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Clin Med II > CHF and valve disease > Flashcards

CHF and valve disease Flashcards

1
Q

Cardiac output

A
  • CO= HR X SV

- how much blood is ejected in one min

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2
Q

HR

A
  • how many times heart beats per min
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3
Q

SV

A
  • how much blood is ejected with each beat
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4
Q

preload

A
  • loading condition of heart at end of diastole right before systole
  • max diastolic stretch for that contraction
  • mainly det by venous return
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5
Q

cardiac contractility

A
  • ability of heart to contract
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6
Q

inotropic influence

A
  • increases contractility
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7
Q

positive inotropes

A
  • digitalis

- sympathetic sitmulation

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8
Q

neg inotropes

A
  • akinesis secondary to MI
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9
Q

LVEF

A
  • % of blood leaving heart each time it contracts

- normal= 55-65%

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10
Q

frank starling curve

A
  • preload on X axis
  • SV on Y axis
  • further you stretch the heart the more vigorous the contraction
  • once heart is stretched too much results in dysfunction
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11
Q

what is the more common type of HF

A
  • diastolic HF
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12
Q

low output HF

A
  • pumping or filling ability impaired

- most common type

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13
Q

high output HF

A
  • excessive need for cardiac output
  • much more rare
  • Beri-beri
  • anemia
  • thyrotoxicosis
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14
Q

right sided HF

A
  • blood backs up into systemic venous system
  • legs
  • hepatic veins
  • GIT
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15
Q

causes of right sided HF

A
  • left sided HF most common
  • severe or chronic pulm disease
  • pulmonic valve stenosis
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16
Q

left sided HF

A
  • blood backs up into lungs -> pulmonary edema
  • blood will eventually back up into ride side of heart -> systemic venous sys
  • systolic and/or diastolic dysfunction
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17
Q

causes of left sided HF

A
  • acute MI
  • chronic CAD/ multiple MI
  • cardiomyopathies
  • LVH d/t HTN
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18
Q

systolic dysfunction

A
  • impaired ejection of blood from heart during systole
  • HFrEF
  • causes reduced SV
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19
Q

causes of systolic dysfunction

A
  • ischemic heart disease most common
  • idiopathic dilated cardiomyopathy
  • HTN
  • valve disease- mitral valve regurg
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20
Q

diastolic dysfunction

A
  • impaired filling of ventricles
  • HFpEF
  • causes reduced SV
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21
Q

causes of diastolic dysfunction

A
  • long standing HTN most common
  • restrictive cardiomyopathies
  • valve disease- mitral valve stenosis
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22
Q

what system is used to classify HF

A
  • NY heart association functional classifications
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23
Q

class I HF

A
  • sx only with significant activity
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24
Q

class II HF

A
  • sx with ordinary ADLs
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25
class III HF
- sx with only minimal exertion
26
class IV HF
- sx at rest
27
common sx of HF
- SOB, esp DOE - orthopnea - paroxysmal nocturnal dyspnea - weight gain - swelling - chest pain/ pressure - fatigue or weakness - heart palpitations if assoc with arrhythmias
28
triggers for newly dx HF
- acute MI or recent MI - afib with RVR - other tachyarrhythmias
29
triggers for decompensation in pts with known HF
- change in diet- increased fluid or salt | - change in meds- reduced diuretic dose, missed dose, non-compliance
30
common PE findings for HF
- weight gain - hypoxia - elevated JVD and + hepatojuglar reflex - S3 gallop - pulmonary rales, decreased breath sounds - pitting edema of LE
31
diagnostic testing for HF
- EKG - BNP* - cardiac biomarkers - CBC and chem 10 - kidney and liver fn - CXR - echo for new dx or significant change in chronic dx
32
CXR findings in HF
- blunting of costophrenic angles - pulmonary vein engorgement- increased interstitial markings - cephalization - kerley B lines - cardiomegaly
33
how do you treat HTN in HF
- BB - ACE (or ARB if needed) - if ACE is tolerated then change to ARNI
34
how do you treat ischemic heart disease in HF
- ASA - BB - Statin - revascularization if needed
35
what diuretics do you use in HF
- lasix first - spironolactone as adjuvant - budesonide or torsemide if need even more adjunct tx
36
how do you reduce afterload and improve cardiac output for HF
- ACE (or ARB if needed) | - if ACE is tolerated then switch to ARNI
37
how do you improve cardiac remodeling
- BB
38
what drug improves outcomes for AA with HF
- bidil | - hydralazine + isosorbide dinitrate
39
what drug reduces hospitalizations in HF
- digoxin
40
stepwise approach for tx of HFrEF
- start on ACE at dx - start lasix at start of sx - add BB for all pts - add sprinonolactone if sx persist - change from ACE or ARB to ARNI as long as not c/i - add Bidil for AA with HF class III-IV - ICD if EF < 35% in class II-III
41
tx of new dx of acute decomp HF
- hospitalize - IV lasix - monitor ins, outs, weight, sodium - rate control with BB or CCB once sx improve, if pt is already on it, or if they require it to tx arrhythmia - ACEI right away if systolic dysfunction - monitor K, Mg, kidneys
42
tx for severe hemodynamic compromise HF
- intubation and admit to CCU - inotropic agents- dobutamine or milrinone - vasopressors - mechanical and surgical intervention when severe
43
what is the most common cause of valve disease in developing countries?
- rheumatic fever
44
what is the most common cause of valve disease in developed countries?
- degenerative or inflammatory processes | - usually valve thickening, calcification, or dysfunction
45
what is the most common cause of acute valve regurg?
- infective endocarditits
46
which type of valvular diseases results in pressure overload?
- stenosis | - results in ventricular remodeling (LVH)
47
which type of valvular disease results in volume overload?
- regurgitation - back flow either as valve is closing or leaks when valve is supposed to be closed - results in eccentric hypertrophy
48
what is the hallmark of the PE for a pt with valvular disease
- murmur
49
imaging to dx valve disease
- transthoracic echo is gold standard - BNP may be elevated in severe disease - to dx regurg use doppler echo
50
mitral stenosis
- presumed to have rheumatic heart disease even if no hx - thickening of valve, posssible calcium deposits - diastolic murmur - blood flow from LA to LV during diastole
51
history with MS
- rheumatic fever, prior untreated GABHS - pregnant pt - immigrant - afib
52
symptoms of MS
- usually asymptomatic until mitral valve area is < 1 cm - new DOE - afib - insidious onset cough - orthopnea, palpitations, fatigue - sx may be precipitated by pregnancy
53
physical exam findings for MS
- diastolic murmur - heard best at apex in LL position - opening snap then S2 sound - irregular pulse d/t afib
54
treatment for MS
- rate control, anticoag, and conversion to NSR to treat afib - procedure of choice- percutaneous mitral balloon valvuloplasty - replacement if stenosis + regurg - can do maze procedure- ablation to reduce afib recurrence
55
organic mitral regurg causes
- primary abnormality - degeneration of mitral valve (often with prolapse) most common - rheumatic heard disease - infective endocarditis - trauma - mitral annular calcifications
56
functional mitral regurg causes
- secondary | - CAD most common -> ischemia or infacrtion -> LV dilation -> CHF sx (eventually)
57
what is the characteristic sound of mitral regurg
- pansystolic or holosystolic murmur
58
what causes acute mitral regurg
- post MI (2-5 days) -> rapid onset dyspnea and pulm HTN - infective endocarditis - indicates the chordae tendinae/ papillary muscle apparatus has ruptured and is a surgical emergency
59
history of mitral regurg
- previous MI or ischemia - CHF - h/o infective endocarditis - cardiomyopathy
60
chronic symptoms of mitral regurg
- may be asymptomatic for life - dyspnea, SOB - orthopnea - pulm edema - progressive LVD over 6-10 years
61
acute symptoms of mitral regurg
- HF and cardiogenic shock | - severe pulmonary edema
62
PE findings for mitral regurg
- pansystolic murmur - best heard at apex - radiates to axilla - S3 sound possible
63
prognosis of mitral regurg
- degree of LVD reflects severity and chronicity of regurg - severe LV volume overload -> LV failure and reduced CO - can be well tolerated for many years
64
treatment for mitral regurg
- surgery when sx dev or have LV dysfunction - want surgery before irreversible damage - surgery indcated when EF < 60% or marked LVD and reduced contractility - pulm HTN suggests severe MR and requires prompt surgery - acute MR= emergent surgery
65
mitral valve prolapse
- usually in healthy young women, often asymptomatic - hear mid-systolic click - worse with valsalva
66
what is the most common congenital valve lesion
- mitral valve prolapse
67
treatment for mitral valve prolapse
- BB if symptomatic | - repair/ replacement when severe
68
aortic stenosis
- blocks ejection of blood from LV into aorta - can be congenital or pathologic - very common in elderly - hypertrophied heart muscles require more BF -> relative ischemia -> arrhythmias
69
what is the most common surgical valve lesion in developed countries
- aortic stenosis
70
risk factors for aortic stenosis
- HTN - hyperlipidemia - smoking
71
symptoms of aortic stenosis
- CHF like - syncope with severe obstruction to flow - onset of sx= severe stenosis - <1.0 cm of stenosis is severe
72
PE findings for aortic stenosis
- systolic murmur - crescendo decrescendo murmur - best heard over aortic area - radiates to neck - paradoxical S2 split - heave or thrill when severe
73
management of aortic stenosis
- no meds found to be effective - treat coexisting conditions - repair, implantation, or replacement based on onset of sx and LV dysfunction
74
causes of aortic regurgitation
- congenital - infective endocarditis - HTN - CT diseases- marfan's or ehler's danlos
75
symptoms of chronic aortic regurgitation
- most common presentation- SOB and dyspnea - palpitations - elevated LV preload -> increased LVEDV -> LV dysfunction -> CHF
76
acute symptoms of aortic regurg
- sudden onset pulmonary edema - hypotension - cardiogenic shock
77
PE findings for aortic regurg
- diastolic decrescendo - wide pulse pressure on BP when severe - best heard at right sternal boarder
78
treatment for aortic regurg
- repair/ replacement before irreversible dysfunction - no pharm tx is effective - surgery before LVEF < 50% and or/ LVESD > 55 mm - acute= surgical emergency - no percutaneous approaches
79
causes of tricuspid stenosis
- rheumatic fever - carcinoid syndrome - infective endocarditis - trauma- CAD, MI
80
symptoms of tricuspid stenosis
- RA enlargement on EKG | - RHF
81
treatment for tricuspid stenosis
- diuretics for fluid overload | - bio prosthetic replacement
82
tricuspid regurg
- d/t RVD or RHF - treat underlying cause - may have tall pointed P waves
83
pulmonic valve regurgitation causes
- high pressure- pulm HTN | - low pressure - inherent problem with the valve
84
symptoms of pulmonic valve regurgitation
- RHF | - loud P2 with early diastolic murmur
85
treatment for pulmonic valve regurg
- correct cause

Clin Med II (16 decks)

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