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MOD 1 Quiz 2 > Clinical considerations for heart failure > Flashcards

Clinical considerations for heart failure Flashcards

1
Q

Impact Left sided heart failure?

A 
Diastolic (preserved EF)
-impaired relaxation
-pericadial disease
Systolic (reduced EF)
-impaired contractility
-increased afterload
Valvular
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2
Q

Impact Right sided heart failure?

A

Cardiac
Pulmonary
-Pulmonary Parenchymal disease
-Pulmonary Vascular disease

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3
Q

Impair contractility?

A

Myocardial infarction
Transient myocardial ischemia
Dilated cardiomyopathy

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4
Q

Increase afterload?

A

Aortic stenosis

Uncontrolled Hypertension

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5
Q

Impair relaxation?

A

left ventricular hypertrophy
hypertrophic cardiomyopathy
restrictive cardiomyopathy
transient myocardial ischemia

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6
Q

Cause Valvular failure?

A

mitral stenosis
aortic reguritation
Chronic mitral reguritation

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7
Q

Cause preicardial disease?

A

pericardial constriction

pericardial tamponade

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8
Q

Cause cardiac disease?

A

left sided heart failure
pulmonic valve stenosis
right ventricular infarct

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9
Q

Cause pulmonary parenchymal disease?

A 
COPD
intersitial lung disease
respiratory distress syndrome
chronic lung infection
bronchiectasis
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10
Q

Cause Pulmonary vascular disease?

A

pulmonary embolism

Primary Pulmonary Hypertension

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11
Q

Etiology Heart Failure?

A 
Any insult that causes altered structure or function of the heart
-Coronary artery disease
-Hypertension
Rheumatic heart disease (Africa/Asia)
Chagas disease (south america)
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12
Q

Prognosis Heart Failure?

A

30-40% patients dies within one year of onset

60-70% die within 5 years

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13
Q

Adaptive measures to acute injury/ chronic insidious insult?

A

Short term- bring heart back to normal cardiac output

long term- lead to further heart failure

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14
Q

Basic Heart Failure?

A

myocardial dysfunction which leads to inadequate tissue perfusion

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15
Q

Generally Heart failure is what kind of output?

A

Low output failure
high output is possible, when heart is unable to meet increased metabolic demands despite increased cardiac output (Thyrotoxicosis, severe anemia, sepsis)

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16
Q

Angiotensin II and Aldosterone cause?

A

Increased cytokine production
Inflammatory cell adhesion and chemotaxis
Activation of macrophages at sites of injury and repair
Stimulates growth of fibroblasts and synthesis of collagen fiber

17
Q

Endothelins cause?

A

Vasoconstriction
Induce vascular smooth muscle proliferation
Myocyte hypertrophy

18
Q

Short term adaptive mechanisms?

A

Increase CO by increasing heart rate, preload, and contractility
Maintain adequate perfusion to critical organs by volume expansion and selective vasoconstriction
Facilitate repair

19
Q

Long term adaptive mechanisms?

A
  • High catecholamine state can provoke dysrhythmias, increased oxygen demand (increase HR and increase afterload)
  • Hypertrophy meant to enhance CO can further exacerbate HF by increasing preload and afterload and/or decrease diastolic filling
  • Chronic activation of RAAS can lead to total body volume overload and increased preload
  • Myocardium can become infiltrated with fibroblasts, impairing both contractility and diastolic filling
20
Q

Things that cause symptoms and signs of clinical presentation?

A

decrease oxygen delivery/ gas exchange
Activation of RAAS
Altered cardiac structure
passive hepatic congestion

21
Q

NYHA Functional Class?

A

Relies on patient report of symptoms and can underestimate the limitation in exercise capacity

22
Q

Functional Classes?

A

1- not limited
2- slight limit
3- everyday activity
4- can be symptomatic at rest

23
Q

AHA/ACC Objective Stages?

A

Emphasizes development and progression of disease

24
Q

Objective Stages?

A

A- only at risk
B- no symptoms
C- symptoms now/ past
D- End stage

25
Q

Risk for Stage A?

A

HTN, atherosclerotic, DM, obesity, metabolic syndrome, cardiotoxic, family Hx cardiomyopathy

26
Q

Single most useful test in evaluation with suspected heart failure?

A

2-D echocardiogram

27
Q

Other things to evaluate patient with suspected heart failure?

A 
History and physical
12- lead EKG
2 view chest xray
Labs
BNP
28
Q

Labs?

A

CBC, urinalysis, electrolytes, glucose, lipids, renal and liver function, thyroid function tests, BNP

29
Q

BNP?

A

brain natriuretic peptide
released when ventricle is stretched
elevated in both preserved EF and reduced EF, although levels are generally higher in reduced EF

30
Q

However with BNP?

A

can be elevated in persons over 60 or in women who do not have heart failure
Cannot be used in isolation to confirm or exclude the presence of heart failure

31
Q

Chest xray findings in heart failure?

A 
Cardiomegaly
Batwing appearance
Kerley B lines
Pleual effusion
Cephalization of blood vessels and Pulmonary edema
32
Q

Treatment of heart failure?

A

Modify/eliminate contributing risk factors
Non-pharmacologic- dietary salt restriction, fluid restriction, daily weights
Pharm

MOD 1 Quiz 2 (9 decks)

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