CHF / HF / Shock Flashcards
What does the phrenic nerve do
Assist with sensory signaling from the pericardium
Innervates the diaphragm to help maintain respiration (main innervation of diaphragm)
Where is the phrenic nerve located
on the left and it crosses over the aorta (comes out of C3-C5)
What is heart failure
clinical syndrome of decreased cardiac output
How does HF present
fluid overload
may be systolic or diastolic
*often associated with underlying cardiac etiology
What are the different classifications of CHF
Acute vs chronic
Compensated vs decompensated
Right side vs left side
Systolic vs diastolic
What is chronic HF
More common type
Develops over months to years
m/c w/ cardiomegaly
*hallmarked by fluid overload
What are some causes of chronic HF
Ischemia
Valve disease
HTN
What is acute HF
ACS with wall motion abnormality, acute valve disease, arrhythmia, infection
How does acute HF present
Flash pulmonary edema
shock
normal cardiac silhouette
What is flash pulmonary edema
Rapid onset of pulmonary edema because the heart can not keep up with the fluid volume in body
What is LV HF
Most common type
LV failure
Decreased CO -> pulmonary edema
What is RV HF
Primary:
-Pulm valve stenosis
-pulm HTN
-increased preload & decreased CO
Secondary:
-most common (Left sided HF)
What is compensated HF
Body is able to compensate for the underlying condition
What is decompensated HF
Acute exacerbation within a patient that has known CHF
Body can no longer keep up with condition
Increase in sx with volume overload
How do patients with decompensated HF present
orthopnea
exertion dyspnea
fatigue
How does the body compensate for heart failure
Sympathetic system increases B1 effects (contractility / SV / BP)
and a1 (increase vasoconstriction = increase preload and BP and decrease BF to kidneys)
What happens when RAAS is activated
Angiotensin 2: Vasoconstrict = increased thirst
Aldosterone: Fluid retention through Na+ resorption
Adrenergic: Release catecholamines = increase HR/ Vac. resistance/ contractility
What is systolic HF
reduced ability for the heart to squeeze effectively
What is diastolic HF
Maintain EF but unable to relax and fill with blood during diastole
What occurs as a result of systolic HF
Reduced ejection fraction (HFrEF)
What are the causes of systolic HF
MI effecting LV
Dilated cardiomyopathy
increased preload
valvular disease
Tacchyarrythmia
How does diastolic HF present
Decreased preload
increased afterload
What are the most common causes of HF
Chronic HTN
Ischemia
Chronic valvular disease
What on a physical will you find with CHF
S3 heart sound
Crackles
Elevated JVD
Hepatojugular reflux
peripheral edema
Ascites
SOB / orthopnea
What is anasarca
Diffuse edema
At what volume will a patient be symptomatic with edema
2.5-3L
Pitting vs non pitting edema
Pitting: more common
Non pitting: More reflective of lymphatic obstruction
What is shock
Supply / demand mismatch
= hypo perfusion
*lack of O2 and nutrients to vital organs relative to their vital demands
What are the types of shock
hypovolemic
cardiogenic
obstructive
distributive
What is seen in patients with shock
Low / high temp
tachycardia
low BP
MAP <65
AMS
pale /clammy/cyanotic
tachypneic
decreased GFR
acidosis
What are cariogenic shock associated with
MI
Arrythmia
HF
Valve dysfunction
What does a positive chronotrope do
increase HR
What do vasopressors do
cause vasoconstriction
What causes distributive shock
redistribution of blood volume
*septic shock is most common
What type of shock is septic shock
distributive shock
what is obstructive shock
from decreased venous return or decreased cardiac compliance
-PE
-tamponade
-tension pneumo
-LVOF obstruction
