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CPR 2 Exam 1 > Clinical Cardiac Part 3 > Flashcards

Clinical Cardiac Part 3 Flashcards

1
Q

What is heart failure?

A

Complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood

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2
Q

What are the cardinal clinical symptoms of heart failure?

A

Dyspnea
Fatigue
Edema
Rales

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3
Q

What happens in heart failure with preserved ejection fraction?

A

Wall becomes thicker, unable to relax to get blood in

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4
Q

What happen in heart failure with reduced ejection fraction?

A

Weak, heart fills fine but can’t eject blood

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5
Q

What is advanced heart failure?

A

Refractory heart failure requiring specialized interventions

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6
Q

What is cor pulmonale?

A

Altered right ventricular structure and/or function in the context of chronic lung disease (failure of right ventricle)

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7
Q

What is the pathophysiology of HFrEF?

A

Precipitating factor (MI) -> decreased cardiac output -> activation of SNS + RAAS -> vasoconstriction

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8
Q

What are the most common CV etiologies of HFrEF?

A 
CAD (most common)
Cardiomyopathies
Myocarditis
Valvular disease
Cardiac infection
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9
Q

What are extra-cardiac causes of HFrEF?

A 
Thyroid disorders
Sarcoidosis
SLE
Alcohol 
Chemotherapy (left ventricular problems)
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10
Q

What are risk factors for both types of heart failure?

A 
Age
DM2
Smoking
Hypertension
Atherosclerosis
Obesity
Metabolic syndrome
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11
Q

What are risk factors for HFrEF?

A 
Male
LVH
Bundle branch block
Previous MI
Smoking
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12
Q

What are risk factors for HFpEF?

A

Older age
Female
Hypertension
Atrial fibrillation

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13
Q

What is paroxysmal nocturnal dyspnea?

A

Waking up with SOB at night

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14
Q

What are symptoms of congestion?

A 
Dyspnea on exertion
Paroxysmal nocturnal dyspnea
Orthopnea
Nocturnal cough
Weight fluctutations
Edema
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15
Q

What are symptoms of hypoperfusion?

A

Exercise intolerance
Fatigue
Decreased mentation
Cold intolerance

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16
Q

Which medications exacerbate heart failure?

A

Statins
CCB
COX2 inhibitors

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17
Q

Adequate perfusion is what?

A

Warm

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18
Q

Hypoperfusion is what?

A

Cold

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19
Q

Congestion is what?

A

Wet

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20
Q

No congestion is what?

A

Dry

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21
Q

What are PE signs for congestions?

A 
S3 gallop
Orthopnea
Peripheral edema
Pulmonary edema
Ascites
Hepatojugular reflex
Elevated jugular venous pressure
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22
Q

What are PE signs for hypoperfusion?

A 
Cool extremities
Hypotension
Renal dysfunction
Altered mental status
Hyponatremia
Narrow pulse pressure
Pulsus alternans
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23
Q

What is a S3 gallop?

A

Ventricular gallop immediately after S2

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24
Q

What cardiac findings are found on PE for heart failure?

A

Enlarged/displaced PMI

Right ventricular heave

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25
Q

What is your goal for PE on a patient with heart failure?

A

Identify the etiology of heart failure
Identify prognostic factors
Provide information about patient management

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26
Q

What do you order when you suspect heart failure?

A

EKG
CXR
BNP

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27
Q

Conduction abnormalities in heart failure patients important why?

A

Cause and prognosis

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28
Q

What with CXR detect in patients with heart failure?

A

Cardiac enlargement

Non-cardiac pulmonary pathology that can influence clinical presentation

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29
Q

What las should be ordered?

A

Renal function
Serum potassium
BNP

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30
Q

BNP within normal limits in an untreated patient rules out what?

A

Heart failure

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31
Q

BNP and N-terminal-pro BNP should be ordered for diagnosis of what two conditions?

A

Acute heart failure

Prognosis in chronic heart failure

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32
Q

What can falsely elevated BNP?

A 
Advanced age
Renal insufficiency
Anemia
COPD
Pulmonary HTN
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33
Q

When is a 2D TTE recommended for heart failure?

A

Suspected heart failure

Known heart failure with worsening symptoms

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34
Q

What is seen in HFrEF on ECHO?

A 
Reduced LVEF
Atrial and ventricular dialation/hypertrophy
Valvular disfunction
Pericardial pathology
Elevated ventricular filling pressure
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35
Q

Why is TEE ordered in heart failure?

A

Rule out intracardiac thrombus or infectious source

36
Q

When is stress ECHO ordered in heart failure?

A

Rule out ischemia as precipitating cause

37
Q

When is cardiac MRI ordered in heart failure?

A

Determining the etiology of cardiomyopathy by identifying the presence of inflammation, fibrosis, and infiltrative pathology

38
Q

When is cardiopulmonary exercise testing ordered in heart failure?

A

Important component in the determination of candidacy for mechanical circulatory support and cardiac transplantation

39
Q

Is the ACCF and AHA staging progressive?

40
Q

Is the NYHA functional classification progressive?

41
Q

What is class A for heart failure?

A

High risk of heart failure

Without structural heart disease or symptoms

42
Q

What is class B for heart failure?

A

Structural heart disease

Without signs or symptoms of heart failure

43
Q

What is class C for heart failure?

A

Structural heart disease

Prior or current symptoms of heart failure

44
Q

What is class D for heart failure?

A

Refractory to heart failure

Requiring specialized interventions

45
Q

What is class I for heart failure?

A

No limitation in physical activity

Ordinary physical activity does not cause symptoms of heart failure

46
Q

What is class II for heart failure?

A

Slight limitation of physical activity
Comfortable at rest
Ordinary physical activity results in symptoms of heart failure

47
Q

What is class III for heart failure?

A

Marked limitation of physical activity
Comfortable at rest
Less than ordinary activity causes symptoms of heart failure

48
Q

What is class IV heart failure?

A

Unable to carry on with any physical activity without symptoms of heart failure
Symptoms of heart failure at rest

49
Q

What are the goals of treatment in heart failure?

A

Improve symptoms
Improve quality and duration of life
Prevent hospital admission

50
Q

What are the goals of treatment in HFrEF?

A

Improve symptoms

Prevent remodeling

51
Q

What is the first line therapy for HFrEF?

A

ACEi
Beta-blockers
*titrate to max dose before adding more meds

52
Q

What is the second line therapy for HFrEF?

A

Add mineralcorticoid antagonist (spiralactone)

53
Q

What is the third line therapy for HFrEF in patients who can tolerate ACEi or ARB?

A

Replace ACEi with ARNI

54
Q

What is the third line treatment for HFrEF in patients who have sinus rhythm and QRS duration greater than 130 ms?

A

Evaluate for CRT

55
Q

What is the third line treatment for HFrEF in patients who have sinus rhythm and HR greater than 70 bpm?

A

Ivabradine

56
Q

If a HFrEF patient is resistant to symptoms what do you do?

A

Add digoxin
HYD-ISDN
LVAD
Heart transplant

57
Q

If a HFrEF patient is not resistant to symptoms what do you do?

A

Consider reducing diuretic dose

58
Q

What do diuretics do in HFrEF?

A

Relieve symptoms and signs of congestion

*specifically furosemide

59
Q

What is the best treatment for HFrEF?

A

Cardiac transplantation

*also cardiac rehab, exercise programs

60
Q

What is the only medication that should be used to treat HFpEF?

61
Q

How do you treat class A heart failure?

A

HTN

Hyperlipidemia

62
Q

How do you treat class B heart failure (diastolic dysfunction wihout symptoms)?

A 
HTN
Thiazide diuretics
ACE inhibitors
ARBs
Non-dihydropyridine CCBs
63
Q

How do you treat class C heart failure (with preserved ejection fraction)?

A

Diuretics
Beta-blockers
ACE inhibitors
ARBs

64
Q

How do you treat class D heart failure (with preserved ejection fraction)?

A

Diuretics

ARBs (prevent hospitalization)

65
Q

What what is the first step in treating decompensated heart failure?

A

Identify precipitating factors

Identify comorbidities

66
Q

What is the treatment for warm-wet HF?

A

Vasodilators
Diuretics
Renal replacement therapy

67
Q

What is the treatment for warm-dry HF?

A

Up-titration of disease-modifying oral therapy (HFrEF)

Treat comorbitities

68
Q

What is the treatment for cold-dry HF?

A

Fluid challenge

Inotropic agent

69
Q

What is the treatment for cold-wet HF?

A 
Vasodilator
Inotropic agent
Vasopressor (if refractor hypotension)
Diuretics (when perfusion restored)
MCS (if shock refractory to drugs)
70
Q

What are complications of heart failure?

A 
Anxiety
Sleep disturbance
Worry
Dyspnea
Fatigue
Orthopnea
Bloating
Chest pain
Cough
71
Q

What does cor pulmonale develop from?

A

Chronic pulmonary HTN resulting from parenchymal lung disorders, primary pulmonary vascular disease, or conditions leading to alveolar hypoxia

72
Q

What are the most common causes of cor pulmonale?

A

COPD

Chronic bronchitis

73
Q

What is the most common mechanism of cor pulmonale?

A

Pulmonary HTN -> increased RV afterload -> altered RV structure and function

74
Q

Chronic cor pulmonale results in what?

A

Compensatory RVH

75
Q

What are the symptoms of cor pulmonale?

A

SYSTEMIC SWELLING
Lower extremity swelling
Increased abdominal girth from ascites

76
Q

What are signs in the neck of cor pulmonale?

A

Elevated JVP

77
Q

What are signs in the heart of cor pulmonale?

A

Tricuspid murmur
S3 gallop
RV heave along left sternal border

78
Q

What are signs in the lungs of cor pulmonale?

A

Wheezing

Rales

79
Q

What are signs in the abdomen of cor pulmonale?

A

Hepatomegaly
Pulsatile liver
Ascites
Hepatojugular reflux

80
Q

What are sign in the extremities of cor pulmonale?

A

Lower extremity edema

Cyanosis

81
Q

How do you diagnose cor pulmonale on EKG?

A

Right axis deviation

RV hypertrophy

82
Q

How do you diagnose cor pulmonale on CXR?

A

Enlargment of main central pulmonary arteries and hilar vessels

83
Q

What is used to diagnose cor pulmonale when 2D TTE can’t?

A

MRI

Cardiac catheterization

84
Q

What is the treatment for cor pulmonale?

A 
Keep SaO2 above 90%
Diuretics
Na restriction
IV inotropes
Manage arrhythmias
Palliative care
85
Q

What is the strongest predictors of outcomes in patients with heart failure?

A

Right ventricular hypertrophy

Right ventricle dysfunction

86
Q

How do you prevent heart failure in stage A?

A

Appropriate dietary and exercise modifications

87
Q

How do you prevent heart failure in stage B?

A

Initiation of heart failure-specific therapies

CPR 2 Exam 1 (20 decks)

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