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ICM Exam 3 Cardiology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

A larger heart is a ____

A

weaker heart

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2
Q

Heart failure includes problems with __ and__

A

contraction and relaxation

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3
Q

Systolic dysfunction causes

A

decreased ej. fraction

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4
Q

Heart Failure symptoms (6)

A
  1. Fatigue and poor stamina
  2. Dyspnea
  3. PND (parox. nocturnal dyspnea)
  4. Orthopnea (nocturnal cough)
  5. Abdominal fullness
  6. Edema
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5
Q

Signs for HF

A
  1. Resting Tach
  2. Low Systolic with narrow PP
  3. High JVP
  4. Hepatojjugular reflex
  5. Pulmonary rales
  6. S3 and S4 gallop
  7. **********************************
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6
Q

Pathologic features..____ in left heart fail

A

Flooded lungs

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7
Q

High ____ Pressure in LHF

A

pulmonary venous pressure

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8
Q

____ is a development in LHF

A

Pulmonary edema (fluid in alveolar sp.)

Causes dyspnea and hemoptysis

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9
Q

___ and ____ on CXR for LHF

A

Enlarged cardiac shadow (Hypertrophy)

Pulmonary infiltrate

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10
Q

Auscultation of lungs in HF

A

Rales (pulm)

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11
Q

______ from high hepatic venous pressure

A

nutmeg liver

backpressure going into the liver from the IVC from the Rt heart, causing sinusoids to fill with blood, liver veins become dilated)

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12
Q

FIrst sign of volume overload

A

Jugular venous distension (Lay 30 degrees and look at IJV)Should be EMPTY normally

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13
Q

Always observe JVD on…

A

right side (more direct)

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14
Q

Symptoms of right CHF

A

Fatigue, edema *******

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15
Q

Reduced CO causes…

A

Increased RAAS = salt and water retention = increased volume

Increased SNS = vasoconstriction and increased afterload/contractility

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16
Q

Pathophysiology of HF

A

Myocardial cell death from Necrosis, apoptosis, fibrosis, _____

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17
Q

LV remodeling means heart has had ____

A

an insult area will either thicken or get thinned and stretched out)

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18
Q

Heart fail etiology

A
  1. Atheroscclerosis
  2. HTNDM
  3. Valve disease
  4. Alcohol
  5. Viral
  6. Familial
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19
Q

Stage A-D HF

A

A = at risk (with DM or HTN)

B = Asymptomatic, Uncontrolled HTN, Structural disease

C = Previous/current Sx

D = Refractory Sx

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20
Q

Functional stages of heart failure (NYHA) classification

A

1 = no symp or limitations to regular activity

2 = mild symptoms in ordinary physical activity

3 = marked symp with less than usual activity, comfort at rest

4 = Severe limmit and Sx at rest. Bedbound patients

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21
Q

People in Stage A can be in

A

Class 1

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22
Q

People in Stage C can be

A

class 2 or 3

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23
Q

Dx of HF

A
  1. Clinical exam
  2. ECG
  3. Chest film
  4. BNP
  5. ECHO
24
Q

Heart fail ECG is usually…

A

usually abnormal but nonspecific

25
Q

CXR - 6 signs

A
  1. Cardiomegaly
  2. Vascular enlargement
  3. Cephalization
  4. Kerley B lines
  5. Pleural eff
  6. Enlarged main PA
26
Q

Many CXR signs may be

A

absent in chronic compensated HF

27
Q

BNP is secreted as

A

pro BNP

28
Q

BNP is released when there is…

A

increased pressure/stretch in the atrium

29
Q

BNP is most increased during

A

CHF

Other conditions may cause small release, but CHF is highest by far

30
Q

Echo for HF assesses… (5)

A
  1. Chamber size
  2. Severity of LV systolic dysfunction
  3. Regional LV function (CAD)
  4. Assess LV diastolic function and estimation of pressures
  5. Valve/pericardial/RV abnormalities
31
Q

EF equation

Normal/severe?

A

LV EDV - LV ESV

____________

LVEDV

Normal 55-65%, Severe = less than 30%

32
Q

Natural Hx of Heart failure

A

usually the time course varies, some may progress further/more rapidly than others

33
Q

3 General Tx measures

A

Dietary sodium restriction

Daily weight

Vaccinations

34
Q

Vax recommended in HF

A

influenza and pneumococcus

35
Q

Meds that Improve Sx only

A

DIuretics and Digoxin

36
Q

Meds that Improve Sx and prognosis

A

ACEI (-pril’s) / ARBs

Hydralazine and isosorbide

B-blockers

spironolactone

Devices (ICD, resynch)

37
Q

___ is not first line Tx

A

DIgoxin

38
Q

Next stage after Rx

A

ICD”call krause”

39
Q

Indications for ICD (primary prevention)

A

CAD, prior MI with EF less than 30 EF less than 35, chronic class 2-3 CHF despite meds

40
Q

People with chronic HF are prone to

A

sudden cardiac death

41
Q

Resynchronization effects

A

improves LVEFImproves Symptoms and NHYA classReduces functional MR (improves survival)

42
Q

Indication for resynch.

A

EF less than or equal to 35% ***************

43
Q

Chronic inotropic support

A

DobutamineMilrinone

44
Q

LVAD (left vent assist devices)

A

Bridge therapyDestination therapy

45
Q

Last advanced therapy measure

A

cardiac transplantation

46
Q

Chronic HF: Advanced therapies

A

Chronic inotropic supportLVADCardiac transplant

47
Q

LVAD function

A

One end on LV, the other in aorta sucks blood from left ventricle and pumps it back into the aorta

48
Q

5 most frequent acute decompensated HF causes

A

Diet noncompliance Med noncompliance failure to seek care Other (ischemia, HTN, Arrhythm.) Inappropriate Tx

49
Q

Acute dcompensated CHF graph

A

Warm and Dry is normal (PCW ad CI nrmal)Warm and Wet (PCW elevated)Cold and dry (CI decreased)Cold and wet = PCW high, CI low)

50
Q

Low perfusion at rest is indication for

A

Inotropic agents

51
Q

___________ Y axis is indication for

A

Naturetic agents

52
Q

Tx for acute CHF

A

Address precipitating causeseducate patient

53
Q

HF with preserved LVEF

A

Increased LV filling pressure d/t abnormalities in LV relaxation and complience40% ____________************

54
Q

Diastolic fail Tx

A

*******************************

55
Q

______ is measured in HF

A

Anti-pro-BNP

ICM Exam 3 Cardiology (8 decks)

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