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Year 2 CV > Exam 3, HF, myocarditis, Pales > Flashcards

Exam 3, HF, myocarditis, Pales Flashcards

1
Q

Definition of CHD

A

syndrome with abnormality of cardiac structure or function is responsible for inability of heart to eject or fill with blood at a rate sufficient to meet demands

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2
Q

What are the systolic components of HF

A

myocardial function
preload (EDV)
afterload
HR

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3
Q

What are the diastolic components of HF

A

impaired relaxation

impaired compliance- stiff

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4
Q

What is high output failure HF

A

normal heart function

increased metabolic demand, increased peripheral blood flow from decreased PVR

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5
Q

What causes systolic HF

A

inadequate CO/EF

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6
Q

how do you calculate EF

A

SV/EDV

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7
Q

What causes Diastolic HF

A

inability of ventricles to relax and fill normally with blood during diastole

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8
Q

What is forward HF

A

decrease in perfusion of the organs/tissues down-stream from the heart

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9
Q

What is backward failure

A

backing up blood into organs upstream, increasing hydrostatic P, leading to congestion/edema

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10
Q

What is L HF

A

caused by conditions affecting L ventricle
CAD/ MI
aortic/mitral valve problems
HTN
cardiomyopathies
forward failure Sx in systemic circulation (downstream)
backward Sx in lungs

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11
Q

What is R HF

A

caused by conditions primarily affecting R ventricle
pulmonary diseases/ cor pulmonale
tricuspid/ pulmonary valves
pulmonary HTN
pulmonary emboli
backward failure symptoms in systemic circulation

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12
Q

what is biventricular failure

A

end result of L and R failure

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13
Q

What causes acute HF

A

massive MI, chorda tendinae rupture
Large PE
predominately forward failure

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14
Q

what causes chronic HF

A

progresses slowly
exacerbation
predominately backward failure

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15
Q

What are 3 main causes of HF

A

L heart
R Heart
High output

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16
Q

What can cause high output HF

A

metabolic disorders: thyrotoxicosis

Excessive blood flow: anemia, AV fistula, beriberi

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17
Q

What are causes of diastolic HF

A

chronic HTN, Hypertrophic CMP, restrictive CMP, ischemic fibrosis, pericardial diseases

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18
Q

what are causes of R HF

A

Cor pulmonale, pulm art HTN

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19
Q

What are causes of systolic HF

A

decreased contractility, icn preload, inc afterload, change in HR

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20
Q

CAD or MI will lead to what changes in the heart

A

dilated CM

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21
Q

how can HTN lead to dilated cardiomyopathy

A

HTN causes left ventricular Hypertrophy causing diastolic dysfunction and then ventricular dilation so systolic dysfunction

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22
Q

how does valvular Heart disease lead to dilated CM

A

regurg, increase EDV, preload, increase worklooad, hypertrophy, dilation, systolic dysfunction

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23
Q

What changes occur in heart from infective myocarditis

A

dilated cardiomyopathy

can be viral, bacerial fungal or helminthic

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24
Q

What are types of non-infective myocarditis

A

toxic: chemo, metals, lithium, malaria, radiation causing inflammation and fibrosis
autoimmune/CTD assoc myocarditis: giant cell myocarditis PM/DM, SLE/RA

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25
What are the affects of cocaine on myocardium
may cause vasospasm leading to MI arrhythmia myocarditis/cardiomyopathy from released catecholamines
26
when can peripartum cardiomyopathy occur
between last mo of pregnancy and first 5 mo after delivery
27
What is takosubo cardiomyopathy
stress, apical ballooning or broken heart
28
what ar Sx of takotsubo cardiomyopathy
CP, SOB, syncope
29
what gene mutations can cause genetic HCM
myosin heavy chains proteins regulating Ca handling autosomal dominant
30
What type of dysfunction (systolic or diastolic) does HCM cause
diastolic
31
what are symptoms and signs of HCM
SOB, chest pain, syncope, arrhythmias | systolic murmur along left sternal border
32
What maneuvers increase/decrease systolic murmur along left sternal border
increase with valsalva menuever/upright | decrease with squatting
33
What are causes of non-genetic hypertrophic cardiomyopathy
similar to HCM but more generalized thickening with no disproportional involvement of the septum aortic stenosis-related hypertrophy
34
What are Sx of non-genetic hypertrophic CM
diastolic dysfunction: SOB, edema | obstruction: syncrope, chest pain
35
what is restrictive cardiomyopathy chracterized by:
impaired filling causing predominately diastolic dysfunction
36
what are the infiltrative diseases that cause restrictive cardiomyopathy
amyloidosis | sarcoidosis
37
what systemic storage diseases cause restrictive cardiomyopathy
hemochromatosis, glycogen storage diseases
38
what fibrotic and endomyocardic conditions can cause restrictive cardiomyopathy
fibrotic: radiation, scleroderma endomyocardiac: lofflers endocarditis, endomyocardial fibrosis
39
What is pulmonary BP usually measured at
20/10
40
What are the 4 general categories that can cause pulm HTN
pulm arterial HTN L heart disease Cor Pulmonale Chronic thrombotic/embolic disease
41
What drugs are assoc with Pulm HTN
fenfluramine (weight loss) amphetamines cocaine
42
how can L heart disease lead to pulm HTN
L ventricular failure, increase volumes, increase pressures which increase pulm a P and so hypertrophy and ventricular failure on R side
43
What is most common cause of pulm HTN and pathogenesis
cor pulmonale | pulmonary disease leading to HTN and increase RV afterload, RV hypertrophy, RV failure
44
What can cause an increase in metabolic demand that does not match with CO
thyrotoxicosis
45
What can cause excessive blood flow that overwhelms normal abilities of the pump
anemia, AV fistula | conditions that dec TPR (beri beri, sepsis)
46
Clinical manifestations of L sided HF
``` paroxysmal nocturnal dyspnea elevated pulm capillary wedge P pulmonary congestion restlessness confusion, orthopnea, tachy, exertional dyspnea, fatigue, cyanosis ```
47
Clinical manifestations of R sided HF
``` fatigue, increase TPR ascites enlarged liver and spleen may be secondary to chronic pulm problems distended jugular vv anorexia and complains of GI distress weight gain dependent edema ```
48
What are Sx of L HF, backward failure
pulmonary edema | SOB, cough, PND, orthopnea, pleural effusion
49
what are symptoms of R HF
lower extremity swelling/edema anasarca/ascitis/pleural and pericardial effusion could affect lungs too end organ damage
50
what are Sx of forward failure
``` L HF usually hypotenstion weakness exercise intolerance end organ damage ```
51
What are The New York classes for Heart Failure
``` I- Sx with more than ordinary actvity II- Sx with ordinary activity III- Sx with minimal activity IIIa- No dyspnea at rest IIIb- recent dyspnea at rest IV- Sx at rest ```
52
What are the Stages of HF according to ACC/AHA
A- high risk HF with no structural heart disease B- structural Heart disease without Sx or signs of HF C- structure hear disesase with prior or current Sx of HF D- Refractory HF requiring specialized intervention
53
What CHF physical findings can be seen in neck region
JVD hepato-jugular reflux thyroid enlargement in toxic goiter may be present
54
What PE of CHF patient in lungs
crackles and rales decrease breath sounds at base dullness to percussion tactile fremitus
55
what are heart PE findings in CHF
``` PMI displaced if LV enlarged parasternal lift/heave if RV enlarged arrhythmia common S1 diminished, P2 accentuated with pulm HTN S3 with low EF S4 with diastolic dysfunction ```
56
What other conditions can lead to increased BNP levels
``` old age renal failure cor pulmonale pulm HTN pulm embolism ```
57
What are Kerley B lines on CXR
the whispy looking infiltrate from CHF in lungs
58
What infor can an echo give you
``` size of heart chambers thickness of walls contractility septal defects valvular structures and their integrity intracardiac structures diastolic dysfunction pulm pressures ```
59
What drugs improve mortality in CHF
ACEI, ARB, aldosterone antagonists | Beta blockers: metoprolol succinate, carvedilol, bisoprolol
60
how do beta blockers work in HF
up regulate beta R improving inotropic and chronotropic responsiveness of myocardium imrpoving contractile function reduce level of vasoconstrictors increase contractility reduce myocardial consumption O2 decrease frequency of PVC and sudden cardaic death
61
what medication combination specifically reduces mortality in african americans
hydralasine and nitrate
62
what do the drugs that decrease mortality in CHF have in common
decrease systolic function/ejection fraction

Year 2 CV (31 decks)

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