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Test4 > CHF class > Flashcards

CHF class Flashcards

1
Q

2 basic mechanisms of heart failure

A

systolic and diastolic dysfunction

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2
Q

RAAS Neuronal changes cause salt and water retention short term and long term effect

A

short: preload increase
long: pulmonary congestion, anasarca

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3
Q

RAAS Neuronal changes cause:

Vasoconstriction short term and long term effect

A

short: maintains bp for perfusion

pump dysfuntion due to increased afterload

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4
Q

Ejection fraction greater than 40% may be seen in

A

diastolic failure

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5
Q

Patient with alcholism may be at risk for which sided heart failure

A

both sides

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6
Q

Cardiomyopathy is defined as

A

disease of heart muscle, with mechanical or electrical dysfunction, with ventricular changes; frequently genetic

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7
Q

Dilated Cardiomyopathy

A

most common, idiopathic, dilation and impaired contraction of ventricles leading to hypertrophy, can be reversed

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8
Q

SAM

A

SYSTOLIC ANTERIOR MOTION anterior mitral valve

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9
Q

Hypertrophic Cardiomyopathy usually due to, treated with what calcium channel blockers, confirmed by; common cause of what USA death

A

LV Hypertrophy
verapamil and diltiazem (negative inotropic)
Confirmed by ECHO (wall >15cm thick)
Sudden cardiac death in young athletes

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10
Q

Restrictive Cardiomyopathy characteristics, how diagnosed, causes

A

biatrial enlargement, without ventricle changes, ventricle not being filled, diagnose with echo,
causes: infiltrative( amyloidosis, sarcoidosis, hemochromatosis); noninfiltrative: diabetes, idiopathic; Storage: Fabrays; Other

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11
Q

Amyloidosis occurs from: treatment includes

A

extracellular deposits of fibrils composed of proteins

Treat HF and underlying cause (TTR treatable)

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12
Q

Amyloidosis treatment includes

A

treating hf and underlying disease

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13
Q

heterogeneous disorders, patchy scar formation around infiltrating, noncaseating granulomas

A

Sarcoidosis

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14
Q

Common presentation of Cardiac sarcoid

A

AV block

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15
Q

Stress induced CMP also know as broken heart syndrome

A

Takotsubo

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16
Q

Hallmark of aortic stenosis

A

chest pain, shortnes of breath, syncope

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17
Q

Aortic stenosis murmur heard during which phase of filling

A

systolic

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18
Q

Women in 40 comes with chest pain sob and syncope you suspect aortic stenossi what cause do you suspect

A

rheumatic

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19
Q

Man in 70 comes in aortic stenosis suspect cause

A

Bicuspid valve

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20
Q

Man in 80 come is aortic stenosis suspect cause

A

calcific /degenerativ

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21
Q

Most common cause of Mitral regurgitation

A

degenerative

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22
Q

Mitral regurgitation pathophysiology

A 
Volume overload increases LVEDP;
compensatory dilatation of LA&LV
to lower pressures; increased
Preload, LVH, and reduced
Afterload (low resistance of LA
provides unloading of LV) causing
large total SV; MR Begets MR;
leading to contractile dysfunction
with decrease in EF, increase in
LVEDP
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23
Q

New york Heart Association functional Class 1

A

no limits

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24
Q

New york Heart Association functional Class 2

A

slight limitation, no symptoms at rest

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25
Q

New york Heart Association functional Class 3

A

symptoms develop with less than ordinary activity no symptoms at rest

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26
Q

New york Heart Association functional Class 4

A

symptoms occur at rest

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27
Q

Dilation hypertrophy would be characteristic of which HF (acute or chronic

A

chronic

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28
Q

Diagnostic evaluation of CHF

A

BNP/ANP

CBC, Chem 7, albumin, HepC, Lft, (liver congetions) , TSH, Troponin, CXR, ECG, ECHO

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29
Q

what is BNP/ANP in HF

A

BNP/ANP greater than 400pg/ml in patient with dyspnea due to HF

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30
Q

Cardiorenal syndrome labsd

A

gfr,

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31
Q

congested kidney use what med

A

lasix to decongest

32
Q

When should echocardiogram be done, what is assessed

A

baseline, and 3months, assesses LV function, wall thickness, wall motion, valve dz, pericadial effusion

33
Q

Cardiac MRI is superior over

A

echo

34
Q

left heart cath gold statnder fro

A

cad

35
Q

what should be monitored iwth LHC

A

Kidneys

36
Q

Swan-ganz catheter gives pressure of

A

left ventricle

37
Q

Swan-ganz catheter gives pressure of

A

left ventricle

38
Q

Acute cardio treatment problem

A

decreased intestinal perfusion and mucosal edema
may markedly slow the rate of drug absorption and therefore the
rate of delivery of drug to the kidney.

39
Q

GDMT

A

Guideline directed therpay

40
Q

3 things to look at on heart failure

A

weight, bloodpressure, heartrate

41
Q

Mainstay medical therapy for volume management in hf

A

diuretics loopdiurects

42
Q

Mainstay medical therapy for volume management in hf

A

diuretics loopdiurects

43
Q

mainstay for HF

A

ACE ARB

44
Q

Check what after initiation of ACEI

A

chem 7 (especially K+)

45
Q

Patient with GFR less than 30 ARNI dose should be

A

24/26

46
Q

ARNI starting dose normal

A

49/51 then change to 97/103

47
Q

Beta blockers increase, most common used med

A

heart filling time, left side decrease heart rate, Metoprolol

48
Q

Betablocker for patient with low heart rate

A

carvidolol

49
Q

amiodarone can affect what should be done

A

thyroid, treat the high thyroids, get thyroids levels check

50
Q

aldosterone should be started after starting what 2 drugs

A

ACEI and BB

51
Q

aldosterone should be started after starting what 2 drugs

A

ACEI and BB

52
Q

if patient dosent need to be on blood thinner use

A

ablation

53
Q

Aortic stenosis valve replace if severe

have to be on coumadin

A

j

54
Q

you chronic drug use need valve

A

get mechanical

55
Q

pregnancy warfarin contraindicated put on

A

heparin

56
Q

Primary Mitral regurgitation is treated with

A

surgery valve replacement

57
Q

IABP commonly use for how long

A

short term

58
Q

ICD recommended for people with ef less than

A

35%

59
Q

predictors of poor outcomes

A

• severe LV

dilatation and MR.

60
Q

LVAD improvent and survival

A

80% patients with NYHA Class III-IV

improved to Class I-II, 68% survival at 2 years

61
Q

Transplant contraindications

A

Systemic illness with a life expectancy < 2 years despite heart transplantation.
• Irreversible pulmonary HTN (may consider heart-lung transplant – there is some variation on criteria at different centers).
• Active substance abuse, Noncompliance to medical therapy.
• Multisystem disease with severe extracardiac organ dysfunction (example amyloidosis).
• Clinically severe symptomatic cerebrovascular disease

62
Q

Possible considerations

A 
Age > 70 years of age
• Obesity (BMI > 35)
• Diabetes with poor glycemic control, irreversible renal dysfunction (GFR < 30), neoplasm, certain infections HCV with mild
disease)
• Inadequate social support
63
Q

Possible considerations

A 
Age > 70 years of age
• Obesity (BMI > 35)
• Diabetes with poor glycemic control, irreversible renal dysfunction (GFR < 30), neoplasm, certain infections HCV with mild
disease)
• Inadequate social support
64
Q

Who should be involve with crhonic heart failure

A

palliative care

65
Q

Teach patients 2

A

2g sodium, 2L fluid, weight gain 2 lbs take extra lasix

66
Q

Normal Ejection fraction is

A

55-60%

67
Q

what mechanisms does the heart use to compensate for failure

A

frank-starling, neurohormonal (augmented MAP) and ventricular remodeling

68
Q

increase in preload causing increase in stretch leading to increase CO of the heart is a description of what mechanism

A

Frank-Starling Mechanism

69
Q

what is an example of the neurohormonal model of HF

A

reaction of Renin-angiotensin aldosterone system (RAAS) and sympathetic nervous system

70
Q

RAAS Neurohormonal changes cause sympathetic stimulation what are the short and long term effect

A

short: increases HR and contractility
Long: increase energy expenditure

71
Q

patient with hyperthyroidism may be at risk for what type heart failure

A

high output

72
Q

Patient with sepsis may have what type heart failury

A

high out put

73
Q

patient with anemia may have what type heart failure

A

high output

74
Q

systolic hf defined by EF of

A

less than 40%

75
Q

diastolic hf defined by EF of

A

greater than 40%

76
Q

patient with pulmonary disease should be cautioned for what HF

A

right sided heart failure

Test4 (20 decks)

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