Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FA Step2 CK Cardiology > Cardiology: Congestive Heart Failure > Flashcards

Cardiology: Congestive Heart Failure Flashcards

1
Q

Define congestive heart failure

A

clinical condition caused by ability of the heart to pump enough blood to maintain fluid and metabolic homeostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name 5 risk factors for CHF?

A 
CAD
HTN
cardiomyopathy
valvular heart disease
DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how is CHF classified? 4

A

American Heart Association/American College of Cardiology-based on clinical syndromes
New York Heart Association (NYHA)-functional severity
left sided vs right-sided failure
systolic vs nonsystolic failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how is systolic dysfunction defined? 2

A

EF< 50%

Increased left ventricular end diastolic volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how is systolic dysfunction caused?

A

inadequate left ventricular contractility or increased afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how does the heart compensate for decreased EF and increased preload? what law is this? what happens when compensation fails? 2

A

hypertrophy
ventricular dilation
Frank-Starling Law
compensation fails causing increased myocardial work and worsening systolic function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A man was admitted for a CHF exacerbation with low EF. The patient is now ready for discharge, and his medications include furosemide, and metoprolol. What is the nxt step in management?

A 
Add and ACEI to this pts current regimen
ACEI have been shown to have a + mortality benefit when used with beta-blockers in NYHA class II-IV heat failure patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name some signs and symptoms of systolic heart failure?

A

mc=extertional dyspnea
progresses to orthopnea, paroxysmal nocturnal dyspnea (PND), and rest dyspnea
chronic cough, fatigue, peripheral edema, nocturia, and/or abdominal fullness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

name 5 findings on PE for systolic heart failure?

A 
parasternal lift
an elevated and sustained left ventricular impulse
S3/S4 gallop
JVD
peripheral edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what will a CXR show in systolic heart failure?

A

cardiomegaly, cephalization of pulmonary vessels, pleural effusions, vascular congestion, interstitial edema, and prominent hila. figure 2.1-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what will ECHO show in systolic heart failure?

A

will show EF and ventricular dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what lab abnormalities will show in systolic heart failure?

A

BNP>500pg/mL
increased creatinine (sometimes)
decreased Na in later stages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what will ECG show in systolic heart failure?

A

usually non diagnostic

can help show underlying causes-AF, and old MI, or LVH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What two CHF medications provide symptomatic relief for systolic HF and confer no mortality benefit?

A

diuretics and digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is treatment for acute pulmonary congestions in pt with systolic HF management? use LMNOP mnemonic

A 
Lasix
Morphine
Nitrates
Oxygen
Position (upright)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What underlying causes can be corrected in treating systolic HF?

A

arrhythmias
MI
drugs (CCBs, antiarrhythmics, NSAIDs, alcohol, thyroid and valvular disease, high-output states)

17
Q

what drugs do you give to aggressively diuresis someone with acute systolic HF?

A

loop and thiazide diuretics

18
Q

what should be given to treat all patients with acute systolic HF? What do you give if they can’t tolerate it? what should be avoided?

A

ACEIs
ARBs
Beta-blockers should be avoided if pt is decompensated but can be started once euvolemic

19
Q

Describe NYHA functional classification of CHF?

A

Class I- no limitation of activity, no symptoms with normal activity
Class II- slights limitation of activity, comfortable at rest or with mild exertion
Class III- marked limitation of activity, comfortable only at rest
Class IV- any physical activity brings on discomfort, symptoms present at rest

20
Q

left sided, right sided, or both?

  • dyspnea predominates
  • fluid retention predominates
  • S3/S4 gallop
  • bilateral basilar rales
  • JVD
  • hepatojugular reflex
  • pleural effusions
  • pulmonary edema
  • hepatomegaly,ascites
  • orthopnea, paroxysmal nocturnal dyspnea
A
  • dyspnea predominates=left
  • fluid retention predominates=right
  • S3/S4 gallop=both
  • bilateral basilar rales=left
  • JVD=right
  • hepatojugular reflex=right
  • pleural effusions=left
  • pulmonary edema=left
  • hepatomegaly,ascites=right
  • orthopnea, paroxysmal nocturnal dyspnea=left
21
Q

What lifestyles changes are used to treat chronic systolic HF?

A

limit salt intake
limite fluid intake
treat co-morbid conditions

22
Q

what medications are used to prevent remodeling of the heat and decrease mortality for NYHA class II-IV pts? 2 what should be avoided?

A

long term beta blockers
ACEIs/ARBs
avoid CCBs

23
Q

what 2 medications are recommended for chronic systolic HF if underlying cause is prior MI?

A

daily ASA

statin

24
Q

what medication combination can prevent fluid overload in pt with chronic systolic HF?

A

loop diuretics +/- thiazide

25
Q

when should pts with chronic systolic HF be anticoagulated?

A

previous embolic events, AF, or mobile left ventricular thrombus

26
Q

Which medication is shown to decreased mortality in pts with NYHA class III-IV HF?

A

low dose spironolactone

27
Q

what should be considered in pts with EF<35% in chronic systolic HF?

A

biventricular cardiac defibrillator (ICD)

28
Q

what 2 things can be considered in CHF that is unresponsive to maximal medical therapy?

A

mechanical left ventricular assist device or cardiac transplantation

29
Q

how is calcium levels affected with loop vs thiazide diuretics?

A

loops lose calcium

thiazides take it in

30
Q

define non systolic dysfunction

A

decreased ventricular compliance with normal systolic function

31
Q

what are two etiologies of non systolic dysfunction?

A

impaired active relaxation (ischemia, aging, hypertrophy)

impaired passive filling (scarring from prior MI, restrictive cardiomyopathy)

32
Q

In nonsystolic dysfunction what happens to LVEDP, CO, and EF?

A

LVEDP increased
CO remains normal
EF normal or increased

33
Q

what is pt’s age in systolic vs nonsystolic dysfunction?

A

systolic=65 yrs

34
Q

what cormorbidities in systolic vs nonsystolic dysfunction?

A

systolic=dilated cardiomyopathy, valvular heat disease

nonsystolic=restrictive or hypertrophic cardiomyopathy’ renal disease or HTN

35
Q

what PE findings in systolic vs nonsystolic dysfunction?

A

systolic=displaced PMI, S3 gallop

nonsystolic= sustained PMI, S4 gallop

36
Q

what findings on CXR in systolic vs nonsystolic dysfunction?

A

systolic=pulmonary congestion, cardiomegaly

nonsystolic=pulmonary congestion,normal heart size

37
Q

what ECG/ECHO findings in systolic vs nonsystolic dysfunction?

A

systolic=Q waves, decreased EF (55%)

38
Q

name signs/symptoms of nonsystolic HF? 8

A

stable and unstable angina

SOB, dyspnea on exertion, arrhythmias, MI, HF, and sudden death

39
Q

name treatment for nonsystolic HF? first line, BP controlled how, what isn’t useful?

A

diuretics are first line therapy
maintain rate and BP control via beta-blockers, ACEIs, ARBs, or CCBs
digoxin is not useful in these pts

FA Step2 CK Cardiology (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions