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Clinical Medicine Lecture - Professor Kramer > Cardio ppt 3 - Exam 6 > Flashcards

Cardio ppt 3 - Exam 6 Flashcards

1
Q

CHF patho?

A

Heart is unable to pump blood at a sufficient rate for demand of tissues

Final pathway of essentially every significant pathologic cardiac condition

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2
Q

How does the heart compensate for demand?

A

Frank-Starling mechanism

Hypertrophy (remodeling) with or without dilation

Hormonal activation

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3
Q

What hormones are activated when the heart is compensating for demand?

A

Norepinephrine

Renin-Angiotenison- aldosterone

Atrial natriuretic peptide

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4
Q

Cardiac Pathologic causes

of CHF?

A

Hypertension

Myocardial infarction

Valve abnormalities

Ventricle preload or afterload disturbance

Heart rate

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5
Q

Non-cardiac high output failure causes of CHF?

A

Thyrotoxicosis - can cause a catecholamine increase which increase HR and increase demands

Severe anemia

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6
Q

CHF prevalence ?

A

2% of US population

10% of people over age 80

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7
Q

Typical labs for dx CHF?

A

BNP - high indicates HF

CXR - fluid in heart? or crackles?

Echocardiography - how bad is
the HF?

EKG

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8
Q

CHF BNP level?

A

N-terminal pro-BNP

Elevated

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9
Q

CHF CBC finding?

A

anemia

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10
Q

CHF BMP finding?

A

BUN elevated

Creatinine elevated

Potassium - elevated

Sodium - hypoatremia

kidneys gets creamed with CHF

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11
Q

CHF LFT finding?

A

elevated

Hepatojugular reflux

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12
Q

Cardiac enzymes CHF findings?

A

Troponin - elevated

CK-MB - elevated

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13
Q

CHF CXR imaging ?

A

Cardiomegaly

Cephalization - lung marking in apex of lung

Interstitial edema - Kerley B lines - atelectasis

Alveolar Fluid

Bilateral pulmonary effusion

Venous dilation - batwing hilum

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14
Q

CHF EKG findings?

A

LVH

low voltage

arrhythmia

conduction defects

new / old MI

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15
Q

CHF Echo findings monitor?

A

most useful imaging study

monitor ejection fraction - a key diagnostic and prognostic indicator in CHF

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16
Q

CHF Echo findings assess?

A

size and function of chambers

valve abnormalities

pericardial effusion

shunting - inappropriate movement of blood

segemental wall abnormality

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17
Q

Other studies for CHF?

A

Cardiac catheterization - Evaluate atherosclerosis , CO

Stress imaging or radionucleotide angiography - assess cause or severity of disease

TSH

Iron studies - hemochromatosis

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18
Q

Stage A Heart Failure ?

A

high risk of developing CHF

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19
Q

Stage B Heart Failure ?

A

Structural heart disease - evidence ; no symptoms

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20
Q

Stage C Heart Failure ?

A

Structural heart disease w/ symptoms - PND, Dysnpnea on extertion

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21
Q

Stage D Heart failure ?

A

Advanced structural heart disease , symptoms at res

Dyspnea and everything at rest, and even worse with exertion t

22
Q

CHF prognosis

A

5 year mortality 50%

<5% yearly mortality rate for no symptoms (Stage B)

30% yearly mortality rate for severe symptoms (Stage D)

23
Q

NYHA classification I definition?

A

No limitation to physical activity

activity does not cause fatigue, dyspnea, anginal pain

24
Q

NYHA classification II definition?

A

Slight limitation to physical activity

25
Q

NYHA classification III definition?

A

marked limitation to physical activity

26
Q

NYHA classification IV definition?

A

symptoms even at rest - unable to engage in physical activity - STAGE D

27
Q

Typical CHF patient treatment?

A

LABAD

lifestyle changes - lose weight

Diuretic - Loop - furosemide - often first thing ordered cause the fluid and has most symptomatic relief

ACEI - lisinopril

BB - metoprolol

Aldosterone antagonist - sprinolactione - increase mortality

Digoxin - decrease symptoms - ATPase inhibitor , positive inotrope and negative chronotorpic effects

28
Q

Treatments to consider for CHF?

A

Digoxin

Ivabradine

Pacemaker - consider at mobitz II and 3rd degree

Defibrillator - if EF is less than 30%

LVAD - stethoscope will hear no heart beat

Heart transplant - option

Removing calcium channel blockers - good for HTN not so good for HF - cause some increase in mortality ( amilodipine and now they are developing HF you may want to consider taking them off it ) -

long acting nitrates can be used but used for more acute HF presentation - helps with pain - but it mainly helps move fluid from lungs to other areas to help with diuresis - LOOK UP

29
Q

What is more important in patient education with CHF ?

A

evaluate for reversible causes

30
Q

Lifestyle modifications for CHF?

A

Progressive aerobic exercise

sodium reduction

smoking cessation

alcohol cessation

stress reduction

31
Q

What diuretics do you used for CHF?

A

Thiazide (better for HTN) or LOOP ( better for CHF) shorter acting

they offer symptomatic relief especially for RSHF

32
Q

What is the only effective medication for Diastolic HF?

A

Diuretic

33
Q

What medications used for CHF decrease mortality?

A

ACEI or ARB

BB

34
Q

What medications used for CHF decrease symptoms?

A

Digoxin - inotrope

35
Q

Surgery or procedures for CHF patients?

A

ICD

Biventricular Pacemaker

36
Q

When do you consider ICD for CHF patients?

A

if EF below 35% - percentage when to start to consider it

37
Q

When do you consider a pacemaker for CHF patients?

A

if QRS is prolonged

38
Q

What is used in severe cases of CHF?

A

LVAD - left ventricular assist device

Intra-aortic balloon pump - counter pulsation - allows more blood flow to the coronaries

Heart transplant

39
Q

LCHF patho?

A

Inadequate pumping or filling of the left ventricle

40
Q

LCHF patho - systolic?

A

Inadequate pumping causes decreased forward flow and organ perfusion

Reduced ejection fraction

Ultimately to back up to pulmonary circulation

41
Q

LCHF patho - diastolic?

A

Inadequate filling

Creates back flow to pulmonary circulation

42
Q

LCHF common causes?

A

Hypertension

Ischemic heart disease

Aortic or mitral valve disease

Primary myocardial diseases

43
Q

LCHF history?

A

pulmonary issues

Dyspnea - exertional 
Orthopnea
PND
unproductive cough
fatigue
exercise intolerance
44
Q

LCHF physical exam?

A

S3 gallop - systolic -
S4 gallop - diastolic

bibasilar crackles

occasional wheezing

parasternal lift - heave

Large apical impulse

Pulse pressure narrow - systolic and diastolic are close together

45
Q

S3 is a ventricular gallop and it is a sign of ________ CHF and LV is __________.

A

systolic

compliant - LV is like a bag

46
Q

S$ is a atrial gallop and it is a sign of __________ CHF and LV is ___-_________.

A

diastole

non-compliant LV - cannot fill

47
Q

RCHF patho?

A

Abnormal filling or contractility of the right ventricle

Leads to systemic back up of venous blood

Especially to liver

48
Q

Common causes of RCHF?

A

LCHF
COPD
pulmonary HTN

49
Q

History of patient with RCHF?

A

Peripheral edema - biggest complaint

Decreased appetite

Nausea

Nocturia -when patient lays down at night the fluid is returned to the vasculature system and goes to the kidneys which then try to get rid of it

50
Q

Physical exam on a patient with RCHF you will see what?

A

JVD - hepatojugular reflux

pitting pedal edema

variable BP

hepatomegaly

51
Q

What medication offers the most symptomatic relief in RCHF patients?

A

Diuretics - Loop - furosemide

Clinical Medicine Lecture - Professor Kramer (28 decks)

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