Exam II: CHF, Cardiomuopathies, Pericardial Disease, Sepsis Flashcards
CHF: Inability of the heart to ___ and ___ blood sufficient to meet ___ ___.
fill and pump, tissue demands
CHF Symptoms
exertional ___
d___
c___
ankle swelling
dyspnea more in the supine position
h___
fatigue
dyspnea
congestion
hypoperfusion
CHF Causes
Cardiac valve abnormalities
Impaired ___ ___due to ischemic heart disease or cardiomyopathy
Systemic ___
Pulmonary hypertension (___ ___)
Pericardial disease
myocardial contractility, hypertension, cor pulmonale
Cor pulmonale is defined as an alteration in the ___ and ___ of the ___ ventricle caused by a primary disorder of the respiratory system.
structure, function, right
Pulmonary hypertension is the common link between ___ and ___.
lung dysfunction, the heart in cor pulmonale
Right-sided ventricular disease caused by a primary abnormality of the ___side of the heart or ___ is not considered cor pulmonale, but cor pulmonale can develop secondary to a wide variety of cardiopulmonary disease processes.
left, congenital heart disease
In chronic cor pulmonale,___ hypertrophy ___ generally predominates.
RV, (RVH)
What condition has these causes: emphysema, pulmonary thromboembolism, interstitial lung disease, adult respiratory distress syndrome, and rheumatoid disorders are associated with what disorder
Cor Pulmonale
Chronic obstructive pulmonary disorder is the most common cause of ___.
cor pulmonale
decreased ___ wall motion
[Systolic heart failure ]
ventricular
decreased ___(0.45) leads to the increased diastolic volume in the ___ ventricle
[Systolic heart failure ]
ejection fraction, left
___ contractility
[Systolic heart failure ]
decreased
inability to___
[Systolic heart failure ]
empty
Causes:
CAD – ischemia – local dysfunction
Chronic___ or ___
overload
P___
Toxins (ETOH, cocaine)
[Systolic heart failure ]
pressure or volume,
Pericardial disease,
Toxins (ETOH, cocaine)
Systolic heart failure is also called:
[Systolic heart failure ]
heart failure with reduced ejection fraction
Chronic pressure overload – ___ and ___
[Systolic heart failure]
aortic stenosis and chronic HTN
(notes slide 5)
Chronic volume overload – ___ and ___
[Systolic heart failure]
regurgitant valvular disease and high-output cardiac failure
(notes slide 5)
All other causes (other than ___/___ cause global dysfunction)
[Systolic heart failure]
CAD/ischemia
Hallmark of chronic LV systolic dysfunction is:
___ ___ ___
[Systolic heart failure]
Decreased ejection fraction
Higher LV volume required to produce
___ ___
[Systolic heart failure]
stroke volume
Loss of ___ ___ results
in stroke volume reduction
[Systolic heart failure]
inotropic force
Decreased compliance of the ___and inability to ___ at normal pressures.
[Diastolic heart failure]
LV, fill
Increased ___in a chamber of normal size.
[Diastolic heart failure]
pressures
Impaired ___ of the LV
inability to fill.
[Diastolic heart failure]
relaxation
Causes: CAD, HTN, aortic stenosis (___hypertrophy), ____ cardiomyopathy, pericardial disease, fibrosis, diabetes, aging
[Diastolic heart failure]
concentric, hypertrophic
Seen more in ___
[Diastolic heart failure]
females
Also called:___
[Diastolic heart failure]
heart failure with preserved ejection fraction
Increased LV pressure with __ ___
[Diastolic heart failure]
diastolic filling
Decreased ___filling due to decreased compliance.
[Diastolic heart failure]
LV
Decreased stroke volume due to decreased___volume
[Diastolic heart failure]
LVED
Age:
[Systolic HF versus Diastolic HF]
Sys: 50-70
Dia: Frequently elderly
Gender:
[Systolic HF versus Diastolic HF]
Sys: Male
Dia: Female
EF:
[Systolic HF versus Diastolic HF]
Sys: Depressed EF </= 40%
Dia: Preserved >/= 40%
Left ventricle:
[Systolic HF versus Diastolic HF]
Sys: Dilated LV
Dia: Concentric hypertrophy-nl size
Cause:
[Systolic HF versus Diastolic HF]
Sys: MI
Dia: HTN, diabètes obesity, chronic lung
LV Filling
[Systolic HF versus Diastolic HF]
Sys: Decreased wall motion, preserved filling
Dia: Non-compliant LV, resistant to filling
Systolic or ___
[Forms of heart failure]
diastolic
Acute or ___
[Forms of heart failure]
chronic
___ – sudden reduction in CO, systemic hypotension, no peripheral edema.
[Forms of heart failure]
Acute
Chronic – pre-existing long-term___, ___ congestion, BP maintained
[Forms of heart failure]
cardiac disease, venous, maintained
___ or right-sided
[Forms of heart failure]
Left-sided
___-___ (normal CI, but unable to respond to stress; caused by CAD, cardiomyopathy, HTN, valvular disease, pericardial disease)
[Forms of heart failure]
Low-output
High-output (a___, pregnancy, AV fistulas, severe ___, beri-beri)
[Forms of heart failure]
anemia, hyperthyroidism
Cardiac output – resting CO may be normal, but with exertion it can’t ___ or CO may be ___.
[Hemodynamic effects of CHF]
increase, decreased
Frank-Starling –___ ___ is decreased so a lower ___ ___ is produced at any given LVEDP.
[Hemodynamic effects of CHF]
Myocardial contractility, stroke volume
Inotropic state – ___is decreased due to depletion of ___ in the heart.
[Hemodynamic effects of CHF]
contractility, catecholamines
Afterload – increased ___ – (def: tension the ___muscle must develop to open the aortic or pulmonic valve)
[Hemodynamic effects of CHF]
vasoconstriction, ventricular
Heart rate – increased to raise ___because ___ ___ is fixed or decreased; tachycardia (increased sympathetic tone).
[Hemodynamic effects of CHF]
CO,stroke volume
Sympathetic nervous system – activated causing ___ and ___constriction.
[Hemodynamic effects of CHF]
arteriolar and venous
Myocardial hypertrophy – compensation for ___ ___ overload
[Hemodynamic effects of CHF]
chronic pressure
Cardiac dilation – compensation for ___ ___to increase ___by Frank-Starling law; increases myocardial oxygen demands.
[Hemodynamic effects of CHF]
volume overloads, CO
Concentric – ___
[Hemodynamic effects of CHF]
hypertrophied, thickened muscle
Pressure overload
Eccentric – ____
[Hemodynamic effects of CHF]
dilated ventricle
Volume overload
___ cardiac output
[Pathophysiologic key elements]
Decreased
____ stroke volume
[Pathophysiologic key elements]
Decreased
___ventricular end-diastolic pressures
[Pathophysiologic key elements]
Increased
Ventricular ___ or ___
[Pathophysiologic key elements]
dilation or hypertrophy
___ BP
[Pathophysiologic key elements]
Decreased
___tissue perfusion
[Pathophysiologic key elements]
Decreased
Peripheral vaso___
[Pathophysiologic key elements]
Vasoconstriction
___ blood volume (retention of ___, ___
[Pathophysiologic key elements]
Increased, Na+, water)
Metabolic___
[Pathophysiologic key elements]
acidosis
Treatment medically: (4)
[Pathophysiologic key elements]
diuretics, angiotension-converting enzyme inhibitors, vasodilators, digitalis.
Diuretics provide ___
[Pathophysiologic key elements]
relief of circulatory congestion
ACE inhibitors – (3)
[Pathophysiologic key elements]
enalapril, captopril , ramipril
ACE inhibitors – enalapril, captopril , ramipril – improve ___ ___ and may prolong life
[Pathophysiologic key elements]
LV function
Compensatory mechanisms to maintain CO (3)
Cardiac, autonomic nervous system, humoral
Cardiac:
Frank-Starling – ___ preload to ___stroke volume (SV becomes relatively___ over time)
[Compensatory mechanisms to maintain CO]
increase, increase, fixed
Cardiac:
Ventricular ___ or ___
[Compensatory mechanisms to maintain CO]
dilation or hypertrophy
Cardiac:
___cardia
[Compensatory mechanisms to maintain CO]
Tachy
Autonomic Nervous System
Increased ____ tone – venous, arterial vasoconstriction
[Compensatory mechanisms to maintain CO]
sympathetic
Autonomic Nervous System
Decreased ___tone
[Compensatory mechanisms to maintain CO]
parasympathetic
Humoral
Renin-Angiotensin-Aldosterone system activated
___ renal perfusion – maladaptive
[Compensatory mechanisms to maintain CO]
Decreased
Humoral
___ ADH
[Compensatory mechanisms to maintain CO]
Increased
Humoral
Increased catecholamines – ___, ___, ___
[Compensatory mechanisms to maintain CO]
myocyte necrosis, remodeling, death
Humoral
___atrial natriuretic peptide, B- type natriuretic peptide – cause diuresis, vasodilation, anti-inflammation (___over time)
[Compensatory mechanisms to maintain CO]
Increased, blunted
Increased atrial natriuretic peptide, B- type natriuretic peptide – released in response to stretching of the ___ and ___ – helps blunt ___ for a while
[Compensatory mechanisms to maintain CO]
atria and ventricle, remodeling
Heart failure results in the release of biologically active signaling molecules, the so-called “___ ___” that is initially compensatory in maintaining cardiac output and blood pressure but that, over time, results in progressive
___ ___ dysfunction
[Compensatory mechanisms to maintain CO]
neurohumoral response, left ventricular
This paradigm of progressive heart failure has led to studies showing that treatment with drugs that block the activity of these biologic mediators (___ ___) ___ mortality
[Compensatory mechanisms to maintain CO]
beta blockers, reduces
This concept is further supported by extensive
data showing that mortality is ___ in heart failure patients treated with ____
[Compensatory mechanisms to maintain CO]
reduced, angiotensin-converting enzyme inhibitors
Pulmonary congestion:
Pulmonary edema
[LV HF VS RV HF]
LVHF
Jugular venous distention, edema, hepatomegaly, ascites, weight gain, ankle swelling, abdominal distention
[LV HF VS RV HF]
RVHF
Tachypnea, moist rales, resting tachycardia, S3 gallop, hypotension, diaphoresis
[LV HF VS RV HF]
LVHF
Hypoxia, fatigue, cough, rales
[LV HF VS RV HF]
LVHF
Systemic congestion
Peripheral venous HTN, peripheral edema
[LV HF VS RV HF]
RVHF
Class I: Ordinary physical activity ___ ___ cause symptoms
[NY Heart Association Classification – Based on Functional Status of Patient]
does not
Class II: Symptoms occur with ___ exertion
[NY Heart Association Classification – Based on Functional Status of Patient]
ordinary
Class III: Symptoms occur with___exertion
[NY Heart Association Classification – Based on Functional Status of Patient]
less than ordinary
Class IV: Symptoms occur___
[NY Heart Association Classification – Based on Functional Status of Patient]
at rest
Severity of___symptoms has an excellent correlation with ___ and ___.
[NY Heart Association Classification – Based on Functional Status of Patient]
HF, quality of life and survival.
Stage A: ___
[AHA classification]
High risk with no symptoms
Stage A: Risk factor reduction, ___ and ___education
[AHA classification]
patient and family
Stage A: Treat HTN, DM, dyslipidemia; ___ or ___in some patients
[AHA classification]
ACE inhibitors or ARBs
Stage B: ___heart disease, no symptoms
[AHA classification]
Structural
Stage B: Ace inhibitors or ARBs in all patients, ___ ___in selected patients
[AHA classification]
Beta blockers
Stage C: Structural disease, ___ or ___ symptoms
[AHA classification]
previous or current
Stage C: ___ and ____ in all patients
[AHA classification]
ACE inhibitors and Beta blockers
Stage C: Dietary sodium restriction, ___ and ____
[AHA classification]
diuretics and digoxin
Stage C: Cardiac resynchronization if ___ ___ ___present
[AHA classification]
bundle branch block
Stage C: ____, mitral valve surgery
[AHA classification]
Revascularization
Stage C: Consider ___ team
[AHA classification]
multidisciplinary
Stage C: Aldosterone antagonist,___
[AHA classification]
nesiritide
Stage D: ____symptoms requiring special intervention
[AHA classification]
Refractory
Stage D: Iso___
[AHA classification]
topes
Stage D: ___, transplantation
[AHA classification]
VAD
Stage D: H___
[AHA classification]
Hospice
Reversing pathophysiology of ___ ___ and stop the cycle of ___ ___ mechanisms
[CHF Treatment goals]
heart failure, poor compensatory
Short term goals:
Relieve ___
Improve___ ___
Improve quality ___ ___
[CHF Treatment goals]
congestion
tissue perfusion
of life
Long term goals:
Slowing or reversing the progression of ___ ___
[CHF Treatment goals]
ventricular remodeling
Two drug classes that have shown to decrease ventricular remodeling are ___ and ___
[CHF Treatment goals]
beta-blockers and ACE inhibitors.
ACE inhibitors: ___, ___, ___, ___.
[Treatment Systolic HF]
enalapril, captopril, lisinopril, quinapril
Beta-blockers: ___, ___, ___
[Treatment Systolic HF]
Metoprolol (Lopressor), bisopropolol (Zebeta), carvedilol (Coreg)
Aldosterone antagonist: ___, ___
[Treatment Systolic HF]
spironolactone, eplerenone
Angiotensin II receptor blockers – (all of the above can slow progression of___, reduce M &M)
[Treatment Systolic HF]
vent remodeling
