Chronic Heart Disease/Mitral stenosis Flashcards
What is needed for a Framingham’s diagnosis of CHF?
2 Major criteria
1 Major with 2 Minor criteria
Are paroxysmal nocturnal dyspnea, neck vein distention, and rales major or minor criteria?
Major
Are bilateral ankle edema, nocturnal cough, and dyspnea on ordinary exertion major or minor criteria?
Minor
Are radiographic cardiomegaly, acute pulmonary edema, and S3 gallop major or minor criteria?
Major
Are hepatomegaly and pleural effusion major or minor criteria?
Minor
Are increased central venous pressure and hepatojugular reflux major or minor criteria?
Major
Are decrease in vital capacity by one third and tachycardia major or minor criteria?
Minor
How much weight has to be lost within 5 days of starting diuretics in order for it to be considered a major criteria?
4.5kg
Do minor criteria count if they can be explained by another medical condition?
No
What is NYHA Class I CHF?
No limitation on physical activity
How would NYHA classify a patient who has some physical limitations but is still comfortable at rest?
Class II CHF
How would NYHA classify a patient who has marked physical limitations but is still comfortable at rest?
Class III CHF
What is NYHA Class IV CHF?
Unable to carry out physical activity
Uncomfortable even at rest
What causes the sensation of dyspnea?
The afferent signal to the respiratory center does not match the feed-forward signal from the motor cortex
What are some hepatic effects of CHF?
Hepatomegaly–>pain from growing faster than capsule
“Nutmeg” Liver (brownish color)
What causes dust cells in the lungs to be brown with CHF?
Dust cells (alveolar macrophages) have engulfed RBCs…the hemosiderin in the RBCs cause the color
What is the most common inpatient diagnosis in patients over 65?
Heart failure
What do ACE inhibitors end in?
-pril
What do ACE inhibitors do?
Decrease blood volume
May vasodilate
What do β-blockers all do for CHF?
Decrease heart rate
Reduce renin–>decreased blood volume
What are epelerenone and spironolactone?
Aldosterone antagonists
What do aldosterone antagonists do?
Block aldosterone effects–>diuretic
Which patients should be on aldosterone antagonists?
Those with symptomatic heart failure or those with a history of STEMI
How does furosemide work?
Inhibits Na/K/2Cl transporter in the ascending limb
