Exam 4 - Heart Failure Flashcards
Heart Failure is defined as a complex syndrome that results from:
any structural or functional impairment of ventricular filling or blood ejection
s2
Five signs of tissue-hypoperfusion that result from HF:
fatigue, dyspnea, weakness, edema, and weight gain
s2
HF may be caused by structural abnormalities of what 5 cardiac structures?
pericardium, myocardium, endocardium, heart valves, or great vessels
s2
what EF % classifies HF with reduced EF (aka systolic HF)?
EF ≤ 40%
s2
what EF % classifies HF with preserved EF (aka diastolic HF)?
EF ≥50%
s2
A pt with clinical symptoms with an EF between ___ - ___% is labeled as having borderline HF w/ preserved EF
40-50%
s2
True or false: Diastolic dysfunction is present in both HFrEF and HFpEF.
True!
s2
Patters of what 2 things are the major distinguishing features between HFrEF and HFpEF?
LV dilation and remodeling
s2
What serves as the main marker for establishment of HF risk factors, treatment, and outcome?
Ejection Fraction!
s2
Which of the 2 HFs are women more likely to be affected by?
HF w preserved EF
s3
Which of the 2 HFs are men more likely to be affected by?
HF with reduced EF
s3
Which HF is more likely to have modifiable risk factors and a higher prevalence of MI, previous coronary intervention, CABG, and PVD?
HF w reduced EF
s3
what is the primary determinant of HFpEF?
left ventricular diastolic dysfunction
s4
what 5 things determine LV’s ability to fill?
pulmonary venous blood flow
LA function
mitral valve dynamics
pericardial restraint
active and passive elastic properties of LV
s4
What 3 things are majority of measurements of LV Diastolic dysfxn dependent on?
HR, loading conditions, and myocardial contractility
s4
Higher ________ are required to achieve normal end-diastole volume in pts with HFpEF.
LV filling pressures
s4
What is the steeper rise of the end-diastolic pressure-volume curve indicative of?
what does it result in regarding LV compliance?
delayed LV relaxation and an increase in myocardial stiffness
resulting in reduced LV compliance that restricts filling
s5
The reduced LV compliance that eventually restricts filling can precipitate what (regarding the left atrium and pulm system)?
LA hypertension, LA systolic & diastolic dysfunction,
pulmonary venous congestion, and exercise intolerance
s5
What does the left picture indicate about contractility?
what does the right picture indicate regarding LV compliance?
Left: a decrease in myocardial contractility as indicated by a decrease in the slope of the end-systolic pressure-volume relation
Right: a decrease in LV compliance as indicated by an increase in the position of the end-diastolic pressure-volume relation
These diagrams emphasize that heart failure may result from LV systolic or diastolic dysfunction independently
s5
List some common causes of Left Ventricular Diastolic Dysfxn
LV End- diastolic dysfunction or delay in relaxation which is considered a form of “active stiffening” is complicated by
Failure of the actin-myosin disassociation, which occurs due to inadequate perfusion or dysfunctional intracellular Ca++ homeostasis
S9
The NYHA system focuses primarily on ____ to classify HF?
the degree of physical limitation
S18
The ACC/AHA focus on ____ to classify HF?
on the presence & severity of HF
S18
What should be noted with classification of HF?
- note that these stages are progressive
- oftenclassified using a combination of both scoring systems
S18
Which NYHA Classification has no limitation and no symptoms from ordinary activity?
NYHA Class I
S18
What NYHA Classification has mild limitation with activity and comfortable at rest or with mild exertion?
NYHA Class II
S18
Which NYHA Classification has significant limitation with any activity and comfortable only at rest?
NYHA Class III
S18
Which NYHA Classification has discomfort with any physical activity and symptoms occuring at rest?
NYHA Class IV
S18
Which ACC/AHA classification has high risk of developing heart failure but no functional or structural heart deficits?
ACC/AHA Class A
S18
Which ACC/AHA classification has structural heart deficit but no symptoms?
ACC/AHA Class B
S18
Which ACC/AHA classification has heart failure symptoms due to underlying structural heart deficit with medical management?
ACC/AHA Class C
S18
Which ACC/AHA classification has advanced disease requiring hospitalization, transplant, or palliative care?
ACC/AHA Class D
S18
Which condition has improved survival rate in the past three decades: HFrEF or HFpEF?
HFrEF
S19
Which condition benefits with using medications: HFrEF or HFpEF?
HFrEF
S19
What are the treatments for HFpEF?
- Mitigation of sx’s
- treat associated conditions
- exercise
- weight loss
S19
What are the treatments for HFrEF?
- Beta Blockers
- ACE-Inhibitors
S19
What class of medication stimulate β-receptors on the myocardium to activate adenylyl cyclase to increase cAMP?
Catecholamines
Slide 31
How does a implantable hemodynamic monitoring improve chronic HF?
it allows remote observation of intracardiac pressures to guide tx and prevent decompensation
Slide 24
What are the medical treatments for Chronic HF?
- Diuretics
- B-blockers
- ACE-inhibitors & ARBs
- Lifestyle change
S21-22
What are 2 important biomarkers in the diagnosis of HF?
BNP and N-terminal pro-BNP
17
How does Loop Diuretics help CHF?
- reduce LV filling pressures
- decrease pulmonary venous congestion
- improve HF sx
S21
Which type of pts. are Thiazide diuretics useful and why?
pts with poorly controlled HTN
to prevent the onset of HFpEF
S21
How does a Implantable cardioverting-defibrillators (ICDs) helps patients with chronic Heat failure?
Its used to prevent sudden death in pts with advanced heart failure?
Slide 24
Which type of CHF are Beta-Blockers strongly recommended for?
HFrEF
(HF with reduced EF)
prescribed for other indications (HTN, MI, HR control w/Afib)
S21
̴ ____% HF deaths are d/t sudden cardiac dysrhythmias
50%
Slide 24
What is the mainstay treatment for HFrEF?
ACE-inhibitors and ARBs
(studies do not show benefit in HFpEF unless used for treatment of HTN)
S22
What is the name of the device used by patients in the terminal stages of HF that may benefit from mechanical circulatory support (MCS) by a ventricular assist device (VAD)?
LV assist device
silde 25
What are the lifestyle changes that pt. can do to treat CHF?
- Aerobic fitness
- Weight loss
- Salt-restricted, Dietary Approaches to Stop Hypertension (DASH) diet
- Control of HTN and blood glucose
S22
HF preserved EF is associated w/ lower BNP and NT-proBNP levels [than HF reduced EF] due to what characteristics?
concentric hypertrophy, normal LV chamber size and lower LV end diastolic wall stress
17
Causes of LV relaxation
Due to afterload, which is elevated in hypertensive pts. Tachycardia exacerbates the failure of LV relaxation.
S9
What is the goal of surgical treatment for CHF?
to prevent ventricular remodeling and retain the natural geometry of the heart
S23
What are the benefits of coronary revascularization via CABG or PCI?
- can reverse LV dysfunction following MI
- may prevent permanent EF reductions
- reduce 10-year mortality by 7% (CABG)
S23
What is commonly seen w/ HFpEF despite having only a modestly depressed LV systolic fx?
Profound exercise intolerance
S9
What is another name for Cardiac resynchronization therapy (CRT) and what is the treatment for?
“biventricular pacing”
tx for HF w/ ventricular conduction delay (prolonged QRS)
S23
Cardiac resynchronization therapy (CRT)
Placement of a ____ cardiac pacemaker (w/RA & RV leads), an additional lead is introduced through the coronary sinus and advanced until it reaches the lateral wall of the ____.
This stimulates the heart to contract more ____ and efficiently and improve COP
dual chamber
LV
synchronously
S23
Prolonged compression of coronary arteries restricts diastolic coronary blood flow, which contributes to ____ ____ and a further reduction in exercise tolerance.
subendocardial ischemia
S9
What NYHA class is CRT recommended?
NYHA class III or IV w/ EF < 5% and a QRS duration 120-150 ms
S23
What are the outcomes of CRT?
- fewer HF sx
- better exercise tolerance
- improved ventricular function
- less hospitalizations
- decreased mortality
S23
What are the most common symptoms of HF?
Fatigue, tachypnea, dyspnea, paroxysmal nocturnal dyspnea, orthopnea, S3 gallop, JVD, peripheral edema, exercise intolerance, and reduced tissue perfusion.
S10
What are the risks of CRT?
- infection
- misplacement
- device failure
S23
What are the most common symptoms of HFpEF?
paroxysmal nocturnal dyspnea, pulmonary edema, dependent edema
s10
What is the most common sign of HFrEF?
S3 gallop
S10
CRP and GDF15 (growth differentation factor 15 represent what component of HF?
inflammatory component of HF
17
When EF is reduced, the presence of HF symptoms establishes the diagnosis of?
HFrEF (following standard guidelines)
S10
LVAD is used for
- temporary ventricular assistance while heart is recovering its function
- Pts awaiting cardiac transplant
- Pts are on inotropes or balloon pump (IABP) with potentially reversible medical conditions
- Pts with advanced HF who aren’t transplant candidates
Slide 25
Which type of HR is harder to diagnose?
HFpEFis often more difficult to diagnose,especially when the pt has little/no symptoms at rest
S11
What is disease process is classified as a long-standing HF disease?
Chronic heart failure
Slide 27
What does cardiac catheterization define?
Elevated LV systolic and diastolic stiffness usingpressure-volume analysis or provocative testing (s/a exercise & rapid IV volumeexpansion)
S11
What other diagnostic measure can offer further information about severity of HFpEF?
Direct measurement of RV filling.
S11
True or false: Acute heart failure: Slow onset, often presenting w/life-threatening conditions
False: Acute heart failure: rapid onset, often presenting w/life-threatening conditions
Pts may require hospitalization, txis aimed at decreasing volume & stabilizing hemodynamics
Slide 27
What diagnostic finding provides strong evidence of HFpEF and is a predictor of mortality?
Mean pulmonary capillary wedge pressure >15mmHg at rest or 25mmHg duringexercise
S11
The term Acute heart failure applies to what patient population?
- present with worsening preexisting HF
- present for the first time with HF
Slide 27
What would you expect to see on CXR of someone w/ HF?
pulmonary dz, cardiomegaly, pulmonary venous congestion, and interstitial or alveolar pulmonary edema.
S13
What is an early radiographic sign of LV failure and pulmonary venous HTN?
distention of the pulmonary veins in the upper lobes of the lungs
S13
What are the sx of ADHF?
- **fluid retention
- weight gain
- dyspnea**
as the result of decompensation due to inadequate compensation
Slide 27
You read in the chart that the pt has perivascular edema, so you look at pt’s CXR and you see…
hilar or perihilar haze with ill-defined margins
S13
What are the characteristics of De novo AHF?
- increase in intracardiac filling
- pressuresor acute myocardial dysfunction
- decreased peripheral perfusion
- pulmonary edema
Slide 28
Pt presents with interlobular edema. What would you expect to see on CXR?
Kerley lines, which produce a honeycomb pattern
S13
What is the leading caused of de novo HF?
- Cardiac ischemia cause by a coronary occlusion
How can a SRNA stabilize a patient with cardiac ischemia caused by a coronary occlusion ?
- stabilizing hemodynamics
- restoring myocardial perfusion
- improving myocardial contractility
Slide 28
Pt presents with alveolar edema, what would you expect to see on CXR?
homogeneous densities in the lung fields, typically in a butterfly pattern
S13
Radiographic evidence of pulmonary edema may lag behind the clinical evidence of pulmonary edema by up to ____hours
12 hours
S13
Myocardial hypertrophy, dynamic LV outflow obstruction, mitral regurg, diastolic dysfunction, myocardial ischemia and dysrhythmias are all related to what condition?
hypertrophic cardiomyopathy
45
Nonischemic cause of de novo HF include
- drug-induced (toxic)
- peripartum cardiomyopathies
Slide 28
Hypertrophied myocardium has a ____ relaxation time and ___ compliance
prolonged relaxation and decreased compliance!
45
Which criteria is more specific in diagnosis of HFpEF and incorporates several echocardiographic indexes based on 2-dimensional measurements?
European Sociaty of Cardiology (ESC)
S15
De novo HF may lead to _____ _________ dysfunction.
long-term cardiac dysfunction
management of theunderlying causemay allow for complete restoration
Slide 28
Nesiritide works by inhibiting the ________ and promoting arterial, venous, and coronary vaso-____________, decreasing LVEDP and improving ___________.
Nesiritide works by inhibiting the **RAAS **and promotingarterial, venous, and coronary vasodilation, decreasing LVEDP and improving dyspnea
33 - AHF
ESC guidelines rely entirely on ____ echocardiogram; and are limited because they do not incorporate ____testing.
resting
provocative
S15
Nesiritide induces diuresis and ____________, relaxes cardiac muscle, and lacks any ____________ effects
Nesiritide induces diuresis and natriuresis, relaxes cardiac muscle, and lacks any dysrhythmic effects
Natriuresis is when the body excretes more sodium and causes a diuretic response
33 - AHF
European Society of Cardiology criterias
S15
What class of medication is proven to correct elevated filling pressures and reduceafterload.
Vasodilators
Slide 30
T/F
Nesiritide has shown advantage over traditional vasodilators such as NTG & SNP
False
Nesiritide has not shown advantage over traditional vasodilators such as NTG & SNP
33 - AHF
The hemodynamic profile that is included in acute HF?
- low cardiac output
- high ventricular filling pressures
- HTN or HoTN
Slide 29
hypertrophic cardiomyopathy
Surgery is reserved for pt w/ large outflow tract gradients & severe symtoms despite medical tx. What are 3 surgical strategies?
What treatment if still symptomatic?
-septal myomectomy
-cardiac cath w/ injection to induce ischemia to septal perforator arteries
-echo guided percutaneous septal ablation
If still symptomatic, MVR can be done to counteract systolic anterior motion of mitral leaflet
48
What underlying pathologies are common in HF pts with EKG abnormalities?
LVH, previous MI, arrhythmias and conduction abnormalities
S16
Which medication is effective in rapidly decreasing afterload?
Which medicatioin is used as an adjunct to diurectic therapy?
- SNP
- NTG
Slide 30
T or F?
Myocardial ischemia is present in Hypertrophic cardiomyoapthy whether or not they have CAD
True
45
hypertrophic cardiomyopathy
What is the primary tx for pt at risk for death r/t dysrhytmias?
ICD placement!
48
Dysthytmias are the most sudden cause of death in young pts w/ hypertrophic cardiomyopathy. What causes dysrthymias?
disorganized cellular architecture, scarring, and an expanded interstitial matrix
45
What are the 6 most common inotropic drugs used in AHF? (chart)
32 - AHF
What characterizes dilated cardiomyoapthy
what is the initial symptom?
LV [or biventricular] dilation, biatrial dilation, decreased ventricular wall thickness, and systolic dysfunction
initial symptom–> HF (CP may occur as well)
46
What is the first line of treatment for AHF should be given immediately in pts with fluid overload to mitigate?
Diuretics
Slide 29
What is class of medication emerged as potential adjunct therapy, to reduce the arterial constriction, hyponatremia, and the volume overload associated with AHF?
Vasopressin receptor antagonists
Slide 30
In asymptomatic patients, what is the only sign of Hypertrophic cardiomyopathy?
unexplained left ventricular hypertrophy
46
What Exogenous recombinant BNP binds to A and B-type natriuretic receptors?
Exogenous BNP: Nesiritide, a recombinant BNP that binds to A- and B-type natriuretic receptors
33 - AHF
What are some diagnostic abnormalities in patients w/ hypertrophic cardiomyopathy?
hint: ekg and echo
EKG abnormalities (75-90% pt) show high QRS voltage, ST segment and T wave abnormalities, abnormal Q, and atrial enlargment
Echo: myocardial wall thickness >15mm; and EF >80%
terminal states: EF severely depressed
46
What is an example of Vasopressin receptor antagonists?
Tolvapatan
Slide 30
True of false: An AHF patient with hypotension or cardiogenic shock may first require hemodynamic support prior to diuretic therapy.
True
29
dilated cardiomyoapthy
Ventricular dilation may lead to what 2 valve abnormalities?
mitral and tricuspic regurgitation
49
Which diagnostic testing has low predictive value for diagnosis or risk- prediction of heart failure?
EKG alone
S16
What are the diruetic given as a bolus followup by a continous infusion
Furosemide
Bumetanide
Torsemide
given as bolus or continuous infusions
Slide 29
hypertrophic cardiomyopathy
Cardiac catherization allows direct measurement of ______ ____?
left ventricular end diastolic pressure
46
Common complications in dilated cardiomyopathy? (4)
dysrhythmias, conduction abnormalities, emboli and sudden death
49
Medical treatment for hypertrophic cardiomyopathy (4)
-BB, CCB
-if develop HF–> diuretics
-disopyramide (add on if still symptomatic)
-amiodarone if develops dysrhythmias! (most effective)
disopyramide has negative inotropic effect- improves LV outflow obsructi
47
When medical management fails and organ dysfunction occurs, urgent _________ ___________ __________ (MCS) is indicated.
When medical management fails and organ dysfunction occurs, urgent mechanical circulatory support (MCS) is indicated
34 - AHF
Reducing in_________ _________ leads to decreased________ ________ and ________ _______ _________ __________ (______), reducing pulmonary congestion.
intravascular volume
central venous
pulmonary capillary wedge pressures (PCWP)
Slide 29
Common echo and EKF findings in dilated cardiomyopathy are?
- echo: dilation of all 4 chambers, especially the LV. Global hypokinesis
- EKG: ST and T wave abnormalities w/ LBBB
- comon dyrhythmias: PVC and AFIB
50
What complication that develops in hypertrophic cardiomyopathy is associated w/ increased risk of thromboembolism, HF and death?
What is the treatment
a-fib–> amiodarone!
Need long term anticoagulation if chronic
47
The Society of Thoracic Surgeons (STS) developed a MCS decision-making tool based on pt clinical profiles. What is that tool or Profile System called?
Inter-agency Registry of Mechanically Assisted Circulatory Support
INTERMACS Profile System
34 - AHF
Treatment for dilated cardiomyopathy
Tx is similiar to chronic HF. AC initiated as well.
Prophylactic ICD–> decreases sudden death by 50%
Ultimately–> cardiac transplant :( (DCM is the main indication for transplant)
50
What are some examples of catecholamines being use for Acute HF treatment?
epinephrine
norepinephrine
dopamine
dobutamine
Slide 31
What is a class of medication indirectly increase cAMP by inhibiting its degradation to help treat acute HF?
What is an example of this medication ?
PDE-inhibitors
milrinone
Slide 31
Stress cardiomyopathy aka apical ballooning syndrome is a temporary primary cardiomyopathy characterized by what abnormalities?
LV apical hypokinesis and ischemic EKG changes (coronary arteries are still patent)
-Temporary dysruption of contractility in LV apex (and rest of heart has normal contractility)
51
___________ _______________ Pump: functions by cyclic ____________balloon inflation after ________ valve closure, followed by deflation during __________
Intraaortic Balloon Pump (IABP): functions by cyclic helium balloon inflation after aortic valve closure, followed by deflation during systole
35 - AHF
Common symptoms in stress cardiomyopathy? What is the most common cause?
chest pain, dyspnea.
Stress is most common cause
women > men
51
IABP improves LV coronary perfusion by ____________ LVEDP
____________and x-ray are the primary modes for placement evaluation
IABP improve LV coronary perfusion by **reducing **LVEDP
TEE and x-ray are the primary modes for placement evaluation
35 - AHF
IABP degree of support varies because of the set ____________, the ________ of the balloon, and the ____________ of supported beats
IABP degree of support varies b/o the set volume, the size of the balloon, and the ratio of supported beats
35 - AHF
Full IABP support would be 1:1 (one inflation for every heartbeat)
In tachycardic pts, a setting of __:__
(________ inflation per every________ heartbeats) is ideal
Full support would be 1:1 (one inflation for every heartbeat)
In tachycardic pts, a setting of 1:2 (one inflation per every two heartbeats) is ideal
35 - AHF
IABP provides only ____________ improvements in cardiac output
(_____-_____ L/min) and render pts immobile, limiting its long-term use
Overall, IABP provides only modest improvements in cardiac output (0.5–1 L/min) and render pts immobile, limiting its long-term use
35 - AHF
What is a Ventricular Assist Device (VAD) that can be placed percutaneously to reduce LV strain and myocardial work in the setting of acute heart failure?
Impella
36 - AHF
How long can an Impella be left in a patient for?
Can be utilized for up to 14 days
36 - AHF
An Impella serves a transition to ____________ or a bridge to ____________ procedures.
What are the four procedures mentioned on this slide?
Serves as a transition torecovery
Bridge to cardiac procedures (CABG, PCI, VAD, transplant)
36 - AHF
The Impella consists of a miniature ____________ blood pump inserted through the ____________ artery, advanced through the aortic valve and is situated in the ______
The Impella consists of a miniature rotary blood pump inserted through the **femoral **artery, advanced through the aortic valve and is situated in the LV
36 - AHF
The Impella pump draws blood continuously from the LV through the ________port and ejects it into the ascending aorta through its ____________ port
The Impella pump draws blood continuously from the LV through the distal port and ejects it into the ascending aorta through its proximal port
36- AHF
____________ VAD: support devices that can provide extracorporeal membrane oxygenation (ECMO)
Consists of a small pump & controller, which is helpful for transport, but generates ________, causing more ________ and lower flows.
Peripheral VAD: support devices that can provide extracorporeal membrane oxygenation (ECMO)
Consists of a small pump & controller, which is helpful for transport, but generates heat, causing more hemolysis and lower flows
38 - AHF
Peripheral VAD: If these devices have an ____________, they are considered ECMO, and used to support the right or left side of the heart
If these devices have an oxygenator, they are considered ECMO, as opposed to having no oxygenator, but used to support the right or left side of the heart
38 - AHF
What VAD/ECMO device is necessary for cardiorespiratory support or as an alternative to Peripheral VAD/ECMO?
Why would we use this device over Peripheral VAD/ECMO?
Central ECMO may be necessary for cardiorespiratory support or as an alternative to peripheral ECMO
We would use Central ECMO if adequate flow rates are not achievable with Peripheral VAD.
36 - AHF
Where are Central VAD/ECMO devices placed (2 spots)?
How are these spots surgically accessed?
Central cannulas are placed in the right atrium and aorta
Accessed:
Invasive and require sternotomy or thoracotomy for placement
36 - AHF
What are the three benefits of Central VAD/ECMO?
Benefits:
1. complete ventricular decompression
2. avoidance of limb impairment
3. avoidance of SVC syndrome
36 - AHF
T/F
Pts on ECMO likely have increased lung perfusion as blood bypasses the lungs before returning to the aorta
FALSE
Pts on ECMO likely have reduced lung perfusion as blood bypasses the lungs before returning to the aorta
39 - AHF
Due to ECMO ____________anesthetics may be significantly limited by functional shunting around the lungs
For this reason what other anesthetic techniques are considered?
**Inhaled anesthetics **may be significantly limited by functional shunting around the lungs
higher amount of inhaled anesthetics may be required
TIVA should be considered for pts on ECMO
39 - AHF
The CRNA should recognize that the ECMO membrane is ____________, causing many agents, including fentanyl, to become ____________within the circuit.
CRNA must recognize that the ECMO membrane is lipophilic, causing many agents, including fentanyl, to become sequesteredwithin the circuit
39 - AHF
- Peripheral VAD = __________ membrane oxygenation (ECMO)
- Consists of a small pump & controller = helpful for _______,
- but generates ____»_space; ______ and lower flows
- If oxygenator = ECMO,
- no oxygenator = used to ______ R or L heart
AHF Surgical Treatment
- extracorpeal
- transport
- heat … hemolysis
- support
Cetnral VAD/ECMO
- cannulas placed in ___ atrium + aorta
- invasive _____ / ______ to place
- benefits = complete _____ decompresion ,, avoid ____ impairment ,, avoid ____ syndrome
AHF Surgical Treatment
- Right
- sternotomy / thoracotomy
- ventriuclar ,, limb ,, SVC
ECMO
- Pts on ECMO have reduced ____ perfusion bc blood bypasses before returning to aorta
- Inhaled Anes = ____ bc of shunting
- _____ should be considered for ECMO pts
- ECMO membrane = ____ + may cause agents like ____ to become sequestered within circuit
AHF Surgical Tx
- lung
- limited
- TIVA
- lipophilic ,, fentanyl
Biventricular Assist Device
- Used to _____ support of ventricles with 2 independent circuits
- This allows for ______ of either L or R sided support
- separate circuits achieved by _____ placement
- R + L sides can be centrally ______ individually
AHF Surgical Tx
- decouple
- weaning
- percutaneous
- cannulated
- HF pts have increased risk of :: ___ failure, ______, pna, + require longer periods of ______ _________
- Comprehensive preop exam to determine if ______ or require treatment
- 3 reasons to POSTPONE surgery ??
AHF Preoperative Mgmt
- Renal failure ,, sepsis ,, mechanical ventilation
- compensated
- decompensation ,, change in status ,, De Novo AHF
- ____ held on day of surgery
- continue ____ bc it’s managment is essential
- ______ put pt at risk for intraop Hotn
- perform a _______ if worsening dyspnea
- 4 labs necessary ??
- ____ lab is not routine
- ICDs and Pacemakers should be ______ prior to surgery
AHF Preoperative Mgmt
- Diuretics
- Beta blockers
- ACE-I
- TTE – echo
- CBC , lytes , LFTs , coagulation
- BNP
- interrogated
- Group of myocardial disease with ___________ or _____ dysfx
- These exhibit as ventricular __________ or ________
- Cardiomyopathy is either confined to __________ (primary) or part of _____ disorders (secondary)
Cardiomyopathies
- mechanical or electrical
- hypertrophy or dilation
- heart or systemic
- affects all ___
- most common ______ CV disease
- characterized by _____ + absence of other diseases that could cause it
- presents with hypertrophy of the ___________________ and ________________
- Histologic features are hypertrophied ____ cells and ________ myocardial scarring
Hypertrophic Cardiomyopathy
- ages
- genetic
- L Ventricle Hypertrophy
- intraventricular septum and antero-lateral free wall
- myocardial ,, patchy
