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Disease 2 > CHF > Flashcards

CHF Flashcards

1
Q

Describe cardiogenic pulmonary edema

A

An abnormal, diffuse and extravascular accumulation of fluid in the pulmonary tissues and air spaces that arises with changes in hydrostatic forces associated with left sided heart failure

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2
Q

How is heart disease ranked as a cause of death in the US?

A

1

Accounts for 1 in 7 deaths

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3
Q

What are some of the difference between cardiogenic pulmonary edema and non-cardiogenic pulmonary edema (ARDS)?

A

Non-cardiogenic pulmonary edema is the result of the immune system attacking the body
Cardiogenic edema is a result of increased hydrostatic forces in the pulmonary capillaries
Non-cardiogenic edema generates exudate
Cardiogenic edema generates transudate

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4
Q

Describe the basic gist of what is happening in the heart that results in pulmonary edema

A

The left ventricle fails to move blood forward
Pressure in the left ventricle increases
Because pressure in the left ventricle increased, blood from the left atrium cant get in completely so the pressure in the atrium grows
The blood in the pulmonary circulation gets backed up as a result
Pulmonary capillaries act as a relief valve

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5
Q

What is the normal systolic pressure in the pulmonary capillaries?

A

10-15 mmHg

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6
Q

What is the normal capillary oncotic pressure?

A

25-30 mmHg

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7
Q

What happens when pulmonary arterial pressure exceeds 30 mmHg?

A

When PAP exceeds capillary oncotic pressure, the balance tips and fluid is pushed out of the capillaries and is not pulled back in by the oncotic pressure resulting in pulmonary edema

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8
Q

Do red blood cells affect oncotic pressure?

A

No, since the hemoglobin protein is inside the cell wall of the RBC, they do not affect oncotic pressure

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9
Q

What are some causes of heart failure?

A

CAD
Arrhythmias
Myocarditis
Acute valve dysfunctions
Cardiomyopathy
Hypertension that isnt controlled

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10
Q

What are the two “flavors” of heart failure?

A

Heart failure with reduced ejection fraction
Heart failure with preserved ejection fraction

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11
Q

What is heart failure with preserved ejection fraction as called?

A

Diastolic heart failure

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12
Q

Describe what has happened in HFrEF

A

The left ventricle has suffered something that has resulted in reduced contractility and can no longer move the normal amount of blood

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13
Q

What does an ejection fraction of >70% indicate?

A

Hyperdynamic

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13
Q

How can you estimate LVEF?

A

By using an echocardiogram to estimate heart function

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14
Q

Describe what is happening in HFpEF

A

The fraction of the left ventricular volume being ejected is preserved
But the total volume of the left ventricle is reduced because the ventricle is failing to fully relax after systole so it cant be completely refilled

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15
Q

What is the normal range for ejection fraction?

A

50-70%

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16
Q

What does an ejection fraction of 40-49 indicate?

A

Mild dysfunction

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17
Q

What ejection fraction constitutes a mild dysfunction

A

40-49%

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18
Q

What does an ejection fraction of 30-39% indicate?

A

Moderate dysfunction

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19
Q

What ejection fraction constitutes moderate dysfunction?

A

30-39%

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20
Q

What does an ejection fraction of <30% indicate?

A

Severe dysfunction

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21
Q

What ejection fraction constitutes a severe dysfunction?

22
Q

How can pulmonary edema affect surface tension?

A

Fluid shifting into the interstitium can lead to a swelling of the interstitium resulting in a decreased radius which results in a greater surface tension

23
Q

T/F: Pulmonary edema can disrupt surfactant production

24
You suction a patient and see frothy pinkish white secretions. What is causing this and why is the sputum frothy?
Pulmonary edema Surfactant is causing the sputum to be frothy, red blood cells are causing the sputum to be pink
25
What could you see in a patient who is going into shock as a result of pulmonary edema?
Low blood pressure Obtunded Extremities mottled, cool, clammy Poor capillary refill
25
You auscultate a patient with cardiogenic pulmonary edema, what can you expect to hear?
Fine crackles that start at the lung bases and move up and coarsen as edema grows more severe Wheezes Rhonchi Potential heart murmurs
26
What might you observe when examining a patient who is experiencing pulmonary edema?
Diaphoresis Nasal flaring Cough Intercostal retractions Supraclavicular retractions Cynanosis Enlarged tender liver
27
Describe paroxysmal nocturnal dyspnea
Shortness of breath at night due to fluid shift from the lower extremities resulting in a pulmonary edema and the need to sleep more upright Patients usually know about this, ask them if they sleep sat up at night
28
What hemodynamic indices could indicated cardiogenic pulmonary edema
Increased RAP Increased PAP Increased PWCP Decreased CO Increased PVR
29
What does PCWP allow us the approximate?
Pressure in the left atrium
30
Increased pressure in the circulatory system places strain on the walls of the heart resulting in the release of what?
BNP B-type natriuretic peptide
31
What does BNp do?
Triggers a release of sodium by the kidneys which will cause fluid to follow the sodium and be removed from the body in
32
What does BNP greater than 100 pg/dl indicate?
Suggests congestive heart failure
33
What can testing a patients troponin levels tell us?
Whether or not they have had a myocardial infarction
34
What can testing BUN and creatinine tell us?
Whether or not the kidneys are adequately perfused
35
What would we see on a chest radiograph of a patient with cardiogenic pulmonary edema?
Bilateral fluffy opacities Dilated pulmonary arteries Left ventricular hypertrophy Kerley A and B lines Batswing or butterfly pattern Pleural effusion
36
What would you see on the chest radiograph of a patient with moderate left heart failure?
Cardiomegaly Engorgement of pulmonary artery Kerley A and B lines
36
Bats wing or butterfly pattern is an indication of what?
CHF
37
What would you see on the chest radiograph of a patient with mild left heart failure?
Pulmonary venous congestion with dilated pulmonary arteries
38
What do Kerley A lines represent?
Deep interstitial edema that radiate out from the hilum into the central portions of the lungs
39
Where would you see kerley A lines on a CXR?
Most prevalent in the middle and upper lung regions Do not reach pleura
40
Describe kerley B lines
Short thin horizontal lines of interstitial edema that extend inward from the pleural surface
41
Where are Kerley B lines found?
Most commonly seen in lung bases Can be seen throughout the lung
42
What would you expect to see on the CXR of a patient with severe left CHF?
Cardiomegaly Pulmonary artery engorgement Interstitial pulmonary edema Fluffy patches of pulmonary edema Bats wing pattern
43
Why is supplemental oxygen not necessarily recommended in patients with CHF?
Causes systemic vasoconstriction Causes pulmonary vasodilation
44
How does CPAP affect preload?
Decreases preload by reducing venous return by introducing positive pressure in chest
45
What type of ventilation is typically used to treat people with CHF?
CPAP
46
How does CPAP affect gas exchange?
Improves gas exchange by reducing the thickness of the alveolar walls
47
What are the advantages of CPAP for patients with CHF?
Reduced venous return Decrease alveolar collapse Reduce vascular congestion Improve gas exchange Reduce WOB
48
What are the common meds used to diurese patients?
Furosemide (lasix) Bumetanide Torsemide
49
What medications are typically used to treat preload?
Nitroglycerin Morphine sulfate
50
What medications are typically used to reduce afterload?
Nitroprusside
51
What medications would be used for chronic management of CHF?
Ace inhibitors Angiotensin 2 receptor blockers Diuretics Antiarrhythmic medication

Disease 2 (16 decks)

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