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Health Assessment (Spring 2023) > Exam 4 (HTN & CHF) > Flashcards

Exam 4 (HTN & CHF) Flashcards

1
Q

The MOST COMMON physiologic causes of secondary hypertension in children are: (SELECT 2)

A) obstructive sleep apnea.
B) renal parenchymal disease.
C) coarctation of the aorta.
D) thyroid dysfunction.

A

B) Renal parenchymal disease
C) Coarctation of the aorta

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2
Q

Which drug class is resevered for patients with tachydysrhythmias with a history of hypertension?

A) ACE inhibitors
B) Beta blockers
C) Angiotensin receptor blockers
D) Calcium channel blockers

A

B) Beta blockers

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3
Q

Heart failure is MOST OFTEN a result of: (Select 2).

A) reactive airway disease.
B) ischemic heart disease.
C) decreased SNS output.
D) systemic hypertension.

A

B) Ischemic heart disease
D) Systemic hypertension

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4
Q

In a pregnancy-induced hypertensive crisis, which medication is considered first-line?

A) Hydralazine
B) Nitroglycerin
C) Sodium nitroprusside
D) Labetalol

A

D) Labetalol

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5
Q

Isolated diastolic hypertension consists of: (SELECT 2)

A) diastolic blood pressure < 80 mm Hg.
B) diastolic blood pressure > 80 mm Hg.
C) systolic blood pressure > 130 mm Hg.
D) systolic blood pressure < 130 mm Hg.

A

B) diastolic blood pressure > 80 mm Hg
D) Systolic blood pressure < 130 mm Hg

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6
Q

Onset of acute heart failure will include: (SELECT 2)

A) increased cardiac index.
B) increased stroke volume.
C) decreased blood pressure.
D) decreased cardiac output.

A

C) decreased blood pressure
D) Decreased cardiac output

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7
Q

In which classification of heart failure will a patient have moderately severe structural cardiovascular disease with limitation in activity due to clinical symptoms of heart failure?

A) Class C
B) Class B
C) Class D
D) Class A

A

A) Class C

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8
Q

In systolic heart failure with low cardiac output, increased cardiac output depends on what physiologic change?

A) Increased systemic vascular resistance
B) Decreased stroke volume
C) Decreased cardiac index
D) Increased heart rate

A

D) Increased heart rate

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9
Q

What all happens in left atrial systolic & diastolic dysfunction?

A
  • Reduced LV compliance or increased LV pressures
  • LA pressure increases to preserve LV filling
  • Frank-Starling mechanism in LA
  • LA dilation and reduced compliance
  • Reduced LA filling
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10
Q

What are some of the causes of systolic heart failure?

A
  • CAD
  • Dilated cardiomyopathy
  • Chronic pressure overload from aortic stenosis or chronic HTN
  • Chronic volume overload from regurgitant valvular lesions or high-output cardiac failure
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11
Q

What is the hallmark sign of systolic heart failure?

A

Decreased EF - ≤40%

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12
Q

What are some causes of diastolic heart failure?

A
  • IHD
  • long-standing systemic HTN
  • progressive aortic stenosis
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13
Q

What is Class 1 diastolic heart failure?

A

Class I - abnormal LV relaxation pattern with normal left atrial pressure

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14
Q

BNP is secreted from the?

A

Atrial and ventricular myocardium

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15
Q

What are the physiologic effects of natriuretic peptides?

A
  • Diuresis
  • natriuresis
  • vasodilation
  • anti-inflammatory effects
  • inhibition of the RAAS and SNS
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16
Q

What are the functions of ANP and BNP?

A

They inhibit cardiac hypertrophy and fibrosis

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17
Q

Eccentric hypertrophy happens due to?

A

Volume overload

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18
Q

Concentric hypertrophy happens due to?

A

Chronic pressure overload

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19
Q

What is the gold standard for CHF diagnosis?

A

TEE is gold standard to diagnose HF.

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20
Q

What is the difference between HFrEF & HFpEF?

A
  • HFrEF): EF ≤ 40% & it is a pumping problem
  • HFpEF): EF ≥ 50% & it is a filling issue
21
Q

What BNP levels are indicative of HF?

A

> 500 pg/mL (90% positive predictive value)

22
Q

At what BNP level could someone present with dyspnea?

A

300 pg/mL

23
Q

What defines NYHA Class 1?

A

No limitation of physical activity

24
Q

What defines NYHA Class 2?

A

Slight limitation of physical activity. Comfortable at rest; activity may cause clinical symptoms.

25
Q

What defines NYHA Class 3?

A
  • Marked limitation of physical activity.
  • Comfortable at rest; low physical activity causes clinical symptoms.
26
Q

What defines NYHA Class 4?

A
  • Unable to perform any physical activity without symptoms & has symptoms at rest
27
Q

What defines ACC/AHA class A?

A
  • No structural evidence of CV disease.
  • No functional limitation in ordinary physical activity.
28
Q

What defines ACC/AHA class B?

A
  • Evidence of minimal structural CV disease.
  • Comfortable at rest but slight limitation during ordinary activity.
29
Q

What defines ACC/AHA class C?

A
  • Evidence of moderately severe structural CV disease.
  • Comfortable only at rest w/ limitation in activity d/t clinical symptoms.
30
Q

What defines ACC/AHA class D?

A
  • Objective evidence of severe structural CV disease.
  • Clinical symptoms at rest.
31
Q

What are the S/S of acute HF?

A
  • High ventricular filling pressures
  • Low CO
  • HTN or hypotension
32
Q

What 3 types of drugs are used in acute HF?

A
  • Diuretics: Loop diuretics improve symptoms rapidly
  • Vasodilators: Nitroglycerin and nitroprusside
  • Inotropic drugs: Epinephrine, norepinephrine, dopamine, dobutamine, or phosphodiesterase inhibitors
33
Q

What INTERMACS class/es need/s immediate support?

A

Class 1 & 2

34
Q

What diuretic family is recommended for HF therapy?

A

Thiazide and/or loop diuretics

35
Q

What is the first-line therapy for patients presenting in acute heart failure?

A

Diuretics

36
Q

Beta blockers are beneficial for what type of HF

A

Beneficial for the treatment of HFrEF

37
Q

ACE-I are recommended for what kind of HF?

A

HFrEF

38
Q

What medication combination has a favorably long-term outcome for HF?

A

Therapy with ACE-I and β-blockers

39
Q

For whom are ARBs useful when it comes to HF?

A

Useful for control of arterial pressure in patients with HTN and HFpEF

40
Q

How do vasodilators help a CHF Pt?

A

Decreases resistance to LV ejection → results in increased SV and decreased ventricular filling pressures

41
Q

What are the qualifications for a PPM?

A
  • NYHA 3 or 4 &
  • LVEF < 35% &
  • QRS duration of 120–150 milliseconds
42
Q

What is the gold standard for surgical management of HF?

A

Cardiac transplantation

43
Q

What is bridge to recovery?

A

Require temporary ventricular assistance to allow the heart to recover its function

44
Q

What is bridge to therapy?

A

Awaiting cardiac transplantation

45
Q

What is the bridge to decision stage?

A

Pt is on inotropic drugs or IABP with potentially reversible medical conditions

46
Q

What is the destination therapy stage?

A

Advanced HF who are not transplant candidates → LVAD

47
Q

When are diuretics D/C’ed for someone w/ HF going for surgery?

A

D/C diuretics on the day of surgery

48
Q

What would be the best anesthesia type for someone with HF

A

Neuraxial anesthesia – might be best but may depend on surgeon & Pt compliance

Health Assessment (Spring 2023) (11 decks)

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