CHF Flashcards

1
Q

What is cardiac output?

A

amount of blood left in the ventricle

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2
Q

What is cardiac preload?

A

Pressure in the right side of the heart as blood returns to the heart

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3
Q

What is cardiac afterload?

A

Pressure the heart must pump against within the arterial system to eject blood (Peripheral vascular resistance)

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4
Q

At the hemodynamic level, what causes impaired contractility?

A

Loss of cardiac muscle cells, Beta receptor down-regulation, and reduced ATP production

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5
Q

Systolic Dysfunction

A

Is usually the result of an MI. Evidenced by low ejection fraction and reduced inotropy during ventricular systole.

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6
Q

Diastolic Dysfunction

A

Usually caused by HTN and IHD. Decreased myocardial noncompliant decreasing filling. Low CO with normal ejection fraction.

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7
Q

Who is more likely to develop diastolic dysfunction?

A

Elderly, women, and those with a history of MI

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8
Q

What favourable effect does increased sympathetic activity have?

A

Increased HR, Increased contractility, vasoconstriction causing increased venus return and filling

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9
Q

What unfavourable effect does increased sympathetic activity have?

A

Arteriolar constriction, afterload,increased workload, increased O2 consumption

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10
Q

What favourable effect does increased Renin-Angiotension Aldosterone have?

A

Salt and water retention, increased VR

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11
Q

What unfavourable effect does increased Renin-Angiotension Aldosterone have?

A

Vasoconstriction causing increased afterload

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12
Q

What favourable effect does increased IL-1 and TNF-Alpha have?

A

May have roles in myocyte hypertrophy and LV remodeling

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13
Q

What unfavourable effect does IL-1 and TNF-Alpha have?

A

Apoptosis

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14
Q

What favourable effect does increased endothelin have?

A

Vasoconstriction causing increased VR

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15
Q

What unfavourable effect does increased endothelin have?

A

Increased afterload

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16
Q

What are the BACKWARD effects of LVF?

A

dyspnea on exertion, orthopnea, cough, paroxysmal nocturnal dyspnea, cyanosis, basilar crackles

17
Q

What are the FORWARD effects of LVF?

A

Fatigue, oliguria, increased heart rate, faint pulses, restlessness, confusion, anxiety

18
Q

What are the BACKWARD effects of RVF?

A

Hepatomegaly, ascites, splenomegaly, anorexia, subcut edema, jugular vein distention

19
Q

What are the FORWARD effects of RVF?

A

Fatigue, oliguria, increased heart rate, faint pulses, restlessness, confusion, anxiety

20
Q

How many classes of heart failure are there according to the NYHA?

A

4

21
Q

Class 1 of heart failure

A

no limitation. Normal physical exercise does not cause fatigue, dyspnoea or palpatations.

22
Q

Class 2 of heart failure

A

Mild limitation. Comfortable at rest but normal physical activity produces fatigue, dyspnoea or palpatations

23
Q

Class 3 of heart failure

A

Marked limitation. Comfortable at rest but less gentle physical activity produces marked symptoms of heart failure.

24
Q

Class 4 of heart failure

A

Symptoms of heart failure occur at rest and are exacerbated by any physical activity

25
Q

What is a diagnosis of CHF based upon?

A

Past medical history, physical examination, laboratory and radiologic findings

26
Q

What does a blood test use to diagnose CHF?

A

CBS, Liver biochemistry, cardiac enzymes, BNP, and thyroid function

27
Q

How does echocardiography diagnose CHF?

A

It establishes the presence of systolic and/or diastolic impairment of the left or right ventricle to determine the EF.

28
Q

Importance of Brain Natriuretic Peptide in CHF

A

The hormones pro-BNP and BNP are highly accurate for identifying or excluding HF with high specificity and sensitivity. Particularly valuable in differentiating cardiac from pulmonary causes of dyspnea.

29
Q

What is the Major Framingham Criteria for diagnoses of CHF?

A

PND, Neck vein distention, rales, cardiomegaly, acute pulmonary edema, S3 gallop, increased venous pressure, and positive hepatojugular reflux

30
Q

What is the minor Framingham criteria for diagnoses of CHF?

A

Extremity edema, night cough dyspnea on exertion, hepatomegaly, pleural effusion, vital capacity reduced by 1/3 from normal, tachycardia (>120 bpm). Weight loss > 4.5kg over 5 days of treatment.

31
Q

To establish a clinical diagnosis of CHF using the Framingham criteria a patient must exhibit…

A

at least one major or two minor criteria are required.

32
Q

Beta blockers in CHF should be used if

A

stable and no fluid overload.

33
Q

How does a beta blocker work on CHF?

A

Makes you feel weak and tired for a few days then stable. Reduce HR and BP through SNS to decrease consumption of O2 of the heart muscle

34
Q

What do ACE inhibitors/ ARBS do in CHF

A

Vasodilate, counteract RAAS

35
Q

When should you use a diuretic in CHF?

A

If volume is overloaded. It decreases preload, blood pressure and edema

36
Q

What does digoxin do in CHF?

A

Decreases HR and enhances contractility

37
Q

When should you use Aldactone and what does it do?

A

You should use aldactone if you are still symptomatic and have low K+. It decreases Na retention.

38
Q

Non-pharm measures for CHF

A

Moderate aerobic exercise
Sodium restriction (2-3g/day, 1-2g if advanced HF)
1.5-2L of fluid/day
Daily weighing
Flu and pneumonia vaccines
Close supervision and follow-up