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Cardiovascular > EXAM #2: CHF I & II > Flashcards

EXAM #2: CHF I & II Flashcards

1
Q

What is the definition of heart failure?

A

Inability of the heart to pump sufficient blood to meet the metabolic needs of the body

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2
Q

What is the definition of myocardial failure?

A

Defective myocardial contraction

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3
Q

What is the definition of circulatory failure?

A

Abnormality of a component of the circulatory system leads to inadequate CO

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4
Q

What is the neurohormonal model of heart failure?

A

A series of compensatory adaptations that normally preserve CO are activated:

1) SNS is activated while the PNS is suppressed
2) RAAS is activated

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5
Q

What are the results of the changes seen in the neurohormonal model of HF?

A

1) Peripheral arterial constriction
2) Na+/ water retention
3) Activation of inflammatory mediators that induce cardiac remodeling

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6
Q

What are the specific results of adrenergic stimulation in the neurohormonal model of HF?

A

1) Increased SNS tone
- Increased vascular tone
- Increase circulating NE
- Decreased myocardial NE
2) Beta-1 increased HR and contractility
3) Alpha-1 increased inotropism and peripheral vasoconstriction

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7
Q

When is the RAAS activated in HF?

A

Later than the SNS

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8
Q

What causes activation of the RAAS in the neurohormonal model of HF?

A

1) Decreased RBF
2) Decreased Na+ in the distal renal tubule
3) SNS increases renin release

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9
Q

What are the consequences of sustained high levels of Angiotensin II?

A

1) Organ fibrosis i.e. heart and kidney

2) Enhanced NE release

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10
Q

What is the difference between the hypertrophy of pressure and volume overload?

A

Pressure= parallel/ concentric

Volume= series/ eccentric

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11
Q

What are the adverse consequences of LV remodeling in HF?

A

1) Hypertrophy
2) APD increases
3) Contractile/ regulatory proteins altered
4) Increased myocardial wall tension
5) MV regurgitation

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12
Q

What is backward heart failure?

A

This is the sequelae that result from failure of the LV to fully eject its contents

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13
Q

What is forward heart failure?

A

This describes the effects of HF i.e. reduced CO

  • Decreased perfusion of vital organs
  • Mental clouding
  • Weakness
  • Na+ and water retention
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14
Q

What is the basic manifestation of left heart failure?

A

Central venous/ pulmonary congestion

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15
Q

What is the basic manifestation of right heart failure?

A

Systemic congestion

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16
Q

What is systolic heart failure?

A

Abnormal systolic function leading to high residual volume in the ventricle

*Leads to poor perfusion

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17
Q

What is diastolic heart failure?

A

Abnormal diastolic filling

*Leads to pulmonary and systemic congestion

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18
Q

What are the most common causes of HF?

A

1) Ischemia/ infarction
2) HTN
3) Arrhythmias
4) Infection/inflammatory disease
5) PE

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19
Q

What are the major sx. associated with HF?

A

1) Progressive dyspnea
2) Diminished exercise capacity
3) Fatigue
4) Nocturia
5) CNS impairment

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20
Q

Why do patients with HF get nocturia?

A
  • Lying down= better renal perfusion

- Increased kidney function w/ increased perfusion

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21
Q

What is Class I HF?

A

Asymptomatic i.e. no activity limitation

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22
Q

What is Class II HF?

A

Slight activity limitation

*ORDINARY activity causes sx.

23
Q

What is Class III HF?

A

Marked activity limitation

*LESS than ordinary activity causes sx.

24
Q

What is Class IV HF?

A

Symptomatic at rest

“Conversational dyspnea”

25
Q

What causes pallor and cool extremities in HF?

A

SNS tone that causes cutaneous vasoconstriction

26
Q

What PE sign is indicative of LV failure?

A

Pulmonary rales

27
Q

What PE signs are indicative of RV failure?

A

1) Jugular venous distention (no valves)

2) Kussmaul’s sign

28
Q

What is Kussmaul’s sign?

A

Increased jugular venous distention with inspiration

29
Q

What is hepatojugular reflux?

A
  • RV failure= hepatomegaly
  • Hold hand over dome of the liver
  • After a minute, jugular venous pulses rise
30
Q

What findings are associated with HF on cardiac PE?

A

1) Apical impulse displaced left and down
2) S3
3) Pulsus alternans
4) Murmurs

Note that “cardiac cachexia” is a late sign of HF

31
Q

List the lab findings associated with HF.

A

1) Hyponatremia from H20 excess

2) Liver enzyme elevations

32
Q

What CXR findings are associated with HF?

A

1) Cardiomegaly
2) Pulmonary congestion/effusion
3) Kerley “B” lines

33
Q

What are Kerley B lines?

A

Congestion of the pulmonary lymphatics

34
Q

What are the leading causes of death from HF?

A

1) Pump failure

2) Tachyarrhythmias

35
Q

What factors are associated with worse prognosis in HF?

A

1) Males
2) IHD
3) S3
4) Low pulse pressure
5) High functional class (III and IV)
6) Reduced exercise capacity

36
Q

What is high output HF?

A

Despite high CO, the metabolic demands of the body are NOT met

37
Q

What are the four goals of therapy in HF?

A

1) Relieve sx.
2) Prolong survival
3) Improve quality of life
4) Delay or prevent progression of myocardial dysfunction

38
Q

What is the therapy based on in HF?

A

Functional Class

39
Q

What immunizations do patients with HF need?

A

1) Pneumonia

2) Influenza

40
Q

What are the two major factors that lead to a worsening of HF?

A

1) Dietary indiscretion

2) Inappropriate reduction in HF meds

41
Q

What is Stage A HF?

A

High risk for HF, but NO disease yet

E.g. HTN, IHD…etc.

42
Q

What is Stage B HF?

A

Structural heart disease evident, but no symptoms

43
Q

What is Stage C HF?

A

Structural disease with sx

44
Q

What is Stage D HF?

A

Refractory HF

45
Q

What are the general measures to treat HF?

A

1) Reduce risk factors
2) Education on lifestyle/diet modifications
3) Activity-modification

46
Q

What type of diuretic should be used for a patient with a high creatinine?

A

Loop

*Thiazide is fine if creatinine is less than 2

47
Q

What are the anti-neurohormonal durgs?

A
  • ACEIs
  • ARBs
  • Beta-blockers
48
Q

What are the “agents of choice” for HF?

A

ACEIs

E.g. Lispinopril/ enalapril

49
Q

What is the hallmark ARB?

A

Losartan

*Note that Candasartan is more efficacious in treating HF

50
Q

What type of beta-blockers are indicated for HF?

A

1) Beta-1 selective

2) Beta-1 + alpha-1

51
Q

What are the two beta-blockers used to treat HF?

A

Metoprolol and Carvedilol*

In US, this is the only one approved for HF (Coreg)

52
Q

What is the MOA of spironolactone?

A

Aldosterone antagonist

53
Q

What are the non-pharmacologic therapies for HF?

A

1) Intra-aortic balloon pump
2) LV assist device
3) Transplant

Cardiovascular (38 decks)

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