Cardiovascular Diseases - Heart Failure and Valvular Heart Diseases Flashcards
most common cause of systolic dysfunction that leads to left-sided heart failure
Coronary Artery Disease (CAD)
most common cause of diastolic dysfunction that leads to left-sided heart failure
Concentric Left Ventricular Hypertrophy (LVH) due to HPN
most common cause of right-sided heart failure
L-sided heart failure
Earliest CARDINAL SYMPTOM of L-sided heart failure
Dyspnea
Earliest CARDINAL SIGN of L-sided heart failure
L-sided S3
Presentation of L-sided heart failure
- Dyspnea
- L-sided S3
- PND
- Orthopnea
- MV regurgitation
- presence of brain natriuretic peptide (BNP)
- siderophages (hemosiderin-laden macrophages or heart failure cells)
- pulmonary edema (septal edema, peribronchiolar edema)
Presentation of R-sided heart failure
- peripheral ankle edema (hallmark of R-sided heart failure)
- neck vein engorgement
- tricuspid regurgitation
- ascites
- chronic passive congestion of the liver (nutmeg liver, cardiac cirrhosis)
MOST sensitive index of cardiac function
ejection fraction
important bedside measurement to estimate the volume status
JVP (internal jugular vein preferred)
predominant cause of HF and responsible for 60-75% of HF in industrialized countries
Coronary Artery Disease
Cardinal symptoms of heart failure
fatigue and shortness of breath
most important mechanism of dyspnea in heart failure
pulmonary congestion with accumulation of insterstitial or intra-alveolar fluid, which activates juxtacapillary J receptors
most useful test in assessment of LV function
2d-echo with doppler studies
gold standard for assessment of LV mass and volume
MRI
only pharmacologic agents that can adequately control fluid retention in advanced HF
diuretics
major problem in aldosterone antagonists
development of life-threatening hyperkalemia
cornerstones of moden therapy for HP with a depressed EF
ACE-I/ARBs and Beta Blockers
most common side effect of all vasodilating agents
hypotension
most common side effect of IV or oral nitrates
headache
most commonly used inotropic agent for the treatment of acute HF
dobutamine
first choice for therapy in which modest ionotropy and pressor support are required
dopamine
most common reason for re-hospitalization in heart failure
failure to meet criteria for discharge
most common symptom of cor pulmonale
dyspnea
opening snap, rheumatic heart disease, atrial fibrillation
mitral stenosis
pansystolic murmur, can be due to mitral valve prolapse (MVP)
mitral regurgitation
midsystolic click, associated with Marfan’s
mitral valve prolapse
2 Types: calcified (elderly) or congenital (newborn), causes syncope in exercise
aortic stenosis
widened pulse pressure; corrigan, de musset, quincke, muller, durozeiz, traube, hill, becker signs; austin-flint murmur
Aortic Regurgitation/insufficiency
secondary to pulmonary hpn, graham-steell murmur
pulmonary regurgitation
IE in IV drug abusers, carcinoid heart disease, pulsating liver, giant C-V wave jugular venous pulses
tricuspid regurgitation
carcinoid heart disease
pulmonary stenosis
leading cause of mitral stenosis
rheumatic heart disease
most prominent location of kerley b lines
lower and mid-lung fields
papillary muscle usually involved in acute MR because of single blood supply
posteromedial papillary muscle
most complaints in chronic severe MR
fatigue, exertional dyspnea, and orthopnea
most common ecg finding in MVP
normal
most important finding on auscultation in MVP
mid- or late (nonejection) systolic click
most common congenital heart valve defect
bicuspid aortic valve disease
three cardinal symptoms of AS
exertional dyspnea + angina pectoris + syncope
most common cause of midsystolic murmur in an adult
aortic stenosis
murmur that is always related to structural heart disease
diastolic murmurs (Grade I-II systolic murmurs are usually benign)
classic cause of a mid-to-late diastolic murmur
mitral stenosis
classic example of a continuous murmur
patent ductus arteriosus (PDA)
