CHF

Question 1

Most common cause of HF in US

Answer 1

Ischemia

Question 2

Sx of HF include

Answer 2

dyspnea, orthopnea, paroxysmal nocturnal dyspnea, edema, fatigue

Question 3

Signs of HF include

Answer 3

rales, JVD, pitting edema

Question 4

Right Sided HF physiology

Answer 4

blood pools in right atrium, back up of blood in SVC and IVC

Question 5

S/S of Right Sided HF

Answer 5

JVD, peripheral edema

Question 6

Left Sided HF physiology

Answer 6

blood pools in Left atrium and backs up into the pulmonic vein congesting to lungs

Question 7

S/S of Left Sided HF

Answer 7

Classic pulmonary congestive changes

Question 8

High-Output HF physiology

Answer 8

abnormally elevated metabolic demands of tissues and CO cannot meet demands

Question 9

Low-Output HF physiology

Answer 9

insufficient output to meet normal tissue metabolic demands

Question 10

Causes of High-Output HF

Answer 10

Anemia, Thyrotoxicosis

Question 11

Systolic HF physiology

Answer 11

inability to expel sufficient amount of blood

Question 12

Diastolic HF physiology

Answer 12

failure to relax and fill normally

Question 13

heart failure with preserved left ventricular ejection fraction (LVEF)

Answer 13

aka Diastolic HF

Question 14

Functional Classification: NYHA Class I

Answer 14

Sx w/ strenuous activity

Question 15

Functional Classification: NYHA Class II

Answer 15

Sx w/ ordinary activity (2 blocks or flight of stairs)

Question 16

Functional Classification: NYHA Class III

Answer 16

Sx w/ minimal activity (<1 city block)

Question 17

Functional Classification: NYHA Class IV

Answer 17

Sx w/ rest

Question 18

Non-cardiogenic HF

Answer 18

ARDS, caused by shock, trauma, infection, transfusions

Question 19

Adaptations of the heart in HF

Answer 19

change in LV volume and pressure, LV remodeling, neurohormonal activation

Question 20

Remodeling of heart in HF

Answer 20

Hypertrophy, chamber dilation

Question 21

Remodeling of the heart is a change in ventricular

Answer 21

shape, size, and mass secondary to myocyte loss

Question 22

First change in remodeling of the heart

Answer 22

hypertrophy

Question 23

Frank-Starling Law

Answer 23

Increasing EDV results in increased force of contraction

Question 24

Frank-Starling Law as it applies to HF

Answer 24

EDV continues to increase and the heart is forced to increase contractility, until it plateaus and results in heart failure

Question 25

Second change in remodeling of the heart

Answer 25

chamber dilation---as myocyte loss increases

Question 26

RAAS activation in HF is due to

Answer 26

RAAS and ADH are activated bc sensors indicate low perfusion/low O2

Question 27

RAAS activation causes

Answer 27

functions to increase volume (Na+/H2O reabsorption) and vasoconstriction

Question 28

SNS activation in HF is due to

Answer 28

Sensors indicating low perfusion/low O2

Question 29

SNS activation in HF causes

Answer 29

HR increase, vasoconstriction, increased contractility

Question 30

PE findings of HF

Answer 30

Increased HR, narrowed pulse pressure, crackles, rales, hepatojugular reflex, S3

Question 31

Diagnosis

Answer 31

CXR (pulmonary edema), BNP, ECHO (EF of LV, valve function), BUN/Creatinine elevation, Na decreased, elevated LFT

Question 32

ECHO showing systolic HF

Answer 32

reduced EF and increased chamber size

Question 33

CXR findings w/ HF

Answer 33

Cardiomegaly and Bilateral lung infiltrates (back-up of blood in the venous vasculature of the lungs, increased transudation of fluid)

Question 34

Kerley B Lines

Answer 34

short parallel lines at the lung periphery, usually seen at the costophrenic angle on CXR; commonly caused by pulmonary edema

Question 35

Elevated BNP

Answer 35

can indicate many pathologies, HF included

Question 36

Non-pharmacologic Treatment for HF

Answer 36

Fluid restriction, Na+ restriction, weight reduction, cardiac rehab

Question 37

Pharmacologic Treatment for HF

Answer 37

loop diuretics (furosemide/lasix), spironolactone, ACE-I, ARB, Hydralazine+Nitrate, b-blocker

Question 38

ACE-I treat HF by

Answer 38

decrease vasoconstriction -> decreased afterload; decreases preload (decreased volume)

Question 39

ACE-I reduce mortality by

Answer 39

40%

Question 40

Side effects of ACE-I

Answer 40

Dry cough, hypotension, angioedema, hyperkalemia, azotemia

Question 41

ARB is ________ effective than/as ACE-I

Answer 41

equally

Question 42

Unlike ACE-I, ARBs are not associated w/

Answer 42

dry cough

Question 43

If HF pts cannot tolerate ACE-I or ARBs, consider

Answer 43

Hydralazine + Nitrates (vasodilation)

Question 44

Hydralazine + Nitrates is ________ effective than/as ACE-I

Answer 44

less

Question 45

Beta-blocker help treat HF by

Answer 45

decreasing Sympathetic tone (reduce vasoconstriction to decreased afterload)

Question 46

3 b-blocker agents known to be effective

Answer 46

metoprolol, bisoprolol, carvedilol all improve LVEF and mortality

Question 47

Aldosterone Antagonist are used for

Answer 47

severe HF to decrease mortality

Question 48

Which drug/s is used in HF Tx, but is not associated w/ decreased mortality?

Answer 48

Loop diuretics and digoxin make ppl feel better, but do not make them live longer

Question 49

Digoxin is used for _________, bc it causes what effect?

Answer 49

systolic HF; increased myocardial contractility

Question 50

Dobutamine is a

Answer 50

IV inotropic agent (increases contractility)

Question 51

Patients with EF <30-35% are at increased risk of

Answer 51

fatal arrhythmias (Vfib, Afib)

Question 52

ICD (implanted defibrillator) are implanted in pts w/

Answer 52

NYHA III-IV with EF <30%

Question 53

ICD (implanted defibrillator) are implanted when

Answer 53

40d post-MI, 3mo post-revascularization, 3mo on Optimal Drug therapy

Question 54

Stage I

Answer 54

Lasix, ACE-I, b-Blocker

Question 55

Pathology of pulmonary edema would show what type of cells?

Answer 55

"Heart Failure" cells: hemosiderin laden macrophages

Question 56

What electrolyte finding is associated w/ HF?

Answer 56

Decreased Na+ (d/t increased free water)

Question 57

Stage 1 of CHF

Answer 57

Redistribution of pulmonary vessels, cardiomegaly, broad vascular pedicle

Question 58

Stage 2 of CHF

Answer 58

Kerley Lines, peribronchial cuffing, hazy contour of vessels, thickened inter lobar fissure

Question 59

Stage 3 of CHF

Answer 59

consolidation, air bronchogram, cottonwood appearance, pleural effusion

Question 60

What HF drug is not used acutely?

Answer 60

b-blocker