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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
Q

What are the affects of cocaine on myocardium

A

may cause vasospasm leading to MI
arrhythmia
myocarditis/cardiomyopathy from released catecholamines

26
Q

when can peripartum cardiomyopathy occur

A

between last mo of pregnancy and first 5 mo after delivery

27
Q

What is takosubo cardiomyopathy

A

stress, apical ballooning or broken heart

28
Q

what ar Sx of takotsubo cardiomyopathy

A

CP, SOB, syncope

29
Q

what gene mutations can cause genetic HCM

A

myosin heavy chains
proteins regulating Ca handling
autosomal dominant

30
Q

What type of dysfunction (systolic or diastolic) does HCM cause

A

diastolic

31
Q

what are symptoms and signs of HCM

A

SOB, chest pain, syncope, arrhythmias

systolic murmur along left sternal border

32
Q

What maneuvers increase/decrease systolic murmur along left sternal border

A

increase with valsalva menuever/upright

decrease with squatting

33
Q

What are causes of non-genetic hypertrophic cardiomyopathy

A

similar to HCM but more generalized thickening with no disproportional involvement of the septum
aortic stenosis-related hypertrophy

34
Q

What are Sx of non-genetic hypertrophic CM

A

diastolic dysfunction: SOB, edema

obstruction: syncrope, chest pain

35
Q

what is restrictive cardiomyopathy chracterized by:

A

impaired filling causing predominately diastolic dysfunction

36
Q

what are the infiltrative diseases that cause restrictive cardiomyopathy

A

amyloidosis

sarcoidosis

37
Q

what systemic storage diseases cause restrictive cardiomyopathy

A

hemochromatosis, glycogen storage diseases

38
Q

what fibrotic and endomyocardic conditions can cause restrictive cardiomyopathy

A

fibrotic: radiation, scleroderma
endomyocardiac: lofflers endocarditis, endomyocardial fibrosis

39
Q

What is pulmonary BP usually measured at

A

20/10

40
Q

What are the 4 general categories that can cause pulm HTN

A

pulm arterial HTN
L heart disease
Cor Pulmonale
Chronic thrombotic/embolic disease

41
Q

What drugs are assoc with Pulm HTN

A

fenfluramine (weight loss)
amphetamines
cocaine

42
Q

how can L heart disease lead to pulm HTN

A

L ventricular failure, increase volumes, increase pressures which increase pulm a P and so hypertrophy and ventricular failure on R side

43
Q

What is most common cause of pulm HTN and pathogenesis

A

cor pulmonale

pulmonary disease leading to HTN and increase RV afterload, RV hypertrophy, RV failure

44
Q

What can cause an increase in metabolic demand that does not match with CO

A

thyrotoxicosis

45
Q

What can cause excessive blood flow that overwhelms normal abilities of the pump

A

anemia, AV fistula

conditions that dec TPR (beri beri, sepsis)

46
Q

Clinical manifestations of L sided HF

A 
paroxysmal nocturnal dyspnea
elevated pulm capillary wedge P
pulmonary congestion
restlessness
confusion, orthopnea, tachy, exertional dyspnea, fatigue, cyanosis
47
Q

Clinical manifestations of R sided HF

A 
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
Q

What are Sx of L HF, backward failure

A

pulmonary edema

SOB, cough, PND, orthopnea, pleural effusion

49
Q

what are symptoms of R HF

A

lower extremity swelling/edema
anasarca/ascitis/pleural and pericardial effusion
could affect lungs too
end organ damage

50
Q

what are Sx of forward failure

A 
L HF usually
hypotenstion
weakness
exercise intolerance
end organ damage
51
Q

What are The New York classes for Heart Failure

A 
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
Q

What are the Stages of HF according to ACC/AHA

A

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
Q

What CHF physical findings can be seen in neck region

A

JVD
hepato-jugular reflux
thyroid enlargement in toxic goiter may be present

54
Q

What PE of CHF patient in lungs

A

crackles and rales
decrease breath sounds at base
dullness to percussion
tactile fremitus

55
Q

what are heart PE findings in CHF

A 
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
Q

What other conditions can lead to increased BNP levels

A 
old age
renal failure
cor pulmonale
pulm HTN
pulm embolism
57
Q

What are Kerley B lines on CXR

A

the whispy looking infiltrate from CHF in lungs

58
Q

What infor can an echo give you

A 
size of heart chambers
thickness of walls
contractility
septal defects
valvular structures and their integrity
intracardiac structures
diastolic dysfunction
pulm pressures
59
Q

What drugs improve mortality in CHF

A

ACEI, ARB, aldosterone antagonists

Beta blockers: metoprolol succinate, carvedilol, bisoprolol

60
Q

how do beta blockers work in HF

A

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
Q

what medication combination specifically reduces mortality in african americans

A

hydralasine and nitrate

62
Q

what do the drugs that decrease mortality in CHF have in common

A

decrease systolic function/ejection fraction

Year 2 CV (31 decks)

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