Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

HR

A
  • how many times heart beats per min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

SV

A
  • how much blood is ejected with each beat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

cardiac contractility

A
  • ability of heart to contract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

inotropic influence

A
  • increases contractility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

positive inotropes

A
  • digitalis

- sympathetic sitmulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

neg inotropes

A
  • akinesis secondary to MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

LVEF

A
  • % of blood leaving heart each time it contracts

- normal= 55-65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the more common type of HF

A
  • diastolic HF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

low output HF

A
  • pumping or filling ability impaired

- most common type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

high output HF

A
  • excessive need for cardiac output
  • much more rare
  • Beri-beri
  • anemia
  • thyrotoxicosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

right sided HF

A
  • blood backs up into systemic venous system
  • legs
  • hepatic veins
  • GIT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

causes of right sided HF

A
  • left sided HF most common
  • severe or chronic pulm disease
  • pulmonic valve stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

causes of left sided HF

A
  • acute MI
  • chronic CAD/ multiple MI
  • cardiomyopathies
  • LVH d/t HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

systolic dysfunction

A
  • impaired ejection of blood from heart during systole
  • HFrEF
  • causes reduced SV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

causes of systolic dysfunction

A
  • ischemic heart disease most common
  • idiopathic dilated cardiomyopathy
  • HTN
  • valve disease- mitral valve regurg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

diastolic dysfunction

A
  • impaired filling of ventricles
  • HFpEF
  • causes reduced SV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

causes of diastolic dysfunction

A
  • long standing HTN most common
  • restrictive cardiomyopathies
  • valve disease- mitral valve stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what system is used to classify HF

A
  • NY heart association functional classifications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

class I HF

A
  • sx only with significant activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

class II HF

A
  • sx with ordinary ADLs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

class III HF

A
  • sx with only minimal exertion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

class IV HF

A
  • sx at rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

common sx of HF

A
  • SOB, esp DOE
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • weight gain
  • swelling
  • chest pain/ pressure
  • fatigue or weakness
  • heart palpitations if assoc with arrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

triggers for newly dx HF

A
  • acute MI or recent MI
  • afib with RVR
  • other tachyarrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

triggers for decompensation in pts with known HF

A
  • change in diet- increased fluid or salt

- change in meds- reduced diuretic dose, missed dose, non-compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

common PE findings for HF

A
  • weight gain
  • hypoxia
  • elevated JVD and + hepatojuglar reflex
  • S3 gallop
  • pulmonary rales, decreased breath sounds
  • pitting edema of LE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

diagnostic testing for HF

A
  • EKG
  • BNP*
  • cardiac biomarkers
  • CBC and chem 10
  • kidney and liver fn
  • CXR
  • echo for new dx or significant change in chronic dx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

CXR findings in HF

A
  • blunting of costophrenic angles
  • pulmonary vein engorgement- increased interstitial markings
  • cephalization
  • kerley B lines
  • cardiomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

how do you treat HTN in HF

A
  • BB
  • ACE (or ARB if needed)
  • if ACE is tolerated then change to ARNI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

how do you treat ischemic heart disease in HF

A
  • ASA
  • BB
  • Statin
  • revascularization if needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what diuretics do you use in HF

A
  • lasix first
  • spironolactone as adjuvant
  • budesonide or torsemide if need even more adjunct tx
36
Q

how do you reduce afterload and improve cardiac output for HF

A
  • ACE (or ARB if needed)

- if ACE is tolerated then switch to ARNI

37
Q

how do you improve cardiac remodeling

A
  • BB
38
Q

what drug improves outcomes for AA with HF

A
  • bidil

- hydralazine + isosorbide dinitrate

39
Q

what drug reduces hospitalizations in HF

A
  • digoxin
40
Q

stepwise approach for tx of HFrEF

A
  • 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
Q

tx of new dx of acute decomp HF

A
  • 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
Q

tx for severe hemodynamic compromise HF

A
  • intubation and admit to CCU
  • inotropic agents- dobutamine or milrinone
  • vasopressors
  • mechanical and surgical intervention when severe
43
Q

what is the most common cause of valve disease in developing countries?

A
  • rheumatic fever
44
Q

what is the most common cause of valve disease in developed countries?

A
  • degenerative or inflammatory processes

- usually valve thickening, calcification, or dysfunction

45
Q

what is the most common cause of acute valve regurg?

A
  • infective endocarditits
46
Q

which type of valvular diseases results in pressure overload?

A
  • stenosis

- results in ventricular remodeling (LVH)

47
Q

which type of valvular disease results in volume overload?

A
  • regurgitation
  • back flow either as valve is closing or leaks when valve is supposed to be closed
  • results in eccentric hypertrophy
48
Q

what is the hallmark of the PE for a pt with valvular disease

A
  • murmur
49
Q

imaging to dx valve disease

A
  • transthoracic echo is gold standard
  • BNP may be elevated in severe disease
  • to dx regurg use doppler echo
50
Q

mitral stenosis

A
  • 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
Q

history with MS

A
  • rheumatic fever, prior untreated GABHS
  • pregnant pt
  • immigrant
  • afib
52
Q

symptoms of MS

A
  • 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
Q

physical exam findings for MS

A
  • diastolic murmur
  • heard best at apex in LL position
  • opening snap then S2 sound
  • irregular pulse d/t afib
54
Q

treatment for MS

A
  • 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
Q

organic mitral regurg causes

A
  • primary abnormality
  • degeneration of mitral valve (often with prolapse) most common
  • rheumatic heard disease
  • infective endocarditis
  • trauma
  • mitral annular calcifications
56
Q

functional mitral regurg causes

A
  • secondary

- CAD most common -> ischemia or infacrtion -> LV dilation -> CHF sx (eventually)

57
Q

what is the characteristic sound of mitral regurg

A
  • pansystolic or holosystolic murmur
58
Q

what causes acute mitral regurg

A
  • 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
Q

history of mitral regurg

A
  • previous MI or ischemia
  • CHF
  • h/o infective endocarditis
  • cardiomyopathy
60
Q

chronic symptoms of mitral regurg

A
  • may be asymptomatic for life
  • dyspnea, SOB
  • orthopnea
  • pulm edema
  • progressive LVD over 6-10 years
61
Q

acute symptoms of mitral regurg

A
  • HF and cardiogenic shock

- severe pulmonary edema

62
Q

PE findings for mitral regurg

A
  • pansystolic murmur
  • best heard at apex
  • radiates to axilla
  • S3 sound possible
63
Q

prognosis of mitral regurg

A
  • 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
Q

treatment for mitral regurg

A
  • 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
Q

mitral valve prolapse

A
  • usually in healthy young women, often asymptomatic
  • hear mid-systolic click
  • worse with valsalva
66
Q

what is the most common congenital valve lesion

A
  • mitral valve prolapse
67
Q

treatment for mitral valve prolapse

A
  • BB if symptomatic

- repair/ replacement when severe

68
Q

aortic stenosis

A
  • 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
Q

what is the most common surgical valve lesion in developed countries

A
  • aortic stenosis
70
Q

risk factors for aortic stenosis

A
  • HTN
  • hyperlipidemia
  • smoking
71
Q

symptoms of aortic stenosis

A
  • CHF like
  • syncope with severe obstruction to flow
  • onset of sx= severe stenosis
  • <1.0 cm of stenosis is severe
72
Q

PE findings for aortic stenosis

A
  • systolic murmur
  • crescendo decrescendo murmur
  • best heard over aortic area
  • radiates to neck
  • paradoxical S2 split
  • heave or thrill when severe
73
Q

management of aortic stenosis

A
  • no meds found to be effective
  • treat coexisting conditions
  • repair, implantation, or replacement based on onset of sx and LV dysfunction
74
Q

causes of aortic regurgitation

A
  • congenital
  • infective endocarditis
  • HTN
  • CT diseases- marfan’s or ehler’s danlos
75
Q

symptoms of chronic aortic regurgitation

A
  • most common presentation- SOB and dyspnea
  • palpitations
  • elevated LV preload -> increased LVEDV -> LV dysfunction -> CHF
76
Q

acute symptoms of aortic regurg

A
  • sudden onset pulmonary edema
  • hypotension
  • cardiogenic shock
77
Q

PE findings for aortic regurg

A
  • diastolic decrescendo
  • wide pulse pressure on BP when severe
  • best heard at right sternal boarder
78
Q

treatment for aortic regurg

A
  • 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
Q

causes of tricuspid stenosis

A
  • rheumatic fever
  • carcinoid syndrome
  • infective endocarditis
  • trauma- CAD, MI
80
Q

symptoms of tricuspid stenosis

A
  • RA enlargement on EKG

- RHF

81
Q

treatment for tricuspid stenosis

A
  • diuretics for fluid overload

- bio prosthetic replacement

82
Q

tricuspid regurg

A
  • d/t RVD or RHF
  • treat underlying cause
  • may have tall pointed P waves
83
Q

pulmonic valve regurgitation causes

A
  • high pressure- pulm HTN

- low pressure - inherent problem with the valve

84
Q

symptoms of pulmonic valve regurgitation

A
  • RHF

- loud P2 with early diastolic murmur

85
Q

treatment for pulmonic valve regurg

A
  • correct cause

Clin Med II (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions