Cards Test 3 Flashcards
1
Q
HF most commonly results form what?
A
Conditions of impaired left ventricular failure
2
Q
At what pressure value does the pulmonary capillary pressure become high enough to force the flow of fluid into the pulmonary interstitium?
A
> 20 mmHg
3
Q
Would an MI result in systolic or diastolic dysfunction?
A
- impaired contractility
- systolic
4
Q
Would chronic volume overload from valvular regurgitation result in systolic or diastolic dysfunction?
A
- impaired contractility
- systolic
5
Q
Would a dilated cardiomyopathy result in systolic or diastolic dysfunction?
A
- impaired contractility
- systolic
6
Q
Would aortic stenosis result in systolic or diastolic dysfunction?
A
- Pressure overload
- systolic
7
Q
Would uncontrolled HTN result in systolic or diastolic dysfunction?
A
- Pressure overload
- Systolic
8
Q
2 Primary causes of systolic dysfunction
A
- Impaired contractility
- Pressure overload
9
Q
2 Primary causes of diastolic dysfunction
A
- Impaired ventricular relaxation
- obstruction of left ventricular filling
10
Q
Would LV hypertrophy result in systolic or diastolic dysfunction?
A
- Impaired ventricular relaxation
- Diastolic
11
Q
Would hypertrophic cardiomyopathy result in systolic or diastolic dysfunction?
A
- impaired ventricular relaxation
- diastolic
12
Q
Would restrictive cardiomyopathy result in systolic or diastolic dysfunction?
A
- impaired ventricular relaxation
- diastolic
13
Q
Would a transient myocardial ischemia episode result in systolic or diastolic dysfunction?
A
- Either!
- It will impair ventricular relaxation, but it will also impair ventricular contractility. :)
14
Q
Would mitral stenosis result in systolic or diastolic dysfunction?
A
- Obstruction of left ventricular filling
- Diastolic
15
Q
Would pericardial constriction or tamponade result in systolic or diastolic dysfunction?
A
- Obstruction of left ventricular filling
- Diastolic
16
Q
Drug that mimics natural natriuretic peptides
A
Nesiritide (given IV)
17
Q
What causes eccentric hypertrophy?
A
Chronic volume overload
18
Q
What effect does eccentric hypertrophy have on wall stress?
A
Increases wall stress
19
Q
What causes concentric hypertrophy?
A
Chronic pressure overload
20
Q
What effect does concentric hypertrophy have on wall stress?
A
May reduce wall stress substantially
21
Q
What are some sources of pressure overload that can cause HF?
A
- aortic stenosis
- PE
- HTN
22
Q
What are some sources of volume overload that can cause HF?
A
- valvular regurgitation
- Anemia
- Thyrotoxicosis
23
Q
What are some myocardial abnormalities that can cause HF?
A
- CAD
- MI
- Ischemia
- Cardiomyopathies
24
Q
What is high output heart failure usually related to?
A
An endocrine disorder
25
What are some ventricular filling abnormalities that can lead to heart failure?
- mitral stenosis
- constrictive pericarditis
- LVH
26
What are some arrhythmias that can lead to HF?
- Afib
- SVT
- marked brayarrhythmia
27
Top 3 causes of HF in the western world, in order
1. CAD
2. Hypertension
3. Dilated cardiomyopathy
28
Primary complaint of left-sided HF?
Dyspnea on exertion
29
Will the edema of right-heart failure be pitting or non-pitting?
Pitting
30
Gold standard of diagnosing HF
Right heart cath
31
ECHO modality used to assess ventricular wall thickness
M-mode
32
ECHO modality used to assess LV systolic function
2-D
33
ECHO modality used to assess diastolic dysfunction
Doppler
34
ECHO modality that detects regional wall abnormalites
2-D
35
ECHO modality used to estimate pressure gradients
Doppler
36
Mortality increases significantly when the LVEF drops below what?
30%
37
Possible causes of elevated systolic and diastolic PCWP
- LH failure
- Mitral stenosis or regurg
- Cardiac tamponade
- LVH
- Parenchymal lung disease
- Pulmonary vascular disease
38
Good way to estimate LV diastolic pressure
PCW pressure
39
Why might RA pressure be reduced?
Intravascular volume depletion
40
Why might RA pressure be increased?
- RV failure
- Right side valve disease
- Cardiac tamponade
41
Why might RV systolic pressure be increased?
- Pulmonary valve stenosis
| - Pulmonary HTN
42
Why might RV diastolic pressure be increased?
-Volume overload of RH failure
43
Why might diastolic PCWP be elevated
-VSD (left-to-right shunt)
44
What should you expect to see on CXR if left atrial pressures are <10mmHg?
Normal
45
What should you expect to see on CXR if left atrial pressures are >15 mmHg?
Upper-zone vascular redistribution (cephalization)
46
What should you expect to see on CXR if left atrial pressures are > 20mmHg?
- Interstitial edema
| - Kerley B lines
47
What should you expect to see on CXR if left atrial pressures are > 25mmHg?
Alveolar pulmonary edema
48
What diagnostic workup should be performed in ALL cases of suspected heart failure?
- history
- EKG
- PE
- Echo
- Labs
- CAD assessment (stress test, angiogram)
49
Positive inotrope that's used for palliative care in appropriate Stage D HF patients
Milrinone
50
Arteriolar dilator drug
Hydralazine
51
Causes of non-ischemic dilated cardiomyopathy
- viral
- alcohol
- genetic mutation
52
How do you confirm a diagnosis of myocarditis?
-myocardial biopsy
53
What drug do we need to make sure add to the treatment regimen for dilated cardiomyopathy and why?
- Spironolactone
| - Because pts with dilated cardiomyopathies have worsened contractility, which means they're in worse stages of HF
54
Definitive indications for oral anticoagulation in DCM patient
- Previous thromboembolic event
- Afib
- LV thrombus
55
What will happen to the murmur of HOCM with the valsalva maneuver and why?
- Murmur will intensify because preload is decreased
- Because intrathoracic pressure is increased, which decreases venous return, which allows the mitral leaflet and the hypertrophied septum to come closer together
56
What will happen to the murmur of HOCM when the patient squats and why?
- The murmur becomes quieter
| - Because the preload is increased
57
Mainstay of hypertrophic cardiomyopathy tx
-Beta blockers
58
What drugs can we use for hypertrophic cardiomyopathy patients that decrease ventricular stiffness?
-Calcium channel blockers
59
What kind of drugs do you NOT want to give to a hypertrophic cardiomyopathy patient? Why?
- Inotropic drugs
| - because they increase contractility and worsen outflow tract obstruction
60
2 major consequences of the reduced ventricular compliance in restrictive cardiomyopathies
- elevated systemic pulmonic venous pressures
| - Reduced ventricular capacity size, decreasing SV and CO
61
Kussmaul Sign
- paradoxical worsening of JVD with inspiration
- Present in restrictive cardiomyopathy (the stiffened RV can't accomodate increased venous return)
- Also present in constrictive pericarditis
62
What might you see on CXR with restrictive cardiomyopathy?
- pulmonary congestion
| - but not enlarged heart
63
Most common affliction of the pericardium
Acute pericarditis
64
Dressler's Syndrome
-Acute pericarditis occurring 2 weeks to several months after an MI
65
With what type of MI is post-MI pericarditis most closely associated?
-Transmural MI
66
Pericarditis associated with a thin exudate secreted by mesothelial cells lining the serosal surfaces of the pericardium
-Serous pericarditis
67
Most common variation of acute pericarditis
Serofibrinous
68
Type of pericarditis in which portions of the visceral and parietal pericardium may fuse
Serofibrinous
69
Pericarditis that results from an intense inflammatory response to a bacterial infection
Suppurative pericarditis
70
What often causes hemorrhagic pericarditis?
- TB
| - Malignancy
71
When and where do you best hear the friction rub of pericarditis?
- When patient is leaning forward
| - Over the left lower parasternal edge
72
3 Components of the friction rub of pericarditis
- ventricular contraction
- ventricular relaxation
- atrial contraction
73
Evidence of pericarditis on EKG
- Diffuse ST elevation
| - PR depression in II, III, and aVF
74
What diagnostic tool is imperative for diagnosing constrictive pericarditis? What will you find?
- Cardiac catheterization
| - Elevation and equalization of the diastolic pressures in all 4 chambers
75
What should you think if you find elevation and equalization of diastolic pressures in all 4 chambers on cardiac catheterization?
-Constrictive pericarditis
76
Normal pericardial space contains how much fluid?
15-50mL
77
Ewart Sign
- Dullness when percussing over the posterior left lung
| - Associated with pericardial effusion
78
Evidence of pericardial effusion on EKG
- Electrical alterans
| - Reduced voltage
79
What should you think if you find electrical alterans and reduced QRS voltage on EKG?
-Pericardial effusion
80
Good diagnostic tool to determine how much fluid is in the pericardium
-Echo
81
Pulsus paradoxus
- Decrease of SBP >10mmHg during inspiration
| - Associated with cardiac tamponade
82
Definitive diagnostic procedure for cardiac tamponade?
-Cardiac catheterization
83
Definition of pulmonary hypertension
- Pulmonary artery systolic pressure > 30mmHg
| - Or pulmonary artery mean pressure > 20mmHg
84
What are some cardiac causes of pulmonary HTN?
- VSD/ASD (left-to-right shunts)
| - Left atrial hypertension from mitral valve stenosis
85
What might you find upon auscultation of a patient with pulmonary hypertension?
- P2 intensity is increased
| - Also a systolic ejection murmur (what you're hearing is the flow across the pulmonic valve)
86
With pulmonary HTN, would you see right ventricular dilation in early or late stages?
-Late stages
87
EKG evidence of a pulmonary embolism
-S1Q3T3
88
Evidence of PTHN on EKG
- RVH (large R wave in V1 and V2)
- Right atrial enlargement (Increased P wave amplitude)
- Right axis deviation
89
Gold standard for diagnosis of pulmonary hypertension
Right heart cath
90
Drug used to improve exercise capacity in primary PHTN
-Sildenafil (viagra)
91
Most common cause of cor pulmonale?
COPD
92
What should you think if you see on EKG:
- Right axis deviation
- Increase P wave in II, III, and aVF
- RBBB
- Low voltage QRS
Cor pulmonale (Low voltage QRS indicates underlying COPD
93
Types of neurally-mediated syncope
- Neurocardiogenic
- Carotid stimulation
- Situational (reflex) syncope
94
Neurocardiogenic syncope tx
- Beta blockers
- Liberalize salt/fluid intake
- Midodrine
95
Direct alpha agonist used to treat neurocardiogenic syncope
-Midodrine
96
LOC during or immediately after coughing, micturition, swallowing, or defecation
-Situational (reflex) syncope
97
Contraindications for carotid sinus massage
- Recent MI (past 3 months)
- TIA
- CVA
- Presence of Vfib/Vtach
- Presence of carotid bruits
98
BP change requirements for diagnosis of orthostatic syncope
-20mmHg or greater fall in SBP when standing
99
Tilt table contraindications
- pregnancy
- Positive stress test
- Men > 45
- Women > 55
