CHF & Shock Flashcards
What is normal ejection fraction
50-70%
What are the main causes of CHF
Uncontrolled HTN
CAD / cardiac ischemia
valvular heart disease
arrhythmias
decreased O2
increased demand
cardiomyopathy
pericardial disease
congenital disease
What are the most common causes of CHF in the US
uncontrolled HTN (#1)
CAD / Ischemia
What are the models of heart failure
hemodynamic
neurohormonal
ventricular
What is the hemodynamic model of CHF
Emphasizes the effect of altered load of failing ventricles
*tx focuses on vasodilators and inotropic agents
What is the neurohumoral model of HF
activation of RAAS axis
activates sympathetic system
releases cardiac hormones (BNP)
What is ventricular remodeling
Mechanical, neurohormonal or genetic alteration in ventricular size, shape, and function
What are examples of ventricular remodeling
hypertrophy
loss of myocytes
increase in interstitial fibrosis
What is systolic dysfunction
Can’t squeeze -> stretched thin and weakened heart muscle, enlarged chambers
What is diastolic dysfunction
cant relax and fill -> stiff and thickened heart wall, smaller ventricle chamber
What are cardiomyopathy pathologies
amyloid
sarcoid
What does an increase in aldosterone aid with
increasing stroke volume during CO
What does the pituitary glad release when RAAS is activated
ADH
What is left sided backward failure
When blood backs up into the lungs causing pulmonary congestion
What symptoms may a patient have with left sided backward failure
Orthopnea
Dyspnea
coughing up frothy pink sputum
PND
mild-mod JVD
pulm edema
What type of failure is HFrEF
Systolic
*Cannot squeeze as much blood out
What type of failure is HFpEF
Diastolic
*Cannot relax and accommodate enough blood
What symptoms will a patient have with right sided heart failure
pitting edema
severe JVD
Nocturia
hepatomegally
splenogmegally
What criteria is used to diagnose CHF
Framingham criteria
What are CHF differential diagnosis
Acute renal failure
ARDS
Cirrhosis
Pulmonary fibrosis
nephrotic syndrome
pulmonary embolism
What is seen on a chest xray in someone with CHF
Cardiomegaly
pulmonary congestion
pleural effusion
What is cephalization on xray
increased prominence of upper lobe vasculature
What are Kerley b lines on xray
edema of interlobar septa
What is included on a CHF workup
ECG abnormalities
Echo
Angio
BNP
CXR
What type of test is a BNP
Sensitive
What are the treatment options for acute and chronic CHF
Diet / lifestyle changes
Daily weight monitoring
Intensive management
regular activity
Surgery
What are the surgical options for CHF
CABG
Valve repair / replacement
Heart transplant
Device therapy
What is the benefit of a CABG in CHF
reduces ischemia
What is the treatment of choice if a patient has severe CHF, is <60, has no other life-threatening conditions, and adheres to management recommendations
Heart transplant
What are the different device therapy options
ICD
CRT
Intra-aortic balloon pump
LVAD
When is an LVAD used
generally awaiting a transplant
When is an ICD used in HF
Sustained VT or vfib
persistent symptoms and LVEF<30%
When are CRT devices used in HF
HFrEF (<35%)
wide QRS
LBBB
What are the goals of treatment in chronic CHF
improve symptom management
decrease hospitalizations
decrease mortality associate w/ disease
What is the first step in chronic CHF treatment
correct reversible causes
What can you give a patient queen an RAAS is contraindicated
hydralazine + a nitrate
What medication combo will be prescribed to patients in HF
Diuretic
RAAS
Beta blocker
What kind of drug is ivabradine
inhibits SA node so the heart can pump more effectively
Which medications help reduce mortality in patients with HFrEF
Beta blockers
ACEi
Spironolactone
Hydralazine (w/ nitrate)
Where is fluid located in cariogenic pulmonary edema
Interstitial space of the lungs
What are causes of non-cariogenic pulmonary edema
Damage to aveoli
increased capillary permeability
sepsis
low oncotic pressure
How does low oncotic pressure cause pulmonary edema
there is not enough protein due to not making enough (Liver failure) or losing it too quickly (nephrotic syndrome)
How does sepsis cause pulmonary edema
there is systemic inflammation everywhere in the body, leading to extra fluid in all interstitial spaces
Why will a patient have dyspnea/orthopnea with pulmonary edema
O2/CO2 gas exchange is difficult because of the interstitial fluid
How can pulmonary edema be treated
supplemental O2
treat underlying cause
If cardiogenic-> increase contractility and lower systemic BP
If inflammatory or oncotic-> treat related illness
What is occurring in the body during cariogenic shock
heart cannot pump enough blood/O2 to brain and other vital organs
What are the main causes of cariogenic shock
MI
HF
trauma
PE
What are signs of cariogenic shock
Low BP
weak/irregular pulse
Which patients are at increased risk of cariogenic shock
Age
Women
CAD
HF
HTN
DM
obesity
sepsis
hx of CABG
How can you test for cariogenic shock
CXR
EKG
Cardiac Cath
echo
What labs can be drawn for cardiogenic shock
ABG
lactate
renal function
What are symptoms of cariogenic shock
Dyspnea
cold extremities
clammy
dizziness
confusion
LOC
decreased urination
LE edema
What meds can be used in cariogenic shock
antiarrhythmics
anticoags
inotropes/vasopressors
What interventions can be done for cariogenic shock
CABG
PCI
IABP
ECMO
PCADS
What is supportive treatment for cariogenic shock
dialysis
IV fluids
ventilator
supplemental O2
