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Clin Med 2 - CARDS > CHF/ Shock > Flashcards

CHF/ Shock Flashcards

1
Q

what are the different classifications of HF

A

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

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2
Q

what are causes of CHF

A

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)

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3
Q

what is the hemodynamic model/cardiocirculatory model of HF

A

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

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4
Q

what is the neurohumoral model of HF

A

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

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5
Q

what is ventricular remodeling model of HF

A

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

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6
Q

what is biventricular heart failure

A

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

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7
Q

what increases risk for HF

A

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

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8
Q

what are the clinical features of left sided forward heart failure

A

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

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9
Q

what are clinical features of left sided backward heart failure

A

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

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10
Q

what is HFrEF

A

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

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11
Q

what is HFpEF

A

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

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12
Q

what are the clinical features of right sided forward heart failure

A

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

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13
Q

what are the clinical features of right sided backward heart failure

A

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

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14
Q

what is framingham criteria

A

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

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15
Q

what are the major framingham criteria

A

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

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16
Q

what are the minor framingham criteria

A

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

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17
Q

what are suggestive findings of Right heart failure

A

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

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18
Q

what are suggestive findings of Left Heart failure

A

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

19
Q

what are shared findings with left and right sided HF

A

cool peripheries
cyanosis
orthopnea
delayed capillary refill

20
Q

what are the xray findings with CHF

A

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

21
Q

what is Hilar Fullness

A

increased congestion/prominence of hilum

22
Q

what is cephalization

A

increased prominence of upper lobe vasculature

23
Q

what is kerley B lines

A

edema of the interlobular septa

24
Q

what are the work up assessment tools used for CHF diagnosis

A

CXR
ECG
echocardiogram
aniogram
BNP

25
Q

what is the purpose of a BNP

A

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

26
Q

what are the treatment options for acute and chronic CHF

A

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

27
Q

when is heart transplantation the treatment of choice

A

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

28
Q

what are the goals of CHF treatment

A

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

29
Q

what are pharmaceutical options for HF treatment

A

Diuretics
RAAS
beta blockers

30
Q

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

A

hydralazine PLUS nitrate

31
Q

what medicatiosn are used for HFrEF patients

A

ACEi
BB
ARBs
aldosterone antagonists
ARNI
If channel bloker

32
Q

what medication do you need to take when using loop diuretics

A

must take potassium

33
Q

what is cardiogenic pulmonary edema

A

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

34
Q

what are non cardiogenic causes of pulmonary edema

A

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

35
Q

what is cardiogenic shock

A

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

36
Q

what are the signs and symptoms of cardiogenic shock

A

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

37
Q

what are the different types of treatment for cardiogenic shock

A

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

38
Q

what medications are used to treat cardiogenic shock

A

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

39
Q

what are the interventions for cardiogenic shock

A

CABG
PCI aka angioplasty - possible stenting

40
Q

what are the medical device options for treatment of cardiogenic shock

A

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

41
Q

what are supportive treatment options for cardiogenic shock

A

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

42
Q

what are the causes of cardiogenic pumonary edema

A

Left sided heart failure
or
severe HTN

43
Q

what populations are at a higher risk for cardiogenic shock

A

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

Clin Med 2 - CARDS (11 decks)

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