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Med Surg 1 > FINALS: Heart Failure, Cardiomyopathy, & Hypertension > Flashcards

FINALS: Heart Failure, Cardiomyopathy, & Hypertension Flashcards

1
Q

What is pulmonary circulation?

A

The pathway where deoxygenated blood is transported from the heart to the lungs to receive oxygen.

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2
Q

Describe the flow of oxygenated blood through the heart.

A

Blood enters the left atrium from the lungs, flows through the mitral valve to the left ventricle, and is pumped through the aortic valve into the aorta, supplying the body.

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3
Q

What are the four chambers of the heart?

A

The right atrium, left atrium, right ventricle, and left ventricle.

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4
Q

What does the right ventricle do?

A

Pumps deoxygenated blood through the pulmonary valve to the pulmonary arteries, sending it to the lungs for oxygenation.

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4
Q

What is the role of the left atrium?

A

: To receive oxygenated blood from the lungs via the pulmonary veins.

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4
Q

What is the function of the right atrium?

A

To receive deoxygenated blood from the body via the superior and inferior vena cavae.

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5
Q

What condition is associated with dysfunction of the tricuspid valve?

A

Tricuspid valve regurgitation (when the valve does not close properly) can cause blood to flow back into the right atrium, leading to right atrial enlargement and systemic congestion, often resulting in swelling in the lower extremities and abdomen.

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5
Q

What is the primary role of the left ventricle?

A

Pumps oxygenated blood through the aortic valve into the aorta, distributing it throughout the body.

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5
Q

Name the atrioventricular (AV) valves and their locations.

A

The tricuspid valve (between the right atrium and right ventricle) and the mitral (bicuspid) valve (between the left atrium and left ventricle).

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6
Q

Describe the flow of oxygenated blood through the heart.

A

Blood enters the left atrium from the lungs, flows through the mitral valve to the left ventricle, and is pumped through the aortic valve into the aorta, supplying the body.

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6
Q

Describe the flow of deoxygenated blood through the heart.

A

Blood enters the right atrium from the body, flows through the tricuspid valve to the right ventricle, and is pumped through the pulmonary valve to the lungs via the pulmonary arteries.

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6
Q

What are the potential effects if the left ventricle fails to pump blood effectively into the aorta?

A

This can result in left-sided heart failure, leading to poor systemic circulation. Symptoms may include fatigue, low blood pressure, and pulmonary congestion as blood backs up into the lungs.

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7
Q

What condition might result if the right atrium is unable to receive deoxygenated blood from the body?

A

Blood will back up into the veins, leading to systemic venous congestion and conditions like peripheral edema (swelling in the legs and feet) and jugular vein distention (bulging neck veins).

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8
Q

If the right ventricle is unable to pump blood effectively to the lungs, what condition may arise?

A

This can cause right-sided heart failure or cor pulmonale, leading to increased pressure in the veins and symptoms like edema, liver congestion, and difficulty breathing.

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9
Q

What happens if the left atrium cannot effectively receive blood from the lungs?

A

This can lead to pulmonary congestion as blood backs up into the lungs, causing pulmonary edema (fluid in the lungs), which results in shortness of breath and difficulty breathing.

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10
Q

What might occur if the mitral (bicuspid) valve fails to function correctly?

A

Mitral valve regurgitation or mitral stenosis can lead to blood flowing backward into the left atrium, causing pulmonary hypertension and pulmonary edema, as well as symptoms like fatigue and shortness of breath.

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10
Q

What condition results from aortic valve dysfunction?

A

: Aortic valve stenosis (narrowing) limits blood flow from the left ventricle to the aorta, causing the heart to work harder, which may lead to left ventricular hypertrophy. Severe cases can result in heart failure, chest pain, and fainting.

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10
Q

A problem with the heart muscle, usually affecting the ventricles, that impacts the heart’s ability to pump effectively.

A

myocardial failure

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10
Q
A
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11
Q

What are the consequences of pulmonary valve dysfunction?

A

Pulmonary valve stenosis (narrowing) or pulmonary valve regurgitation can increase the workload on the right ventricle, potentially leading to right ventricular hypertrophy (thickening) and right-sided heart failure.

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12
Q
A
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12
Q

Is heart failure the same as myocardial failure?

A

No, heart failure is not synonymous with myocardial failure; it’s a condition where the heart fails due to excessive volume load, not a disease on its own.

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13
Q

the resistance the ventricles must overcome during contraction, influenced by aortic pressure and vascular resistance.

A

Afterload

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13
Q

What conditions increase preload?

A

Hypervolemia (excessive blood volume) and regurgitation of cardiac valves.

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13
Q

The inotropic state of the myocardial muscle, which refers to the strength of contraction of the heart muscle.

A

Contractility

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13
Q

What is backward failure?

A

A condition where the ventricle fails to discharge its contents, causing blood to accumulate in the left atrium and increase pulmonary pressure.

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14
Q

What conditions increase afterload?

A

Hypertension and vasoconstriction, which lead to increased cardiac workload.

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15
Q

Cardiac output adjusted per body surface area, allowing for an individualized measure of heart function.

A

cardiac index.

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15
Q

The amount of blood ejected from the heart into systemic circulation with each contraction.

A

stroke volume

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15
Q

Name some signs and symptoms of left-sided heart failure.

A

Paroxysmal nocturnal dyspnea, orthopnea, elevated pulmonary capillary wedge pressure, restlessness, confusion, tachycardia, exertional dyspnea, fatigue, cyanosis, and pulmonary congestion (cough, crackles, wheezes, blood-tinged sputum).

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15
Q

A condition marked by abnormal left ventricular and neurohormonal function, with symptoms including effort intolerance, fluid retention, and reduced longevity.

A

congestive heart failure

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15
Q

What is systolic heart failure?

A

Systolic heart failure is a defect in the expulsion of blood into circulation, resulting in reduced blood output.

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15
Q

What is diastolic heart failure?

A

Diastolic heart failure is a defect in ventricular filling, resulting in a reduced volume of blood entering the ventricle.

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15
Q

What is forward failure?

A

A condition where there is inadequate delivery of blood into the circulatory system, leading to insufficient blood flow to tissues.

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15
Q

What are typical symptoms of right-sided heart failure?

A

Easy fatigability, lower extremity edema, and right upper quadrant discomfort.

15
Q

What is left-sided heart failure?

A

A condition where the left ventricle fails, leading to symptoms like exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea due to blood backing up into the pulmonary system.

15
Q

What diagnostic tests are used to evaluate heart failure?

A

ECG (for nonspecific changes, old infarcts, or LVH), chest X-ray (to assess cardiomegaly and signs of pulmonary congestion), and 2D echocardiography (to evaluate LV size, ejection fraction, wall motion abnormalities, and valvular disease).

16
Q

What conditions can cause left-sided heart failure?

A

Conditions that elevate LV end diastolic pressure (like CAD, dilated cardiomyopathy, aortic insufficiency, aortic stenosis, HPN), elevated LA pressure (mitral stenosis), and fluid overload (renal failure).

16
Q

What are common causes of right-sided heart failure?

A

Left-sided failure, cor pulmonale (RV failure from lung disease), elevated LA pressure, valvular disease (AI, AS, TS, TR), and conditions like CAD and hypertension.

16
Q

List signs and symptoms of right-sided heart failure.

A

Fatigue, increased peripheral venous pressure, ascites, enlarged liver and spleen, distended jugular veins, anorexia, GI distress, weight gain, and dependent edema.

16
Q

What is right-sided heart failure?

A

A condition often caused by left-sided heart failure or pulmonary disease (cor pulmonale), leading to blood backflow and congestion in the systemic circulation.

16
Q

What are typical symptoms of left-sided heart failure?

A

Easy fatigability, dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND), and nocturia.

16
Q

What are common treatments for heart failure?

A

Removal of precipitating causes, oxygen therapy, potent diuretics, preload and afterload reduction, digitalization, rotating tourniquets, and cardiac surgery (such as valvular replacement for valvular issues).

16
Q

What is the etiology of dilated cardiomyopathy?

A

Often idiopathic (unknown cause).

17
Q

What are the key signs and symptoms of dilated cardiomyopathy?

A

Symptoms of left-sided heart failure, multi-chamber enlargement on chest X-ray, and multi-chamber dilation on echocardiography.

18
Q

What are key features of hypertrophic cardiomyopathy?

A

Symptoms of dyspnea, syncope, family history of the condition, and LV hypertrophy, particularly of the interventricular septum (IVS), seen on echocardiography.

19
Q

What is myocarditis?

A

An inflammatory process affecting the heart, associated with various infections (viral, bacterial, mycotic, and parasitic).

19
Q

What is the primary treatment for hypertrophic cardiomyopathy?

A

Medical management with beta-blockers or verapamil, and sometimes surgical intervention.

20
Q

A condition with symptoms of right-sided heart failure, diastolic dysfunction, and normal-sized ventricles, often associated with amyloidosis.

A

restrictive cardiomyopathy

21
Q

What is the prognosis for patients with amyloidosis causing restrictive cardiomyopathy?

A

Poor prognosis, with decreasing survival rates, especially if amyloid production continues.

21
Q

What are common diagnostic features of myocarditis?

A

Recent onset of congestive heart failure, history of viral infection, elevated ESR and LDH, and dilated LV with decreased systolic function on echocardiography.

22
Q

What is essential hypertension?

A

Elevated blood pressure without a known cause.

23
Q

Elevated blood pressure with a definable cause, such as kidney disease or hormonal disorders.

A

secondary hypertension

23
Q

Blood pressure that fluctuates, sometimes reaching hypertensive levels and sometimes normal.

A

labile hypertension

24
Q

Uncontrolled blood pressure without target organ damage; BP should be lowered within 24 hours.

A

hypertensive urgency

25
Q

What is hypertensive emergency?

A

Severely elevated BP with signs of organ damage (e.g., papilledema, encephalopathy) that must be lowered within an hour.

26
Q

What is white coat syndrome?

A

Elevated blood pressure readings in a clinical setting due to patient anxiety.

27
Q

What are the blood pressure ranges for normal, prehypertension, and hypertension stages 1 and 2?

A

Normal: <120/80 mmHg
Prehypertension: 120-139/80-89 mmHg
Stage 1 Hypertension: 140-159/90-99 mmHg
Stage 2 Hypertension: >160/100 mmHg

27
Q

Name major complications of untreated hypertension.

A

Stroke (brain), ischemic heart disease/heart failure (heart), renal failure (kidneys), hypertensive retinopathy (eyes), and peripheral vascular disease (blood vessels).

28
Q

What are some methods of measuring blood pressure?

A

In-office: Two readings, 5 minutes apart, with confirmation in the other arm if elevated.
Ambulatory BP Monitoring: Useful for “white coat” hypertension and absence of night-time BP decrease.
Self-measurement: Assesses therapy response and helps monitor “white coat” hypertension.

29
Q

Which CVD risk factors are part of the metabolic syndrome?

A

Hypertension, obesity, dyslipidemia, and diabetes mellitus.

29
Q

What are key risk factors for cardiovascular disease (CVD)?

A

Hypertension, cigarette smoking, obesity (BMI ≥ 30 kg/m²), physical inactivity, dyslipidemia, diabetes mellitus, microalbuminuria or GFR < 60 ml/min, older age (men >55, women >65), and family history of premature CVD.

29
Q

List some identifiable causes of hypertension.

A

Sleep apnea, drug-induced causes, chronic kidney disease, primary aldosteronism, renovascular disease, chronic steroid therapy, Cushing’s syndrome, pheochromocytoma, coarctation of the aorta, and thyroid or parathyroid disorders.

30
Q

hat is the main cause of secondary hypertension in patients with chronic renal disease?

A

Conditions like glomerulonephritis or pyelonephritis, characterized by abnormal urinalysis (e.g., albumin, casts) and elevated creatinine.

31
Q

What organs are commonly affected by target organ damage due to hypertension?

A

Heart (left ventricular hypertrophy, heart failure), brain (stroke, TIA), kidneys (chronic kidney disease), blood vessels (peripheral arterial disease), and eyes (retinopathy)

32
Q

What are routine lab tests for diagnosing hypertension?

A

: Electrocardiogram, urinalysis, blood glucose, hematocrit, serum potassium, creatinine, estimated GFR, calcium levels, and lipid profile after a 9-12 hour fast.

33
Q

What is the benefit of lowering blood pressure in terms of health outcomes?

A

Reducing BP can decrease stroke incidence by 35-40%, myocardial infarction by 20-25%, and heart failure by 50%.

34
Q

What are the treatment goals for uncomplicated hypertension?

A

Blood pressure <140/90 mmHg, with adjustments for older adults with isolated systolic hypertension and lower targets for patients with diabetes or chronic kidney disease (BP <130/80 mmHg).

35
Q

What lifestyle modifications are recommended for managing hypertension?

A

Weight reduction, adopting the DASH diet, reducing dietary sodium, regular aerobic physical activity, and moderating alcohol consumption.

36
Q

What are common causes of resistant hypertension?

A

Improper BP measurement, excess sodium intake, inadequate diuretic therapy, medication interactions, excess alcohol intake, and identifiable causes of hypertension (e.g., sleep apnea, kidney disease).

37
Q

What is the initial drug therapy for stage 1 hypertension without compelling indications?

A

Thiazide-type diuretics are preferred, with possible alternatives including ACE inhibitors, ARBs, beta-blockers, CCBs, or combinations.

38
Q

What are the main classes of antihypertensive drugs?

A

Diuretics, vasodilators, and cardioinhibitory drugs.

39
Q

Why is nitroprusside a preferred drug in hypertensive emergencies, and what is a potential risk?

A

Nitroprusside is potent and fast-acting but can cause cyanide toxicity.

40
Q

name IV medications used in hypertensive emergency and their classes.

A

Vasodilators: Nitroprusside, nitroglycerin
Beta-blockers: Labetalol, propranolol
Calcium channel blockers: Nicardipine
ACE inhibitors: Enalaprilat
Alpha-blockers: Phentolamine
Dopamine receptor agonist: Fenoldopam

41
Q

What is the initial goal for treating hypertensive emergency?

A

Reduce DBP by 10-15% (max 25%) within 2-6 hours, targeting DBP of 100-105 mmHg.

42
Q

What medications are commonly used in hypertensive urgency?

A

Oral furosemide, clonidine, or captopril.

43
Q

How is hypertension defined in children and adolescents?

A

BP at or above the 95th percentile, adjusted for age, height, and gender.

44
Q

How should hypertension be managed in pregnant women?

A

Use methyldopa, beta-blockers, and vasodilators, as ACE inhibitors and ARBs are contraindicated.

45
Q

What are considerations for treating hypertension in older adults?

A

Use lower initial drug doses to avoid side effects, though standard doses may be necessary to meet BP targets.

46
Q

Which antihypertensive drugs are recommended for heart failure?

A

Thiazides, beta-blockers, ACE inhibitors, ARBs, and aldosterone antagonists.

47
Q

What antihypertensive drugs are contraindicated in pregnancy?

A

ACE inhibitors and ARBs.

48
Q

What are examples of vasodilators used in hypertension?

A

Alpha-blockers, ACE inhibitors, ARBs, calcium channel blockers, and direct arterial dilators.

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50
Q
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Med Surg 1 (15 decks)

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