF

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5
Q

CHF dx

A

2D echo/doppler

Stages of CHF

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6
Q

CHF trmt

A

Drugs used to block SNS and RAAS: (know)
Beta blockers
ACEI and ARBs
Aldosterone antagonists

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7
Q

Systolic CHF

cause

A

HTN, valvular disease, CAD, myocarditis

Chemo, infiltrative process, hypothyroidism, arrhythmia

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8
Q

Systolic CHF sx

A

Resting SOB, dyspnea on exertion, fatigue, weight gain, weakness, sweating, orthopnea, PND, chest pain/angina

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9
Q

Systolic CHF pe

A

Rales, JVD, peripheral edema, ascites, S3 gallop, murmur (MR), lateral PMI, cool extremities, diminished peripheral impulses, hypotension

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10
Q

Systolic CHF dx

A

Echo- LV EF less than 40%, LA and LV enlargement, wall motion abnormalities
X ray- cardiomegaly, pulmonary edema, pleural effusions
ECG- Q waves, IVCD (intraventricular conduction delay), LBBB, Afib, ST/T changes
Labs- high BNP, hyponatremia, cardiac enzymes

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11
Q

Diastolic CHF?

A

Heart can’t fill well
HF with preserved EF
Usually in older women
Impaired ventricular filling, chamber stiffness, increased left ventricular end diastolic pressure (LVEDP), LVH with small LV cavity

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12
Q

risks Diastolic CHF

A

HTN, CKD, CAD, aortic stenosis, aortic insufficiency, obesity, restrictive CMP, atrial arrhythmias, mitral regurg

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13
Q

causes Diastolic CHF

A

Systolic dysfunction, HTN, aortic stenosis, aortic insufficiency, DM, tachycardia, AFib, ischemia, age, obesity, constrictive and restrictive CMP

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14
Q

sx Diastolic CHF (similar to CHF)

A

Resting SOB, dyspnea on exertion, fatigue, weakness, sweating, orthopnea, PND, chest pain/angina

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15
Q

Diastolic CHF pe

A

Rales, S4, aortic stenosis murmur, edema

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16
Q

Diastolic CHF dx

A

ECG- atrial arrhythmias, LVH, ischemic changes
X ray- pulmonary congestion
Labs- high bnp, cardiac enzymes, high Cr and BUN, proteinuria
Echo- diastolic dysfunction, LVH, aortic stenosis, restrictive physiology “stiff heart”

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17
Q

mcc r side heart failure

A

L hf

18
Q

causes R CHF

A 
MCC is left sided CHF
Chronic lung diseases
Valve problems
Pericardial constriction
L to R shunt
CAD
19
Q

cor pulmonale ?

A

Change in structure and function of the right heart

20
Q

cor pulmonale causes

A

Chronic lung disease, inc RV pressure, RVH, pulm HTN, acute PE, ARDS, RV dilation

21
Q

pulm HTN?

A

Mean arterial pressure over 25 mmHg at rest
Increased RV afterload
Can lead to RHF

22
Q

risks pulm HTN

A

Young adult, FH, drugs, high altitude

23
Q

classification pulm htn

A

WHO group 1- idiopathic, younger pts, more females than males
WHO group 2- from left heart disease
WHO group 3- from lung disease or hypoxemia
WHO group 4- secondary to chronic thromboembolism
WHO group 5- from blood disorders, systemic disorders, and metabolic disorders, miscellaneous

24
Q

Pulmonary HTN sx

A

SOB, nonproductive dough, angina, syncope, peripheral edema, orthopnea, PND

25
Q

Pulmonary HTN

pe

A

Loud S2, TR murmur, RV lift/heave, JVD, pedal edema, ascites, clubbing, hepatojugular reflux

26
Q

Pulmonary HTN

dx

A

Right heart cath- Swan Ganz catheter- Gold std
CXR- enlarged pulmonary trunk and hilar vessels, R heart enlargement, fibrosis and hyperinflation of lungs
ECG- RBBB, incomplete RBBB, RAE
DQ- exclusion of PE
Echo- large RV chamber, D shape conformity, RA enlarged, tricuspid regurg, pulm valve stenosis
CTA- pulmonary emboli

27
Q

Pulmonary HTN

trmt

A

Stop smoking

Control other damage done

28
Q

Idiopathic pulm HTN cause

A

familial

29
Q

Idiopathic pulm HTN

dx

A

R heart cath and vasodilator

Echo

30
Q

Idiopathic pulm HTN

trmt

A 
CCB
Nitrous oxide
IV prostaglandin
Endothelin receptor antagonists
PDE 5 inhibitors
Lung transplant
Atrial septostomy
31
Q

RHF sx

A 
Edema
JVD
Abdominal distension
Hepatomegaly
Splenomegaly
anorexia/nausea
Weight gain
Nocturnal peeing
32
Q

LHF sx

A 
Dyspnea
Tachycardia
crackles/rales
Cough
orthopnea
33
Q

trmt CHF

A

ACEI- Enalapril and lisinopril (-pril); do not provide sustained reduction in HF
ARBs- Losartan (-sartan)
Beta blocker- carvedilol, metoprolol succinate (-ol)
Aldosterone antagonists- promotes adverse cardiac remodeling
Aldo levels are high in HF
Hydralazine and oral nitrate with beta blockers and ACE or if those cant be used?
Entresto- dec risk and hospitalization; prevent degradation of BNP; dec blood volume
Other options:
Lose weight, no Na, use meds, osmosis

34
Q

Invasive therapies for advanced HF

A

LVAD- left ventricular assist device

Transplant

35
Q

Primary prevention acc to ACC

A

ICD- prevents sudden cardiac death in pts with nonischemic dilated CMP or ischemic heart disease have LVEF 35% or lower

36
Q

Pts with refractory end stage HF (stage D)

A

Consider LVAD

37
Q

End of life care guideline for CHF

A

Pts need to have a plan in case they suddenly decline

Should consider deactivating defibrillator device

38
Q

HF checklist

A

Assess adherence to guidance based therapy
Check functional status
Assess markers of HF progression/prognosis
Discuss advance directives
Make goals for future

39
Q

Cardiorenal syndrome ?

A

Kidney failure and heart failure

40
Q

Cardiorenal syndrome

classification

A

Type 1- acute decompensated HF leads to acute kidney injury
Type 2- chronic HF leads to chronic kidney disease
Type 3- acute renal injury leads to cardiac dysfunction
Type 4- chronic kidney disease leads to cardiac dysfunction
Type 5- cardiac and renal dysfunction from systemic disorders

41
Q

Cardiorenal syndrome

trmt

A

Inotropic therapy- dopamine, dobutamine, milrinone

Increase mortality from sudden death of arrhythmias

clin med (35 decks)

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