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Clin Med Cardio Exam 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

When the heart cannot pump blood fast enough to meet the requirements of metabolizing tissues or can only do so from an abnormally elevated diastolic pressure/volume

A

Heart failure

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2
Q

How many patients in the US have heart failure?

A

5 million

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3
Q

Why are numbers of heart failure deaths increasing despite advances in medications?

A

Increased salvage of patients with acute MI

Numbers rising as baby boomers age

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4
Q

What are the different etiologies of heart failure?

A 
Coronary heart disease
Primary pump failure
Valvular heart disease
Congenital heart disease
Long standing, uncontrolled HTN
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5
Q

MI’s or ischemia superimposed on prior infarction(s) make up ___% of all HF cases

A

(This is coronary heart disease) 75%

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6
Q

Cardiomyopathies and viral myocarditis are examples of?

A

Primary pump failure

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7
Q

What causes heart failure?

A

Progressive weakening of the myocardium and consequences from the weakness lead to heart failure

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8
Q

Primary contraction abnormality causing inadequate delivery of O2 to tissues; issue with ejecting the blood from the heart to the rest of the body

A

Systolic heart failure

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9
Q

Elevation of ventricular filling pressures and associated symptoms; When the heart has a decreased ability to fill with blood correctly

A

Diastolic heart failure

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10
Q

Do systolic and diastolic failure occur together in heart failure?

A

Often

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11
Q

Inadequate cardiac output to the body with pulmonary congestion and related symptoms (post MI, aortic/mitral valve disease)

A

Left heart failure

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12
Q

Inadequate flow of blood to the pulmonary system due to COPD/pulmonary hypertension, pulmonic stenosis, etc.

Associated with peripheral edema and hepatic congestions

A

Right heart failure

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13
Q

What is the most common cause of right heart failure?

A

Left heart failure!

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14
Q

Dyspnea, cough, orthopnea, and PND are all symptoms of which type of heart failure?

A

Left sided heart failure - left side fails and fluid backs up into lungs causing all of these symptoms

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15
Q

Peripheral edema, increased liver size, and ascites are all symptoms of which type of heart failure?

A

Right sided heart failure - Right side fails and backs fluid up to the body (limbs, liver, etc.)

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16
Q

Inadequate ventricular emptying; pressures in the atrium and venous system behind the failing ventricle rise resulting n transudation of fluid into interstitial spaces

A

Backward failure

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17
Q

Inadequate forward cardiac output; Na and water retention result from diminished renal perfusion and activation of renin-antiogensin-aldosterone system

A

Forward failure

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18
Q

What are some compensatory mechanisms for the body to overcome heart failure?

A

Redistribution of cardiac output to vital organs (less blood flow to skin and muscle)

Sodium and water retention

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19
Q

What mediates the redistribution of cardiac output to vital organs?

A

Adrenergic nervous system - primarily sympathetic nervous system with norepinephrine release

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20
Q

Why would the body want to retain Na and water?

A

Helps maintain CO

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21
Q

How does Na and water retention help maintain CO?

A

Starling mechanism

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22
Q

What is the cost of Na and water retention?

A

Volume overload from accumulation of fluid and increased afterload from increased SVR

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23
Q

Is the adrenergic system beneficial or harmful?

A

Both!

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24
Q

Increased levels of norepinephrine result in an increase in ???

A

HR, contractility, and SVR

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25
Q

Increased levels of norepinephrine helps maintain?

A

Arterial perfusion pressure (BP) in presence of decreased CO

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26
Q

What is the cost of elevated SVR?

A

Increased after load

Increased O2 requirements of the failing ventricle

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27
Q

Long term elevation of _______ leads to progressive myocardial damage and fibrosis

A

Catecholamines

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28
Q

Where and when is Renin released?

A

Released by kidneys with decreased perfusion or decreased BP

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29
Q

What converts angiotensinogen to angiotensin I?

A

Renin

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30
Q

What converts angiotensin I to angiotensin II? Where does this occur?

A

Angiotensin converting enzyme in LUNGS

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31
Q

What is the problem with angiotensin II?

A

Very potent vasoconstrictor! Increases SVR and RAISES BP!!

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32
Q

What does Angiotensin II stimulate in the adrenal glands?

A

Aldosterone

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33
Q

What does aldosterone do?

A

Increases renal Na and H2O reabsorption - causes edema!

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34
Q

What does long term activation of angiotensin II and aldosterone lead to?

A

Myocardial thinning and fibrosis

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35
Q

No limitation of physical activity; no symptoms of SOB, CP, dizziness, etc.

A

Stage 1 HF

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36
Q

Slight limitation of physical activity. Some (ordinary) activities (exercise, exertion, etc) cause symptoms.

A

Stage 2 HF

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37
Q

Marked limitation of physical activity. Less than ordinary activities (walking, dressing, etc.) cause symptoms.

A

Stage 3 HF

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38
Q

Symptomatic at rest or minimal activity; unable to engage in any physical activity.

A

Stage 4 HF

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39
Q

What are the 3 major clinical manifestations of HF?

A

Dyspnea, orthopnea, PND

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40
Q

Initially occurs with activity, then at rest; due to elevation of pulmonary venous pressure

A

Dyspnea

41
Q

Dyspnea in recumbent position; redistribution of fluid from abdomen and lower extremities into chest

A

Orthopnea

42
Q

Attacks of severe SOB, coughing and wheezing awakening patient from sleep

A

PND

43
Q

What is a classic sign of HF that results from sodium and water retention?

A

Unexplained weight gain and swelling of legs

44
Q

What causes cerebral symptoms in patients with HF?

A

Decreased perfusion to the brain

45
Q

Severe dyspnea at rest as pulmonary congestion preogresses; elevation of PCP leading to interstitial then alveolar edema

A

Acute pulmonary edema

46
Q

Acute pulmonary edema is considered a ___?

A

Medical emergency!

47
Q

PCW greater than 20mmHg

A

Interstitial edema

48
Q

PCW greater than 25mmHg

A

Alveolar edema

49
Q

How do you measure PCP?

A

Right heart cath

50
Q

Common PE findings in patient with HF

A

JVD!
Tachycardia
Cyannosis (hypoxemia)
Patient uncomfortable lying flat

51
Q

What might you hear on lung auscultation of a patient with HF?

A

Moist inspiratory crackles that begin at bases and progress upwards through the lungs

52
Q

What might you hear when auscultating a patients heart in a patient with HF?

A

S3 gallop: Low pitched sound in early diastole

53
Q

Hepato-jugular reflex in a HF patient will be ?

A

+

54
Q

What might you find when palpating the liver of a HF patient?

A

Congestive hepatomegaly

55
Q

“wasted appearance” - weight loss, anorexia, nausea

A

Cardiac cachexia

56
Q

What causes cardiac cachexia?

A

Increased levels of cytokines (tNF)

57
Q

What might you find on CXR of a patient with HF?

A

Cardiomegaly; distention of pulmonary veins; venous redistribution to apices; Pleural effusions; interstitial or alveolar edema

58
Q

What is the best non-invasive tool for assessing HF?

A

Echo-doppler

59
Q

What will an echo-doppler identify in a patient with HF?

A

Ventricular dysfunction and EF

60
Q

What is a common ECG finding of a patient with HF?

A

LVH

61
Q

What is a good blood test to check for acute ventricular dysfunction leading to symptomatic heart failure? Why?

A

BNP - hormone produced by ventricle in response to wall stress

62
Q

What is a common BNP result in patients with HF? What is normal?

A

Normal is less than 50

HF usually greater than 100

63
Q

What drugs help decrease preload in patients with HF?

A

Diuretics and venodilators (nitrates)

64
Q

What drugs help with excess Na retention with edema in HF patients?

A

Diuretics

65
Q

What drugs help decrease after load in patients with HF?

A

Vasodilator therapy (ACEIs and ARBs)

66
Q

What drugs improve cardiac contractility?

A

Digoxin

67
Q

What drugs slow progression of cardiac deterioration by preventing remodeling?

A

ACEIs
Beta blockers
Spironolactone

68
Q

Once your patient with HF is symptomatic, what is their prognosis?

A

Poor

69
Q

What are the goals of drug therapy to control the HF state?

A

Reduction of cardiac workload

Control of excessive Na/water retention

70
Q

What drug therapy do you want to initiate EARLY for patients with HF?

A

ACEI/ARB

71
Q

What should you add to ACEI/ARB in the black population?

A

Hydralazine and nitrates

72
Q

What are the general goals of therapy in HF?

A

Remove precipitating factors
Treat underlying cause
Control HF state
Enhance cardiac contractility

73
Q

How can you reduce the cardiac workload? (Non-pharm and pharm)

A

Decrease/limited activity
Elastic stockings
Anxiolytic therapy
Control dietary sodium

74
Q

Ideal diet for a patient with HF?

A

No added salt, no salt in preparation of foods, AVOID FOODS WITH HIGH SODIUM CONTENT

4gm Na or LESS!

75
Q

Most potent diuretics and cornerstone of diuretic Rx in CHF

A

Loop diuretics

76
Q

Side effects of loop diuretics

A

Hyperkalemia
Hyperuricemia
Metabolic alkalosis

77
Q

What is always elevated in heart failure? Why?

A

LV afterload

Constricuted vascular bed and increased SVR

78
Q

What is increased due to Na/H2O retention?

A

Preload

79
Q

Treatment with vasodilators results in?

A

Decreased SVR
Increased CO
Decreased PCW
Relief of symptoms

Decreased mortality!

80
Q

What do ACEI’s do?

A

Reduce after load and preload

81
Q

How do ACEIs reduce preload?

A

Decreasing production of angiotensin II and aldosterone

82
Q

What is the equation for cardiac output using BP and SVR?

A

CO = BP/SVR

83
Q

ACEIs decrease remodeling of the ____

How?

A

LV

Reducing wall thinning, fibrosis, and by interfering with apoptosis

84
Q

ACEIs are less effective in which population?

A

Black

85
Q

If an ACEI is needed in a black patient, what should you add?

A

Hydralazine + long acting nitrate

BiDil!!

86
Q

What must you monitor on your patient taking an ACE?

A

Renal function

87
Q

What causes the cough that is a side effect of ACEIs?

A

Bradykinin

88
Q

Which medication used to be contradicted in HF, but is now proven to reduce mortality and improve cardiac function?

A

Beta blockers

89
Q

When do you begin a patient with HF on beta blocker therapy?

A

Once patient is stable and euvolemic (normal blood volume)

90
Q

Beta blocker DOC in patients with HF?

A

Carvedilol

91
Q

By blocking aldosterone, spironolactone should be considered as a ______ antagonist rather than narrowly as a K sparing diuretic.

A

neurohumonal

92
Q

______ mediates some of the deleterious effects of renin-angiotensin-aldosterone system activation, such as myocardial remodeling and fibrosis.

A

Aldosterone

93
Q

Why do you need to monitor potassium levels in a patient on spironolactone or aldosterone?

A

Hyperkalemia

94
Q

Digoxin improves CHF symptoms but not ____

A

Mortality

95
Q

If QRS > 120ms (.12s) and severe refractory CHF, _______ (CRT*) improves symptoms and quality of life. Improves EF.

A

Synchronized biventricular pacing

96
Q

When should you suggest an Implantable Cardioverter Defibrillator to your patient?

A

If your patient was resuscitated from cardiac arrest/Vfib or are in hemodynamically unstable vtach

If your patients EF is less than 3.5 with mild to moderate HF symptoms

97
Q

What can you recommend to your patient for end-stage HF?

A

LVAD (LV assist devices)

Decreases workload of native heart and buys time to heart transplant

98
Q

What is the problem with cardiac transplantation?

A

Not enough donor hearts

Clin Med Cardio Exam 2 (6 decks)

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