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Clinical Medicine 2 > Exam 1 - HF > Flashcards

Exam 1 - HF Flashcards

1
Q

Define Preload. What determines it?

A

Loading condition of heart at end of diastole, right before systold. Mainly determined by venous return to heart.

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2
Q

Define Afterload. What determines it?

A

Force heart must generate to eject blood from filled heart. Determined by ventricular wall tension and peripheral vascular resistance.

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3
Q

Define Contractility

A

Ability of heart to contract

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4
Q

What is an Inotropic Influence?

A

Increases heart contractility

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5
Q

What is a Positive Inotropic Action? Examples?

A

Stimulates heart to increase contraction.

Ex: Ditigalis (aka Digoxin), sympathetic stimulation

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6
Q

What is a Negative Inotropic Action? Examples?

A

Something which decreases hearts contractility. Akinesis (lack of movement) of part of heart wall.

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7
Q

What is Left Ventricular Ejection Fraction?

A

Percent of blood leaving the heart each time it contracts.

LEVF aka EF

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8
Q

What is normal EF?

A

55-65%

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9
Q

What can an EF more than 65% signify?

A

Dehydration or massive blood loss

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10
Q

What does the Frank-Starling Curve mean?

A

More pull a contracting agent the stronger the recoil

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11
Q

Define Heart Failure

A

Structural or functional cardiac disorder, or both. (Functional caused by structural.)

–Impaired ventricle filling or impaired ventricle ejection.

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12
Q

Describe Low Output HF? (Hint: what’s impaired, causes)

A

Impaired pumping ability. D/T HTN and CAD.

Most common type of HF.

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13
Q

Describe High Output HF? (hint: pump and causes)

A

Excessive need for high output but still inadequate for body’s needs. 3 causes:

  1. Beri-Beri=Thiamine deficiency causing vasodilation and increased blood volume
  2. Anemia
  3. Thyrotoxicosis
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14
Q

Describe Right Sided HF? (hint: etiology, pathophys)

A

D/t Left Sided HF (most common), Pulm Dz, or Pulmonic Valve Stenosis.
-Blood backup into systemic venous system (legs, hepatic veins, GI tract), and JVD

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15
Q

What are the two types of Left Sided HF?

A

Systolic and Diastolic HF

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16
Q

What happens to blood in Left Sided HF? Etiology?

A

Backs up into lungs (pulm edema), backs up to right side of heart, and systemic venous system.
-D/t MI, CAD w/many small infarcts, caridomyopathy, LVH from long-term HTN

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17
Q

What happens to Afterload and Preload in HF?

A

Increased Afterload and increased Preload

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18
Q

What happens to heart contractility in HF?

A

Decreased contractility

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19
Q

What type of arrythmias can causes HF?

A

Afib w/RVR, other tachyarrythmias

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20
Q

What can cause decompensation in chronic HF?

A

Increased Na, increased fluid, missed diuretic dose, poor compliance, massive thanksgiving meal, moved to nursing home with high Na food

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21
Q

What it the main Sx in HF?

A

SOB/DOE (dyspnea on exertion)

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22
Q

What is the main form of HF?

A

Systolic HF

23
Q

What is MC of Systolic HF?

A

Ischemic heart dz from MI

Also HTN causing LVH, valve dz, CAD

24
Q

What is the murmur heard in Systolic HF?

A

S3 gallop

25
Q

What is heard at lung bases in Systolic HF? What seen on LEs?

A

Lungs bases=Crackles

LEs=putting edema

26
Q

What happens to EF in Systolic HF?

A

Decreased HF

27
Q

S3 gallop murmur heard in which type of HF?

A

Systolic HF

28
Q

EKG findings on Systolic HF?

A

AFib, acute MI, prior MI (pathologic Q-waves), a

29
Q

CXR findings on Systolic HF?

A

Bunted costophrenic angles Pulm vein engorgement, Cephalization, Kerley B Lines, cardiomegaly

30
Q

How to dx Systolic HF? (and all other HFs)

A

Echo

31
Q

Which lab result can rule in HF?

A

BNP. Released due to heart stretch/strain. High BNP can rule in HF.

32
Q

What happens to the LV chamber and walls in Systolic HF?

A

Walls become thin. Chamber becomes dialated.

33
Q

General tx for HF?

A

Reduce Na+, reduce fluids, tx underlying dz. ACEi, loop diuretics (Furosemide), Beta-blocker.

34
Q

What med should all HF patients be getting? What does it do to loads and output?

A

ACE-I. Decreases Afterload and increases CO.

35
Q

When do give Beta-Blocker in HF?

A

When PT is relative stable and not in acute distress.

36
Q

Etiologies of Diastolic HF?

A

HTN, RCMP

37
Q

EF in Diastolic HF?

A

Preserved or increased

38
Q

Murmur in Diastolic HF?

A

S4 gallop=Atrial contraction into stiff ventricle.

39
Q

S4 gallop murmur heard when?

A

In Diastolic HF.

40
Q

Ventricle walls and chamber size in Diastolic HF?

A

Thick ventricular walls. Small LV

41
Q

Tx for Diastolic HF?

A

ACEi, BB, CCB (Dilt)

42
Q

If African American what medication combo improves outcomes?

A

Hydralazine + Isosorbide Dinitrate

43
Q

If HF patient hospitalized what medication class to use?

A

Positive Inotrope to increase contractility.

44
Q

Do Positive Inotropes improve mortality in HF?

A

No, just prevent hospitalization.

45
Q

What do ACE-Is do for HF?

A

Decrease Afterload, increased CO

46
Q

What do Beta-Blockers do for HF?

A

Increase EF, improve remodeling, decrease scar tissue formation

47
Q

Which class diuretics to use in HF?

A

Loop Diuretics (Furosemide/Lasix)

48
Q

What do use an adjunct to Loop Diuretics esp if K is low?

A

Potassium Sparring Diuretics (Spironolactone)

49
Q

If PT w/HF hospitalized and has severe edema what is goal for fluid reduction?

A

1L-1.5L/day

50
Q

What is Acute-on-Chronic HF?

A

PTs with CHF for many years who have been undertreated and undermanaged but bodies have compensated in a number of ways including angiogenesis or lung changes.

51
Q

What is absent in Acute-on-Chronic HF? What to check?

A

Signs and symptoms are mostly normal. Check BNP!

52
Q

How to tx Acute Decompensated HF?

A
  • Hospitalize and use IV Loop Diuretics (Furosemide) w/goal of -1L to -1.5L/day.
  • Fluid restriction to 1.5L.
  • Rate control with BB or CCB if have rapid Afib
  • Monitor K, Mg, and kidney function
53
Q

How to treat Severe Hemodynamic Compromise in HF? (If severely hypoxic or severe resp distress.)

A
  • Intubate, admit to CCU
  • Give Positive Inotrope=Dobutamine, Milrinone
  • Give Vasocontrictors=Dopamine, Epi, Phenylepherine, Vasopressors
  • Mechanical and surgical support=Intraaortic balloom pump, LV assist device

Clinical Medicine 2 (14 decks)

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