Exam 4 (HTN & CHF) Flashcards
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.
B) Renal parenchymal disease
C) Coarctation of the aorta
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
B) Beta blockers
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.
B) Ischemic heart disease
D) Systemic hypertension
In a pregnancy-induced hypertensive crisis, which medication is considered first-line?
A) Hydralazine
B) Nitroglycerin
C) Sodium nitroprusside
D) Labetalol
D) Labetalol
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.
B) diastolic blood pressure > 80 mm Hg
D) Systolic blood pressure < 130 mm Hg
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.
C) decreased blood pressure
D) Decreased cardiac output
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) Class C
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
D) Increased heart rate
What all happens in left atrial systolic & diastolic dysfunction?
- 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
What are some of the causes of systolic heart failure?
- CAD
- Dilated cardiomyopathy
- Chronic pressure overload from aortic stenosis or chronic HTN
- Chronic volume overload from regurgitant valvular lesions or high-output cardiac failure
What is the hallmark sign of systolic heart failure?
Decreased EF - ≤40%
What are some causes of diastolic heart failure?
- IHD
- long-standing systemic HTN
- progressive aortic stenosis
What is Class 1 diastolic heart failure?
Class I - abnormal LV relaxation pattern with normal left atrial pressure
BNP is secreted from the?
Atrial and ventricular myocardium
What are the physiologic effects of natriuretic peptides?
- Diuresis
- natriuresis
- vasodilation
- anti-inflammatory effects
- inhibition of the RAAS and SNS
What are the functions of ANP and BNP?
They inhibit cardiac hypertrophy and fibrosis
Eccentric hypertrophy happens due to?
Volume overload
Concentric hypertrophy happens due to?
Chronic pressure overload
What is the gold standard for CHF diagnosis?
TEE is gold standard to diagnose HF.
What is the difference between HFrEF & HFpEF?
- HFrEF): EF ≤ 40% & it is a pumping problem
- HFpEF): EF ≥ 50% & it is a filling issue
What BNP levels are indicative of HF?
> 500 pg/mL (90% positive predictive value)
At what BNP level could someone present with dyspnea?
300 pg/mL
What defines NYHA Class 1?
No limitation of physical activity
What defines NYHA Class 2?
Slight limitation of physical activity. Comfortable at rest; activity may cause clinical symptoms.
What defines NYHA Class 3?
- Marked limitation of physical activity.
- Comfortable at rest; low physical activity causes clinical symptoms.
What defines NYHA Class 4?
- Unable to perform any physical activity without symptoms & has symptoms at rest
What defines ACC/AHA class A?
- No structural evidence of CV disease.
- No functional limitation in ordinary physical activity.
What defines ACC/AHA class B?
- Evidence of minimal structural CV disease.
- Comfortable at rest but slight limitation during ordinary activity.
What defines ACC/AHA class C?
- Evidence of moderately severe structural CV disease.
- Comfortable only at rest w/ limitation in activity d/t clinical symptoms.
What defines ACC/AHA class D?
- Objective evidence of severe structural CV disease.
- Clinical symptoms at rest.
What are the S/S of acute HF?
- High ventricular filling pressures
- Low CO
- HTN or hypotension
What 3 types of drugs are used in acute HF?
- Diuretics: Loop diuretics improve symptoms rapidly
- Vasodilators: Nitroglycerin and nitroprusside
- Inotropic drugs: Epinephrine, norepinephrine, dopamine, dobutamine, or phosphodiesterase inhibitors
What INTERMACS class/es need/s immediate support?
Class 1 & 2
What diuretic family is recommended for HF therapy?
Thiazide and/or loop diuretics
What is the first-line therapy for patients presenting in acute heart failure?
Diuretics
Beta blockers are beneficial for what type of HF
Beneficial for the treatment of HFrEF
ACE-I are recommended for what kind of HF?
HFrEF
What medication combination has a favorably long-term outcome for HF?
Therapy with ACE-I and β-blockers
For whom are ARBs useful when it comes to HF?
Useful for control of arterial pressure in patients with HTN and HFpEF
How do vasodilators help a CHF Pt?
Decreases resistance to LV ejection → results in increased SV and decreased ventricular filling pressures
What are the qualifications for a PPM?
- NYHA 3 or 4 &
- LVEF < 35% &
- QRS duration of 120–150 milliseconds
What is the gold standard for surgical management of HF?
Cardiac transplantation
What is bridge to recovery?
Require temporary ventricular assistance to allow the heart to recover its function
What is bridge to therapy?
Awaiting cardiac transplantation
What is the bridge to decision stage?
Pt is on inotropic drugs or IABP with potentially reversible medical conditions
What is the destination therapy stage?
Advanced HF who are not transplant candidates → LVAD
When are diuretics D/C’ed for someone w/ HF going for surgery?
D/C diuretics on the day of surgery
What would be the best anesthesia type for someone with HF
Neuraxial anesthesia – might be best but may depend on surgeon & Pt compliance
