cardio day 2 PP2

Question 1

bnp

Answer 1

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

Question 2

CHF ?

Answer 2

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

Question 3

CHF patho

Answer 3

Excessive activation of SNS and RAAS causing LV remodeling

Question 4

CHF sx

Answer 4

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

Question 5

CHF dx

Answer 5

2D echo/doppler

Stages of CHF

Question 6

CHF trmt

Answer 6

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

Question 7

Systolic CHF

cause

Answer 7

HTN, valvular disease, CAD, myocarditis

Chemo, infiltrative process, hypothyroidism, arrhythmia

Question 8

Systolic CHF sx

Answer 8

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

Question 9

Systolic CHF pe

Answer 9

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

Question 10

Systolic CHF dx

Answer 10

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

Question 11

Diastolic CHF?

Answer 11

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

Question 12

risks Diastolic CHF

Answer 12

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

Question 13

causes Diastolic CHF

Answer 13

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

Question 14

sx Diastolic CHF (similar to CHF)

Answer 14

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

Question 15

Diastolic CHF pe

Answer 15

Rales, S4, aortic stenosis murmur, edema

Question 16

Diastolic CHF dx

Answer 16

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”

Question 17

mcc r side heart failure

Answer 17

L hf

Question 18

causes R CHF

Answer 18

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

Question 19

cor pulmonale ?

Answer 19

Change in structure and function of the right heart

Question 20

cor pulmonale causes

Answer 20

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

Question 21

pulm HTN?

Answer 21

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

Question 22

risks pulm HTN

Answer 22

Young adult, FH, drugs, high altitude

Question 23

classification pulm htn

Answer 23

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

Question 24

Pulmonary HTN sx

Answer 24

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

Question 25

Pulmonary HTN | pe

Answer 25

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

Question 26

Pulmonary HTN | dx

Answer 26

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

Question 27

Pulmonary HTN | trmt

Answer 27

Stop smoking | Control other damage done

Question 28

Idiopathic pulm HTN cause

Answer 28

familial

Question 29

Idiopathic pulm HTN | dx

Answer 29

R heart cath and vasodilator | Echo

Question 30

Idiopathic pulm HTN | trmt

Answer 30

``` CCB Nitrous oxide IV prostaglandin Endothelin receptor antagonists PDE 5 inhibitors Lung transplant Atrial septostomy ```

Question 31

RHF sx

Answer 31

``` Edema JVD Abdominal distension Hepatomegaly Splenomegaly anorexia/nausea Weight gain Nocturnal peeing ```

Question 32

LHF sx

Answer 32

``` Dyspnea Tachycardia crackles/rales Cough orthopnea ```

Question 33

trmt CHF

Answer 33

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

Question 34

Invasive therapies for advanced HF

Answer 34

LVAD- left ventricular assist device | Transplant

Question 35

Primary prevention acc to ACC

Answer 35

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

Question 36

Pts with refractory end stage HF (stage D)

Answer 36

Consider LVAD

Question 37

End of life care guideline for CHF

Answer 37

Pts need to have a plan in case they suddenly decline | Should consider deactivating defibrillator device

Question 38

HF checklist

Answer 38

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

Question 39

Cardiorenal syndrome ?

Answer 39

Kidney failure and heart failure

Question 40

Cardiorenal syndrome | classification

Answer 40

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

Question 41

Cardiorenal syndrome | trmt

Answer 41

Inotropic therapy- dopamine, dobutamine, milrinone | Increase mortality from sudden death of arrhythmias