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DMST 283 ECHO 2 > Chronic Heart Failure > Flashcards

Chronic Heart Failure Flashcards

1
Q

What is cardiac arrest?

A

Heart stops beating properly due to electrical disturbances

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2
Q

What is a heart attack?

A

Blockage in or circulation cut off to the coronary arteries

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3
Q

What is heart failure?

A

Heart fails as a pump and cannot meet the O2 demands of the body

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4
Q

In terms of heart failure what is the difference between Systolic and diastolic in terms of EF?

A
  1. Systolic: Reduced EF
  2. Diastolic: Preserved EF
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5
Q

What is the difference between Systolic and diastolic in terms of EF numerically?

A
  1. Systolic: <40%
  2. Diastolic: >55%
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6
Q

What is the difference between systolic and diastolic in terms of contraction and relaxation during failure?

A
  1. Systolic: impaired contraction
  2. Diastolic: Impaired relaxation
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7
Q

How does heart failure happen commonly?

A

Most commonly due to IHD/CAD

(Ischemic heart disease)

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8
Q

What signs send patients into diastolic failure happen commonly?

A

Due to HTN and LVH

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9
Q

In all cases of CHF how many are systolic?

A

60%

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10
Q

How many diastolic failure consist of all CHF?

A

40% with increasing prevalence

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11
Q

What are some things we see during diastolic heart failure? 2

A
  1. Normal EF
  2. Reduced LV compliance elevated filling pressures
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12
Q

What are some less common things seen with diastolic heart failure? 4

A
  1. Infiltrative myocardial disease
  2. LVH caused by aortic stenosis
  3. HTN
  4. Advanced age

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13
Q

What causes elevation of Diastolic failure? 4

A
  1. Elevation of LVEDP
  2. Elevation of LA pressure
  3. Elevation of pulmonary pressures
  4. Elevation of RT heart failure
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14
Q

What is LT CHF due to? 3

A
  1. Myocardial disease
  2. LT heart valves
  3. CAD
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15
Q

What are RT sided CHF due to? 3

A
  1. LT heart failure
  2. RT heart valves
  3. Lung Disease
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16
Q

What are two major left heart failure causes? 2

A
  1. Decreased myocardial function
  2. Increased myocardial workload
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17
Q

What conditions causes decreased myocardial function of the left heart? 5

A
  1. Coronary artery disease (CAD)
  2. Myocarditis
  3. Cardiomyopathy
  4. Infiltrative diseases
  5. Radiation therapy

rim cc

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18
Q

What causes increased myocardial workload category of left heart failure? 4

A
  1. Hypertension
  2. Valvular diseases
  3. Severe regurgitation/ stenosis
  4. Increased preload/ after load

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19
Q

What are some symptoms of left sided CHF? 3

A
  1. The pneas (dyspnea)
  2. Fatigue
  3. Palpitations
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20
Q

What type of fatigue will we see in left sided CHF?

A

Not enough cardiac output +/- poor O2 exchange in lung due to increased pressure

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21
Q

What is the palpitations symptoms in left sided heart failure caused by?

A

Usually due to tachycardia, which is a frequent compensatory mechanism in systolic failure due to increased blood volume

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22
Q

What are some left sided CHF signs? 5

A
  1. Cardiomegaly
  2. Pulmonary edema
  3. Heart/ lung sounds
  4. Cheyene- stocked respiration
  5. Arrhythmia

cap ch

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23
Q

What is the most common cause of right sided CHF?

A

Left side heart failure

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24
Q

What are right sided CHF causes? 2

A
  1. Left sided heart failure
  2. Primary lung Disease
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25
What are some types of primary lung disease that affect right sided CHF? 3
1. Pulmonary hypertension 2. Chronic obstructive pulmonary disease 3. Emphysema *pec*
26
What are some RV failure signs? 4
1. Signs related to underlying disease 2. Murmur 3. **Wheezing, SOB** 4. **Systemic congestion signs**
27
What are some systemic congestion signs in the right heart? 4
1. Jugular venous pulse 2. Pitting edema 3. Ascites 4. Cynaosis *j cap*
28
What are some RV failure symptoms? 4
1. Fatigue 2. Dependent edema 3. RUQ/LUQ pain 4. Anorexia or bloating *draf*
29
What is RV fatigue?
When CO is reduced, or poor O2 exchange in the lung
30
Why is there RUQ/LUQ pain in RV failure?
Liver/ spleen engorgement
31
Why can we get RV failure from anorexia or bloating?
From hepatic or visceral engorgement
32
Cor pulmonale = what?
Pulmonary heart disease
33
What is Cor pulmonale?
Right sided heart failure secondary to lung conditions such as COPD
34
What does Cor Pulmonale not include? 2
1. RT heart failure secondary to LT sided dysfunction 2. Congenital heart disease
35
When does the acute pathophysiology of Cor pulmonale occur? What is an indicator? 2
1. Occurs after sudden and severe stimulus with RV dilation and failure 2. No RVH
36
What are pathophysiology of Cor pulmonale? 3
Chronic: prolonged pressure overload of the RV as it ejects into the high resistance vascular bed 1. RV hypertrophied 2. RV dilation 3. RA enlargement
37
What is the gold standard for measuring pulmonary pressure?
PCWP
38
What does PCWP stand for?
Pulmonary capillary wedge pressure
39
Is PCWP invasive?
Yes
40
Why is PCWP better then echo?
Echo is non- invasive, but only gives an estimate
41
What are some PWCP ranges? What is PWCP roughly equal? 3
Left atrial pressure 1. **4-12 is normal** 2. 12-15mmHg is boarderling 3. **LAP >15mmHg PHTN**
42
How many classes of CHF?
4
43
What is a class 1 CHF?
No limitation of physical activity, ordinary physical activity does not cause symptoms
44
What is class 2 CHF?
Slight libation of physical activity, comfortable at rest. Ordinary physical activity causes symptoms.
45
What is class 3 CHF?
1. Marked limitation of physical activity. 2. Comfortable at rest, but less than ordinary activity causes symptoms
46
What is Class 4 CHF? 3
1. Severe limitation 2. Discomfort with any physical activity 3. Symptoms present even at rest
47
What is preload?
Volume dependent pressure exerted on the walls of the ventricles by the blood in the at end diastole **EDV or end diastolic volume**
48
Which law is related to preload?
Frank starling law
49
What conditions cause increased preload states include? 5
1. Pregnancy 2. Obesity 3. Valvular regurgitation 4. Intracranial shunts 5. Electrolyte imbalances *Vo pie*
50
What is venous return affected by? 3
1. Blood volume 2. Venous pressure 3. Intrathoracic pressure
51
What affects blood volume? 3
1. Body volume 2. Pregnancy 3. Blood loss
52
Intrathoracic pressure is ______________ in a normal adult?
Auto regulated
53
What is afterload?
Amount of tension the ventricles must generate in order to eject blood
54
Afterload is directly affected by what?
Arterial blood pressure
55
High afterload reduces SV but increases what?
End systolic volume in the LV
56
What is afterload increased by? 4
1. High systemic BP = high afterload (LV) 2. High PA pressure = High afterload (RV) 3. Aortic stenosis (LV) / Pulmonary stenosis (RV) 4. Coarctation of the aorta (LV)
57
What is the Cardiac output formula?
CO = HR x SV
58
What are some factors that affect Heart rate? 4
1. Autonomic innvervation 2. Hormones 3. Fitness levels 4. Age *Hafa*
59
What are factors affecting stroke volume? 7
1. Heart size 2. Fitness levels 3. Gender 4. Contractility 5. Duration of contraction 6. Preload 7. Afterload (resistance)
60
What are two CHF pathophysiology? 2
1. Decreased SV/CO 2. Compensation
61
What does deceased SV/CO do in terms of CHF pathophysiology? 2
1. BNP release 2. **BNP lab marker for CHF**
62
What is compensation in terms of CHF pathophysiology? 3
1. Increase HR 2. Structural changes to increase SV 3. Renal changes
63
How does compension increase HR?
Decreases the time to fill
64
How does structural changes increases SV? 2
1. DCM >>>> bigger, but weaker 2. HCM >>>> thicker, but stiffer Dilated cardio myopathy and hypertrophic cardio myopathy
65
What is renal changes in terms of compensation?
Kidneys want more blood, so they release hormones which inadvertently lead to salt and water retention
66
What are some treatment options for CHF? 3
Depends upon underlying cause and symptoms but generally 1. Lifestyle 2. Medication 3. Pacemakers, defibrillator, LV assist devices
67
What are some medications for CHF? 4
1. Diuretics 2. Inotropic agents 3. Beta blockers 4. Anti- arrhythmic
68
What does diuretics do in terms of CHF?
Decreases preload and afterload by promoting urination to decrease intravascular volume
69
What does inotropic agents due in terms of CHF? 2
1. increases contractility, SV 2. HFrEF pts
70
How does ACE inhibitors affects CHF?
Decreases afterload by dilated blood vessels
71
How does beta blockers affect CHF?
Decreases HR and contractility by blocking the sympathetic response
72
How does anti-arrhythmic affects CHF? How does each type work? 2
1. Corrects arrhythmias 2. Each type works differently
73
PTs with arrhytmias are are also frequently on what in conjunction with anti-arrhytmics?
Blood thinners due to high risk of thrombus
74
Most pacemakers have how many wires?
two wires
75
______ pacemakers are new technology
Leadless
76
Where does the two wires of the pacemaker go?
1 lead wire in the RV and one in the RA coronary sinus
77
What is an LV assist device?
External control device with internal pump
78
LV assist devices are very helpful for patients with what?
Severe LV systolic dysfunction <30% EF
79
What does LV assist devices lower?
Lowers LV afterload by pumping some of the forward volume
80
What is the role of echo in CHF?
Determination underlying etiology
81
What does echo assess in terms of CHF? 6
1. Chamber sizes 2. LV/RV systolic function 3. Diastolic function and filling pressures 4. RT sided pressures 5. Valvular function 6. Progression of known diseases
82
What happens to the LV Mass during CHF in terms of geometry?
Increase in LV mass via hypertrophy
83
What are two results of LV increasing of mass during CHF? 2
1. **Concentric LVH**: Result of increased pressure (ex/ HTN) 2. **Eccentric LVH**: Result of increased volume (ex/ severe AI)
84
What happens to the size of the heart during CHF? 2
1. It increases due to dilation of the LA and the LV 2. The RV and RA may also dilate
85
What is the most common method to assess LA size?
LA Volume trace
86
What is the ASE recommended method for assessing LA size?
LA volume trace
87
LA length should differ by how much between the views?
<5mm
88
What do we use to assess systolic performance?
Simpsons biplane EF
89
What can increase preload or afterload significantly
Moderate- severe valvular regurgitation or stenosis
90
What can push an unfit or mildly diseased heart into failure?
Increased preload or afterload due to moderate- severe valvular regurgitation or stenosis
91
What does HFrEF stand for?
Systolic failure
92
What does HFpEF stand for?
Diastolic failure
93
What is this an example of?
Concentric LVH
94
What is this an example of?
Eccentric LVH

DMST 283 ECHO 2 (14 decks)

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