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Semester 5 PMCP Exam 1 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Define

A

Condition that develops when heart’s muscle becomes weakened after it is injured and fails to pump enough blood to meet needs of body

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2
Q

Heart failure is a ___ caused by ___

A

syndrome

multiple disorders

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3
Q

Heart failure definition by ACC/AHA

A

Clinical syndrome that results from any strucutural or functional cardiac disorder that impairs the ability of the ventricle TO FILL WITH and/or EJECT BLOOD

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4
Q

Risk factors for developing HF

A 
High BP
High cholesterol
Obesity
Alcohol use
Smoking
Poor diet
Physical inactivity 
Diabetes
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5
Q

High BP as risk factor - treatment goal

A

Keep it under 140/90 (if no diabetes or kidney disease)

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6
Q

High cholesterol as risk factor - treatment goal

A

Less than 200

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7
Q

Obesity as risk factor - treatment goal

A

weight reduction to BMI of less than 30

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8
Q

Alcohol use as risk factor - treatment goal

A

LImit to 1-2 drinks per day for men, 1 per day for women

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9
Q

Smoking as risk factor - treatment goal

A

Cessation

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10
Q

Poor diet as risk factor - treatment goal

A

Limit sodium intake, diet high in K/Ca

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11
Q

Physical inactivity as risk factor - treatment goal

A

Aerobic activity 20-30 min. minimum (3-5 times per week)

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12
Q

Diabetes as risk factor - treatment goal

A

Keep it under control

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13
Q

What causes heart failure

A

injury to the heart from MI, CAD, idiopathic, viral infection, high BP, damage to valves, diabetes, age, alcohol, toxins

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14
Q

Heart gets injured and then what happens to CO

What systems does this activate

A

reduced

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15
Q

Reduced CO and myocardial injury leads to what

A

Dec baroreceptor stimulation

Dec renal perfusion

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16
Q

Dec baroreceptor stimulation and Dec renal perfusion leads to what

A

Inc SNS - adrenergic system (inc in cetcholamines) and inc in renal angiotensin system

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17
Q

Activation of SNS does what

A

Inc HR - problem with that though is that the sore mm has to work more - oxygen demand of that mm goes up (myocardial toxicity)

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18
Q

Activation of RAAS does what

A

You dont have enough blood - so VC to redistribute the blood - the pump is working harder now though - inc afterload and preload - there is inc resistance

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19
Q

What happens after activation of SNS and RAAS and their impacts

A

Negative remodeling

Worsened LV function

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20
Q

Why is negative remodeling bad

A

The cells rearrange but they will never be the same again - this leads to symptoms of heart failure

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21
Q

SNS inhibited by

A

beta blockers

22
Q

RAAS inhibited by

A

ACE inhibitors

23
Q

if left heart is failing - where is the backflow of fluid

A

lungs - shortness of breath

24
Q

What do you hear when there is fluid in the lungs

A

crackles at the end of inspiration

25
Q

Myocardial disarray

A

Remodeling - there is disorganized alignment leading to arrhythmia

26
Q

Ejection fraction is what

A

the fraction of blood the heart pumps out with each beat

27
Q

Healthy heart EF

A

55%

55% should get ejected

28
Q

Abnormal heart EF

A

50% or less

29
Q

Hemorrhage - Pressures and Resistance and CO

A

Pressures - low
Resistance - high
CO - normal of reduced

30
Q

Sepsis - Pressures and Resistance and CO

A

Pressures - low
Resistance - low
CO - increased

31
Q

CHF - Pressures and Resistance and CO

A

Pressures - elevated
Resistance - high
CO - reduced

32
Q

Systolic heart failure

A

heart failure with reduced ejection fraction

Pumping out of heart isnt working well - it doesnt contract well

33
Q

Diastolic heart failure

A

heart failure with preserved ejection fraction

Hard to filling up - dec filling volume - cant get enough blood in the pump, so you dont have enough coming out

34
Q

Systolic dysfunction - during diastole

A

the enlarged ventricles fill with blood

35
Q

Systolic dysfunction during systole -

A

the ventricles pump out less than 40-50% of the blood

36
Q

Diastolic dysfunction - during diastole

A

The stiff ventricles fill with less blood than normal

37
Q

Diastolic dysfunction - during systole

A

The ventricles pump out 60% of the blood, but the amount may be lower than normal

38
Q

Heart failure - what comes to mind first

A

left systolic

39
Q

Diastolic heart failure can be due to

A

Pressure overload
Ischemia
Hypertrophy
MI

40
Q

Diastolic heart failure causes

A

Abnormal relaxation and increased stiffness

41
Q

D - abnormal relaxation and inc stiffness leads to

A

elevated LV filling pressures - less output

- backflow

42
Q

Diastolic - contraction is ___

A

good because thick

you would want to use digitalis, muscle relaxation

43
Q

Systolic -

A

mm is weak - we want to dec workload of the muscle

digitalis, ace inhibitors

44
Q

Left ventricular failure

A

Elevated LV pressure

Backflow transmitted backwards to the LA, pulm veins leading to pulm congestion = pulm edema

45
Q

Right ventricular failure

A

Elevated RV pressure
Backflow transmitting to RA leading to venous edema - systemic congestion
Can result in hepatomegaly, mesentary and bowel edema, lower leg edema, ascites

46
Q

Left ventricular failure can progress to

A

Right ventricular failure

47
Q

Heart failure sx

A 
Dyspnea on exertion
Orthopnea
Paroxysmal nocturnal dyspnea (wake up because of it)
Fatigue, reduced exercise capacity
Abdominal bloating, discomfort, anorexia
Edema
48
Q

Physical exam findings

A 
jugular venous distention 
hepatojugular reflux
lung crackles 
hepatomegaly, pulsatile liver
Ascites
Pedal edema
Cool extremities
49
Q

cardiac exam findings

A 
Parasternal lift +/-
S3 distention of cord tendinae
S4 contraction against stiff ventricle 
\+/- systolic murmur 
Pulsus alternans - variability in it
50
Q

Common tests for heart failure

A

ECG
Chest x-ray
Echocardiogram
Labs - BNP or Pro BNP = if negative it is unlikely they have heart failure, pos - doesn’t say much

51
Q

Beta blockers have a cardiac ___ effect

A

protective

52
Q

Device therapies

A

Implantable cardioverter defibrillator
Bi ventricular pacemaker
Replacement

Semester 5 PMCP Exam 1 (6 decks)

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