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Mar: Sem 2 - Health Assessment > Exam 4 Heart Failure Part 2 Ashley > Flashcards

Exam 4 Heart Failure Part 2 Ashley Flashcards

1
Q

What is the mainstay Tx for patients who have acute reduced contractility or cardiogenic shock?

A

Positive Inotropes

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2
Q

Several inotropes increase ____, which increases intracellular ____ and ____

A

cAMP
Ca
excitation-contraction coupling

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3
Q

Catecholamines stimulate ____ receptors on the ____ to activate ____ to increase ____

A

beta
myocardium
adenylyl cyclase
cAMP

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4
Q

PDE inhibitors ____ increase cAMP by inhibiting its degredation

A

indirectly

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5
Q

Epinephrine v. NE
MOA
CO
MAP
HR

CHART ALERT!

A

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6
Q

Dobutamine, dopamine, milrinone, levosimendan
MOA
CO
MAP
HR

CHART

A

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7
Q

What is another name for exogenous BNP?
How does it work?

A

Nesiritide
recombinant BNP that binds to A- and B-type natriuretic receptors, inhibiting the RAAS and promotingarterial, venous, and coronary vasodilation, decreasing LVEDP and improving dyspnea
It also induces diuresis and natriuresis, relaxes cardiac muscle, and lacks any dysrhythmic effects

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8
Q

Nesiritide has not shown advantage over traditional vasodilators such as ____ & ____

A

NTG and SNP

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9
Q

What is indicate for acute HF when medical management fails and organ dysfunction occurs?

A

Urgent mechanical circulatory support

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10
Q

The Society of Thoracic Surgeons developes ____ which is a mechanical circulatory support decision making tool based on pt clinical profiles

A

INTERMACS
Inter-agency Registry of Mechanically Assisted Circultorary Support

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11
Q

How does intra-aortic balloon pump function?

A

cyclic helium balloon inflation after aortic valve closure, followed by deflation during systole

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12
Q

IABP improves what 2 things?

A

LV coronary perfusion and reduces LVEDP

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13
Q

What is used as the primary mode for placement evaluation of an IABP?

A

TEE and XRAY

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14
Q

IABP degree of support varies based on the ____, ____ and ____

A

set volume, size of the balloon, and ratio of supported beats

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15
Q

Full support with IABP is a ____ ratio
____ratio is ideal for tachycardic patients

A

1:1
1:2

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16
Q

IABP only provides ____ improvememnts in CO (____)
it renders patients ____ so it does not have good ____ use

A

modest
0.5-1
immobile
long-term

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17
Q

____ is a VAD that can be placed percutaneously to reduce LV strain and myocardial work in the setting of acute heart failure

A

Impella

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18
Q

How long can impella be used for?
What does it serve as?

A

14 days
transition to recovery or a bridge to a cardiac procedure (CABG, PCI, VAD, transplant)

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19
Q

impella consists of miniature ____ inserted through the ____ artery, advanced through the ____ and is situated in the ____

A

rotary blood pump
femoral
AV valve
LV

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20
Q

the impella draws blood from the ____ through the ____ port and ejects it into the ____ through the ____ port

A

LV
distal
ascending aorta
proximal

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21
Q

Impella is also known as what?

A

The world’s smallest heart pump

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22
Q

____ is a support devices that can provide extracorporeal membrane oxygenation (ECMO)

A

Peripheral VAD

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23
Q

A peripheral VAD consists of a small pump and controller which is helpful for ____, but it generates ____ causing more ____ and ____

A

transport
heat
hemolysis
lower flows

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24
Q

If the peripheral VAD has an oxygenator it can be considered ____
If there is no oxygenator it is just used to ____

A

ECMO
support the right or left side of the heart

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25
Q

If we cant achieve adequate flows w/ peripheral VAD, ____ then ____ may be necessary

A

Central VAD/ECMO

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26
Q

A central VAD/ECMO has cannulas placed in the ____ and ____
it is invasive and requires ____ or ____ for placement
What are the benefits?

A

RA, aorta
sternotomy, thoracotomy
benefits: complete ventricular decompression, avoidance of limb impairment, and avoidance of SVC syndrome

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27
Q

T/F
Pts on ECMO do not have reduced lung perfusion

A

False
Pts on ECMO likely have reduced lung perfusion as blood bypasses the lungs before returning to the aorta

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28
Q

inahled anesthetics may be signficantly limited by ____ around the lungs

A

functional shunting

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29
Q

What type of anesthetic should be considered for patients on ECMO?

A

TIVA

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30
Q

Since the ECMO membrane is ____, many of our drugs including ____ will become ____ in the circuit

A

lipophilic
fentanyl
sequestered

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31
Q

Once a patient on ECMO is stabilized, what can we do to start weaning?

A

decouple support of the ventricles with two independent circuits to allow for weaning of either the left- or right-sided support

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32
Q

How do separate circuits be achieved with ECMO?

A

percutaneous placement to support the right and left sides separately

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33
Q

What is another alternative method for separating the assistance of the L and R sides of the heart?

A

The right and left sides can be centrally cannulated individually

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34
Q

HF patients are at increased risk for developing what 4 things?
They require longer periods of ____ and have an overall increased ____ day mortality

A

Renal failure
sepsis
pneumonia
cardiac arrest
mechanical ventilation
30

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35
Q

Pre-op, we need to examine whether HF patients are ____ or require ____

A

compensated
treatment

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36
Q

Surgery for HF should be postponed in what 3 scenarios?

A

decompensation
a recent change in clinical status
in de novo acute heart failure

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37
Q

Which medications reduce peri-operative morbidity and mortality?

A

Beta blockers

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38
Q

generally, which type of medications used for HF should be held on the day of the surgery?

A

Diuretics

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39
Q

Because ACE inhibitors increase the risk of HoTN, the AHA guidelines reccommend discontinuing ACE inhibitors before surgery. T/F?

A

False- maintain therapy peri-operatively

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40
Q

EKG is recommended in any patient with ____ disease

A

cardiovascular

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41
Q

TTE is indicated in patients with ____ during their pre-op eval

A

worsening dyspnea

Slide 42

42
Q

What labs are recommended in HF patients?
Which labs are not routinely recommended?

A

CBC, electrolytes, liver function, and coag studies
BNP is not routinely recommended

Slide 42

43
Q

Which devices should be interrogated prior to surgery?

A

ICD’s and pacemakers

Slide 42

44
Q

Cardiomyopathies have ____ or ____ dysfunction and usually exhibit ventricular ____ or ____

A

mechanical or electrical
hypertrophy or dilation

Slide 43

45
Q

2 groups that cardiomyopathies can be divided into. Define them

A

Primary: confined to the heart muscle
secondary: pathophysiologic cardiac involvement in the context of multiorgan disorder

Slide 43

46
Q

hypertrophic Cardiomyopathy affects ____ ages and has a prevalence of about ____ per 1,000 people

A

all
2-5

Slide 44

47
Q

What is the most common genetic cardiovascular disease?

A

Hypertrophic cardiomyopathy

Slide 44

48
Q

Hypertrophic cardiomyopathy is characterized by ____ in the absence of other diseases capable of inducing ____

A

LVH
ventricular hypertrophy

Slide 44

49
Q

Hypertrophic cardiomyopathy usually presents with hypertrophy of which portions of the LV?

A

interventricular septum
anterolateral free wall

Slide 44

50
Q

What are histological features of hypertrophic cardiomyopathy?

A

hypertrophied myocardial cells and patchy myocardial scarring

Slide 44

51
Q

What are 6 phathophysiological features that hypertrophic cardiomopathies can cause?

A

myocardial hypertrophy
dynamic LVOT obstruction
mitral regurgitation
diastolic dysfunction
myocardial ischemia
dysrhythmias

Slide 45

52
Q

hypertrophied myocardium has a ____ relaxation time and ____ compliance

A

prolonged
decreased

Slide 45

53
Q

T/F
Myocardial ischemia is present in patients with hypertrophic cardiomyopathy regardless of whether or not they have CAD

A

True

Slide 45

54
Q

What is the cause of sudden death in HCM?

A

Dysrythmias

Slide 45

55
Q

What causes dysrhythmias in HCM?

A

disorganized cellular architecture, myocardial scarring, and an expanded interstitial matrix

Slide 45

56
Q

If patients with HCM are asymptomatic, what may be the only sign?

A

LVH

Slide 46

57
Q

HCM patients have ____ seen in 75-90% of them.
This includes what 5 things?

A

EKG abnormalities
high QRS voltage, ST segment alterations, T wave alterations, abnormal Q waves, and LA enlargement

Slide 46

58
Q

HCM
wall thickness in Echo is ____
EF is ____ reflecting ____, except in patients in ____ states where EF is ____

A

>15mm
>80%
hypercontractility
Terminal, severely depressed

Slide 46

59
Q

How can we directly measure LVEDP??

A

Cardiac Catheterization

Slide 46

60
Q

The initial medical therapy for HCM is ____ and ____. If patients develop HF despite management with these meds, they may show improvement with ____

A

BB and CCB
diuretics

Slide 47

61
Q

after giving BB, CCB, and diuretics, patients who have HCM may consider ____ as an add-on therapy.
it has ____ intotropic effects which improves ____ obstruction and heart failure symptoms

A

Disopyramide
negative
LVOT

Slide 47

62
Q

what common dysrhthmia develops with HCM? what does this put them at risk for?
What is the most effective anti-dysrhythmic treatment in these pts?

A

A-fib
thromboembolism, HF, and sudden death
amiodarone

Slide 47

63
Q

long-term anticoagulation is indicated for recurrent or chronic ____

A

a fib

Slide 47

64
Q

This subgroup of patients in HCM can be treated with surgery

A

HCM with Large outflow tract gradients and severe symptoms despite treatment

Slide 48

65
Q

What are the 3 surgical strategies for HCM?

A

septal myomectomy
cardiac cath w/injection to induce ischemia of the septal perforator arteries
echocardiogram-guided percutaneous septal ablation

Slide 48

66
Q

A ____ can be inserted to counteract the systolic anterior motion of the mitral leaflet in ____ patients

A

prosthetic mitral valve
HCM

Slide 48

67
Q

What is the primary treatment for patients at risk for sudden cardiac death d/t dysrhythmias

A

ICD placement

Slide 48

68
Q

Dilated Cardiomyopthy is a PRIMARY myocardial disease characterized by what 4 abnormalities?

A

by LV or biventricular dilatation, biatrial dilation, decreased ventricular wall thickness, and systolic dysfunction w/o abnormal loading conditions or CAD

Slide 49

69
Q

What is the initial symptom of dilated cardiomyopathy (DCM)?

A

HF, chest pain may also occur

Slide 49

70
Q

DCM

What leads to mitral or tricuspid regurg?

A

ventricular dilation

Slide 49

71
Q

What is common with DCM?

A

dysrhythmias, conduction abnormalities, emboli, and sudden death

Slide 49

72
Q

Echo in pts with DCM reveals dilation of ____ chambers, predominantly the ____ as well as ____ ____

A

all
LV
global hypokinesis

Slide 50

73
Q

What is the treatment of DCM similar to?
What is an addition that is commonly initatied?

A

HF
anti-coagulation

Slide 50

74
Q

EKG of DCM shows ____, ____, and ____

A

ST segment abnormalities
T wave abnormalities
LBBB

Slide 50

75
Q

What are common dysrhythmias seen in DCM?

A

PVC and A fib

76
Q

Prophylactic ____ placement decreases risk of sudden death by ____% in DCM

A

ICD
50%

Slide 50

77
Q

What is the principle indication for cardiac transplant?

A

DCM

Slide 50

78
Q

Stress cardiomyopthy is also known as ____ and is a ____ primary cardiomyopathy characterized by LV apical hypokinesis w/ischemic EKG changes, however the coronary arteries remain patent

A

Apical ballooning syndrome
temporary

Slide 51

79
Q

Stress cardiomyopthy has a temporary dysruption in the contractility in the ____ while the rest of the heart has normal contractility

A

LV apex

Slide 51

80
Q

what are common symptoms of stress cardiomyopathy?
What is the main causative factor?
Which population has higher amounts?

A

chest pain and dyspnea
stress (physical or emotional)
Women more than men

81
Q

What is a rare type of primary cardiomyopathy?
What kind of cardiomyopathy is it?
When does it arise?

A

peripartum cardiomyopathy
dilated
3rd trimeester to 5months post-partum

Slide 52

82
Q

Peripartum cardiomyopathy is diagnosed based on what 3 criteria?
What diagnostic studies can we do?

A

development of HF in the period surrounding delivery
absence of another explainable cause
LV systolic dysfunction with a LVEF <45%
Dx studies include:EKG, Echocardiogram, CXR, cardiac MRI, cardiac cath, endomyocardial biopsy& BMP levels

slide 52

83
Q

Secondary cardiomyopathies are d/t ____ that produce myocardial infiltration and severe diastolic dysfunction.

A

systemic diseases

84
Q

What is the most common cause of secondary cardiomyopathy?
Other causes?

A

amyloidosis
Other causes: hemochromatosis, sarcoidosis, and carcinoid tumors

Slide 53

85
Q

Secondary cardiomyopathy should be considered in patients who have HF, but no evidence of what?

A

cardiomegaly or systolic dysfunction

Slide 53

86
Q

What is the BP in patients with secondary cardiomyopathy? what can patients develop?

A

low to normal
orthostatic hypotension

Slide 53

87
Q

How are primary cardiomyopathies classified?

A

Genetic
Mixed
Acquired
Other

Slide 54

88
Q

How are secondary cardiomyopathies classified?

A

infiltrative
storage
toxic
inflammatory
endomyocardial
endocrine
neuromuscular
autoimmune

Slide 55

89
Q

____ is RV enlargement (hypertrophy and/or dilatation) that may progress to right-sided heart failure

A

Cor Pulmonale

Slide 56

90
Q

What are common causes of Cor Pulmonale?

A

Causes:pulmonary hypertension,myocardial disease, congenital heart disease, or any significant respiratory, connective tissue, or chronic thromboembolic disease

Slide 56

91
Q

What is the most common cuase of Cor Pulmonale?

A

COPD

Slide 56

92
Q

EKG changes with Cor Pulmonale

A

RA and RV enlargement
RA is suggested by peaked P waves in leads II, III, and aVF
Right axis deviation and RBBB are also often seen

Slide 56

93
Q

What diagonistics outside of EKG can be done for Cor Pulmonale?

A

TEE, Right heart cath, and CXR

Slide 56

94
Q

HF is a complex state in which the heart is unable to ____ or ____ blood at a rate appropriate to meet tissue requirements

A

Fill with or eject

Slide 58

95
Q

HFrEF is commonly d/t what problem?

A

Ischemic Heart Disease

Slide 58

96
Q

HFpEF is increasing in prevalence and is primarily the result of ____ lifestyle choices and ____

A

poor
comorbidities

Slide 58

97
Q

Factors that induce LVOT obstruction in HCM include what?

A

hypovolemia, tachycardia, increased myocardial contractility, and decreased afterload

Slide 59

98
Q

DCM is the most common form of ____ and is the ____ most common cause of HF

A

cardiomyopathy
2nd

Slide 59

99
Q

Cor Pulmonale is ____ enlargement that may progress to ____ HF. it is caused by dieseases that promote ____.

A

RV
Right HF
pulmonary HTN

Slide 59

100
Q

What is the most important determinant of pulmonary HTN and cor pulmonale in patients with chronic lung disease?
How do we treat it?

A

alveolar hypoxia
long-term oxygen therapy

Slide 59

Mar: Sem 2 - Health Assessment (32 decks)

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