CHF/ Shock

Question 1

what are the different classifications of HF

Answer 1

acute vs chronic
systolic vs diastolic
right vs left side
forward failure vs backward failure

Question 2

what are causes of CHF

Answer 2

Uncontrolled HTN
CAD/IHD
VHD
Cardiac arrhythmias
Increased demand in setting of increased metabolism
decreased O2 in blood
cardiomyopathy
pericardial disease (pericarditis, tamponade)
CHD (congenital heart disease)

Question 3

what is the hemodynamic model/cardiocirculatory model of HF

Answer 3

emphasizes effect of altered load on failing ventricle (treatment focused on vasodilators and inotropic agents)

Question 4

what is the neurohumoral model of HF

Answer 4

activation of RAAS axis (cardiorenal model -function of salt and water retention)
SNS activation
cardiac hormones

Question 5

what is ventricular remodeling model of HF

Answer 5

mechanical, neurohormonal, or genetic alteration in ventricle size, shape, function
hypertrophy, loss of myocytes, increased interstitial fibrosis

Question 6

what is biventricular heart failure

Answer 6

both sides of the heart are affected
symptoms are the same as left sided plus right sided heart failure

Question 7

what increases risk for HF

Answer 7

CAD
DM
HTN
obesity
VHD
really and other heart/vascular condition
tobacco use
poor diet
lack of exercise
excessive alcohol intake

Question 8

what are the clinical features of left sided forward heart failure

Answer 8

decreased CO from LV
less O2 rich blood getting to the tissues: fatigue, weakness, dizziness, AMS, signs of hypoxia, cyaosis, oliguria

Question 9

what are clinical features of left sided backward heart failure

Answer 9

blood backing up into the lungs (pulmonary congestion)
fluid leaking into alveoli, less air exchange, pulmonary edema
cough, crackles, coughing up foamy pink sputum “frothy”
orthopnea
paroxysmal nocturnal dyspnea (PND)
mild to moderate JVD

Question 10

what is HFrEF

Answer 10

heart failure with REDUCED ejection fraction - systolic failure
weakened LV cannot squeeze as much blood out

Question 11

what is HFpEF

Answer 11

heart failure with PRESERVED ejection fraction - diastolic failure
stiff LV cannot relax to accommodate blood

Question 12

what are the clinical features of right sided forward heart failure

Answer 12

less blood being pumped into the lungs for gas exchange, therefore less oxygenated blood to dispense to body
fatigue, weakness

Question 13

what are the clinical features of right sided backward heart failure

Answer 13

blood is backing up into veins, increasing venous pressure in vena cava and cascading in a retrograde fashion all the way to capillaries, pushing fluid out of veins into organs/tissue
manifests as dependent edema (pitting edema) in legs, abdomen, genitals, sacrum, GI tract, liver
weight gain associated with fluid retention
severe JVD
notcuria
hepatomegaly and splenomegaly

Question 14

what is framingham criteria

Answer 14

used for diagnosis of CHF
need 2 major OR one major 2 minor

Question 15

what are the major framingham criteria

Answer 15

SAW PANIC
S3 heart sound (gallop)
Acute pulmonary edema
Weight loss
Paroxysmal noctural dyspnea
Abdominojugular reflux (hepatojugual reflux)
Neck vein distention (JVP)
Increased cardiac shadow on XR
Crackles heard in lung

Question 16

what are the minor framingham criteria

Answer 16

HEART VINO
Hepatomegaly
Effusion, pleural
Ankle edema, bilat
exeRtional dyspnea
Tachycardia
VItal capacity decreased by 1/3
Nocturnal cough

Question 17

what are suggestive findings of Right heart failure

Answer 17

lower limb edema
sacral edema
hepatomegaly
increased JVD
regurgitation murmur in the tricuspid area

Question 18

what are suggestive findings of Left Heart failure

Answer 18

lung crackles
respiratory wheeze
displaced cardiac apex
left-sided heart murmurs

Question 19

what are shared findings with left and right sided HF

Answer 19

cool peripheries
cyanosis
orthopnea
delayed capillary refill

Question 20

what are the xray findings with CHF

Answer 20

cardiomegaly
pulmonary congestion: hilar fullness, cephalization, Kerley B lines
pleaural effusions

Question 21

what is Hilar Fullness

Answer 21

increased congestion/prominence of hilum

Question 22

what is cephalization

Answer 22

increased prominence of upper lobe vasculature

Question 23

what is kerley B lines

Answer 23

edema of the interlobular septa

Question 24

what are the work up assessment tools used for CHF diagnosis

Answer 24

CXR
ECG
echocardiogram
aniogram
BNP

Question 25

what is the purpose of a BNP

Answer 25

it is a sensitive test - if normal rule out HF if REALLY elevated - can rule IN HF helps guide treatment and following patients

Question 26

what are the treatment options for acute and chronic CHF

Answer 26

diet and lifestyle changes daily weight monitoring intensive case management to limit readmissions regular activity to preserve functional status surgical options: CABG, repair vs replacement, transplantation device therapy: ICD, CRT, balloon pump, LV assist device

Question 27

when is heart transplantation the treatment of choice

Answer 27

< 60yo severe, refractory HF no other life-threatening conditions AND highly adherent to management conditions

Question 28

what are the goals of CHF treatment

Answer 28

improve symptoms management and quality of life decreased hospitalizations decreased overall mortality associated with this agent

Question 29

what are pharmaceutical options for HF treatment

Answer 29

Diuretics RAAS beta blockers

Question 30

what is used if a patient has a contraindication for RAAS medications with HR

Answer 30

hydralazine PLUS nitrate

Question 31

what medicatiosn are used for HFrEF patients

Answer 31

ACEi BB ARBs aldosterone antagonists ARNI If channel bloker

Question 32

what medication do you need to take when using loop diuretics

Answer 32

must take potassium

Question 33

what is cardiogenic pulmonary edema

Answer 33

fluid accumulation in interstitial space of lungs (via increased hydrostatic pressure, increased capillary permeability, low oncotic pressure)

Question 34

what are non cardiogenic causes of pulmonary edema

Answer 34

pulmonary infection toxic inhalation chest trauma damage to alveoli, increased capillary permeability due to inflammation

Question 35

what is cardiogenic shock

Answer 35

heart cannot pump enough blood (and O2) to brain and other vital organs most often caused by MI, HF, chest trauma, PE

Question 36

what are the signs and symptoms of cardiogenic shock

Answer 36

Low BP, weak or irregular pulse dyspnea, cold extremities, clammy, dizziness, confusion, LOC, decreased urination, LE edema

Question 37

what are the different types of treatment for cardiogenic shock

Answer 37

medications interventions: PCI, CABG Medical devices: ECMO, IABP, PCADs supportive care

Question 38

what medications are used to treat cardiogenic shock

Answer 38

antiarrhythmics blood thinners in presence of clot blocking coronary arteries inotropes, vasopressors - to increased blood pressure and blood flow

Question 39

what are the interventions for cardiogenic shock

Answer 39

CABG PCI aka angioplasty - possible stenting

Question 40

what are the medical device options for treatment of cardiogenic shock

Answer 40

ECMO - extracorporeal membrane oxygenation device IABP - intra-aortic balloon pump - can be used with ECMO PCADs - percutaneous circulatory assist devices - can support while heart recovers or while waiting for heart transplant

Question 41

what are supportive treatment options for cardiogenic shock

Answer 41

dialysis - if kidneys are damaged IV fluids mechanical breathing support (ventilator) supplemented O2

Question 42

what are the causes of cardiogenic pumonary edema

Answer 42

Left sided heart failure or severe HTN

Question 43

what populations are at a higher risk for cardiogenic shock

Answer 43

Asian american pacific islanders, age, women, CAD, HF, HTN, DM, obesity, hx of CABG, PTX(penumothorax), sepsis