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x Medicine 200 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Systolic Heart Failure heart shape

A

Big, globular, larger volume

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2
Q

Diastolic HF heart shape

A

Normal shape, thicker, has problems with eccentric relaxation

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3
Q

High-Output cardiac failure pathophysiology

A

Peripheral vascular resistance is detected as being lower so the body holds onto more salt

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4
Q

Low-output cardiac failure pathophys

A

Body reads low cardiac output

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5
Q

Drivers of these changes

A

Maintaining MAP for brain and kidneys

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6
Q

Cornerstone of therapy

A

Volume control

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7
Q

Can HF get better?

A

Yes, you can take them out of HF.

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8
Q

New York Heart Association Class

A

Know this for presentations.
Class I: normal exercise tolerance
Class II: symptoms with ordinary exertion
Class III: symptoms with only mild exertion
Class IV: symptom at rest

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9
Q

EF and disease class relationship

A

There is no association

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10
Q

ACC/AHA 2001 Guideline for Stages

A

Stage A: High risk (no HF): HTN, CAD, DM, FH of CM
Stage B: Asymptomatic HF: Previous MI, LV systolic dysfunction (no symptoms), asymptomatic valvular disease
Stage C: Symptomatic: Known heart disease, SOB and fatigue, reduced exercise tolerance
Stage D: Refractory end-stage HF: Can’t improve symptoms or can’t sustain improvements

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11
Q

Systolic/Diastolic dysfunction and Staging

A

Both forms of dysfunction follow the same Stages.

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12
Q

Do Stages change?

A

No, once you are Stage C you will always be stage C or worse. The Classes can change, the stages can’t.

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13
Q

Number 1 goal for management

A

Stabilizing patient (symptom relief), then stabilize the disease

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14
Q

What causes dyspnea

A

Elevated LV end diastolic pressure / PCW pressure

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15
Q

What causes exercise intolerance

A

Inability to increase cardiac output

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16
Q

What happens to SVR during exercise

A

It goes down as muscles fill with blood

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17
Q

Fatigue cause

A

Decreased CO

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18
Q

What causes edma

A

Increased venous pressure/sodium retention

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19
Q

Neurohormonal activation

A

Sympathetics and Renin-Angiotensin System

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20
Q

Causes of decompensation

A

Infection: 1 degree C increase causes 10-15% increase of O2 consumption
Infarction/Ischemia
Indiscretion: too much salt
Iatrogenesis: NSAIDs effect on kidneys can cause decompensation. CCBs are bad for systolic dysfunction.

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21
Q

Narrow pulse pressure means

A

Means diminished stroke volume. Systolic is lower and diastolic is higher because of increased End diastolic volume)

22
Q

Most reliable sign of volume overload

A

JVD

23
Q

Right sided HF signs

A

Elevated JVP, edema, ascites/pulsatile liver, tachy, hypotension with severe disease (low preload)

24
Q

Left sided HF signs

A

Dyspnea, orthopnea, Paroxsymal nocturnal dyspnea, rales, presence of S3, tachy, narrow pulse pressure, hypotension

25
Q

BNP use

A

Useful in general medicine, can distinguish the heart from the lungs. Not useful in established disease.

26
Q

Most useful diagnostic test

A

2D echo

27
Q

Where do you biopsy the heart?

A

The septum to avoid perforation leading to tamponade

28
Q

Why biopsy

A

Hemochromatosis, amyloidosis, sarcoidosis (infiltrative cardiomyopathies)

29
Q

Giant-cell myocarditis

A

Auto-immune, elevated troponin with normal arteries

30
Q

Does EF tell you how bad the disease is?

A

No, no association

31
Q

Volume Status vs. Perfusion

A

Wet and Warm: Diuretic, Vasodilators
Wet and Cold: Inotropes, vasodilators, diuretic
Dry and Warm: Optimize chronic medical therapy
Dry and Cold: Inotropes
Touch the patients to determine if they are warm or cold

32
Q

Measure of perfusion

A

Mental status, peripheral warmth, cap refill, urine output

33
Q

Measures of Volume Status

A

JVP, peripheral edema,

34
Q

High afterload on the failing heart

A

Increased SVR to keep up perfusion hurts the heart in the long run.

35
Q

Vasodilating does what in HF

A

Decreases afterload, can increase CO.

36
Q

When people are wet can you use vasodilators?

A

Yes, they have a ton of preload so vasodilating is a good thing

37
Q

How to tell someone is dry

A

Low JVP

38
Q

How to treat someone who is cold and dry

A

Inotropes

39
Q

When patients are wet tx

A

Vasodilators and diuretics, inotropes for Cold

40
Q

How to treat the Stage B patients

A

Give them beta-blockers and ACEIs to prevent disease progression to symptomatic disease

41
Q

Stage C patients tx

A

Most patients in the hospital. All patients get ACEI or ARB and Beta blocker, then follow subsequent guidelines

42
Q

Diuretics and natural history

A

Make you feel better but have no effect on natural history

43
Q

ACEIs and mortality

A

Reduce death and hospitalizations

44
Q

Beta blockers and mortality

A

Reverse remodeling and decrease mortality

45
Q

Beta blockers contraindication

A

Do not give to people who are acutely decompensated, they will go into shock

46
Q

ARBs

A

Decrease mortality, delay remodeling

47
Q

Digoxin

A

Symptoms improve, mortality doesn’t

48
Q

Spironolactone/Epleronone

A

Saves lives

49
Q

Hydralizine

A

Vasodilator

50
Q

Nitrates

A

Venodilator

51
Q

Cardiac-Resynchronization Therapy for Heart Failure

A

Synchronizes ventricles to decrease mortality in patients with LBBB. The lead isn’t in the Left ventricle, it wraps around the outside

52
Q

Drugs for diastolic HF

A

There are no drugs, all the drugs are for systolic HF

x Medicine 200 (14 decks)

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