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heart failure Flashcards

1
Q

inability of the heart to meet the body’s metabolic needs. at rest or during stress, without exceeding physiologic left and right filling pressures s

A

heart failure

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2
Q

most common primary diagnosis on admissions within the medicare population

A

heart failure

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3
Q

total cost of heart failure in US

A

28.8 billion

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4
Q

cost of HF sustainable?

A

nope

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5
Q

independent risk factors of HF

A
  1. HTN
  2. obesity
  3. diabetes
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6
Q

treatments for HF

A
  1. digoxin
  2. diuretics
  3. bed rest
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7
Q

HF prognosis

A
  1. progressive disability

2. uniform mortality

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8
Q

determinants of systolic performance

A

ejection fraction:

  1. myocardial mass and architecture
  2. contractility
  3. preload
  4. afterload
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9
Q

how to measure cardiac output

A

thermodilution

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10
Q

goal of managing HF

A

achieve adequate cardiac output while minimizing wedge P

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11
Q

Diastolic relaxation components (3)

A
  1. Myofibrillar dissociation
  2. Calcium removal from the cytoplasm against the concentration gradient
  3. Requires enzymatic action and energy
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12
Q

Diastolic passive compliance components (2)

A
  1. A tissue property (stress-strain relationship) during passive myocardial stretch
  2. A ventricular property related to both myocardial stretch response and to constraining effect of contiguous structures
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13
Q

Systolic dysfunction:

  1. Etiology
  2. Pathology components
  3. Pathophysiology
A
  1. Chronic volumes overload, ischemia, infectious, substance abuse or genetic
  2. Dilated LV and hypertrophied LV and/or RV
  3. Decrease in contractility and decrease resting EF (LV remodeled with dilation)
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14
Q

Diastolic dysfunction; HHpEF; Metabolic CV dx.:

  1. Etiology
  2. Pathology
  3. Pathophysiology
A
  1. HTN, Diabetes, Obesity and advanced age
  2. Hypertrophy, fibrosis w/out dilatation
  3. NI resting EF (non-dilated LV) with decrease relaxation and decrease in compliance
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15
Q

Increased load structure HF:

  1. Etiology
  2. Pathology
  3. Pathophysiology
A
  1. Valvular, congenital, obstructive, systemic shunt
  2. Hypertrophy and/or dilatation
  3. Pressure and/or volume overload
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16
Q

Increased load and demand HF:

  1. Etiology
  2. Pathology
  3. Pathophysiology
A
  1. Anemia and thyrotoxicosis
  2. Dilated and hypertrophied LV and RV
  3. Increased C.O. And increased O2 consumption or decreased O2 extraction
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17
Q

Restrictive/ constrictive HF:

  1. Etiology
  2. Pathology
  3. Pathophysiology
A
  1. Infiltration, inflammatory and neoplasticism
  2. Infiltrated / thickened mayo/ pericardium
  3. Restricted LV and RV filling
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18
Q

Left Heart failure HF:

  1. Etiology
  2. Manifestations
A
  1. MI, cardiomyopathy, valvular congenital, HTN

2. Pulmonary congestion and low cardiac output

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19
Q

Right Heart failure:

  1. Etiology
  2. Manifestations
A
  1. Left heart failure, MI, cardiomyopathy, valvular, congenital, cardiomyopathy, lung disease and pulmonary emboli
  2. Peripheral edema, ascites, low cardiac output
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20
Q

Heart failure has a maladaptive adaptation

A

the heart will undergo hypertrophy to normalize wall stress and systolic function but it will lead to altered contractile proteins and calcium handling, apoptosis, fibrosis and failure

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21
Q

function of natriuretic peptides

A

vasodilate and promote sodium excretion

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22
Q

high pulmonary venous pressure

A

left heart failure

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23
Q

high systemic venous pressure

A

right heart failure

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24
Q

NY heart association class (4)

A
  1. no symptoms
  2. symptoms on mod-severe exertion
  3. symptoms on mild exertion
  4. symptoms at rest
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25
Q

ivabradine

A

heart rate lowering agent acting by inhibiting the If current in the sino-atrial node

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26
Q

Shift trial hypothesis

A

addition of ivabradine to recommended therapy would be beneficial in heart failure patients with elevated heart rate

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27
Q

neprilysin

A

inhibition leads to a potentiation of vasoactive peptides that counter maladaptive mechanisms in HF

28
Q

produces a positive inotropic effect through inhibition of the Na-K exchanger that results in higher intracellular sodium levels causing increased calcium transport via sodium-calcium exchange channel

A

digoxin

29
Q

the loss of what can worsen HF?

A

synchronous LV contraction

30
Q

most commonly used drug for suppression of ventricular arrhythmias in HF is

A

amiodarone

31
Q

indications for implantable cardioverter defibrillators

A

syncope or resuscitated cardiac arrest thought ti be due to a ventricular arrhythmia

32
Q

clinical assessment of hemodynamic status (2)

A
  1. thermodilution

2. swanz catheter

33
Q

thermodiultion can measure _____ but there are some pitfalls in inaccuracy such as with (2)

A

CO

  1. tricuspid regurg
  2. fluctuation in body temp
34
Q

Total uptake and release of a substance by an organ equals the blood flow to the organ and the arterio-venous concentration difference for that substance

A

Fick’s method

35
Q

Non-invasive general assessment of atrial, ventricular and valve structure and function

A

TTE

36
Q

Invasive and requires conscious sedation
Higher resolution imaging gives better assessment of valvular structure (e.g. infectious vegitations on valve from endocarditis)

A

TEE

37
Q

Color-flow doppler measures blood velocity (direction and speed) by either TTE or TEE
Does not measure pressure directly, but can make inferences about pressure by converting velocity to pressure:

A

echo

38
Q

Reflection of intravascular volume status
Estimated by pressure in the right atrium (“central venous pressure or CVP”) and/or left atrium (“pulmonary capillary wedge pressure”)

A

Preload: volume of blood in LV at end-diastole

39
Q

Reflection of the heart’s intrinsic ability to contract and generate force during systolic
Estimated generally by the Left Ventricular Ejection Fraction

A

Contractility: ability of myocardium to contract

40
Q

Left ventricular wall stress

Estimated by systemic vascular resistance (SVR) or mean arterial pressure

A

Afterload: resistance to ventricular contraction

41
Q

disease modifying therapies for HF

A
  1. catecholamine pathway
  2. RAAS pathway
  3. revascularization
42
Q

palliative therapies for HF

A
  1. diuretics

2. implantable defibrillator

43
Q

is a life-threatening medical condition of low tissue perfusion resulting in oxygen and nutrient deficit (ischemia/infarction) the impairs tissue function

A

Circulatory shock

44
Q

types of shock (4)

A
  1. hypovolemic
  2. cardiogenic
  3. septic
  4. obstructive
45
Q

causes:

  1. Hypovolemic
  2. Cardiogenic
  3. Septic
  4. Obstructive
A
  1. Hypovolemic
    GI bleeding, excessive diarrhea and dehydration

Cardiogenic
s/p large myocardial infarction, acute valvular disorder

Septic
Significant systemic infection

Obstructive
Pulmonary embolus

46
Q

primary problem:

hypovolemic

A

low preload

47
Q

primary problem:

cardiogenic

A

loss of contractility

48
Q

primary problem:

septic

A

non-specific vasodilation and dehydration

49
Q

primary problem:

obstructive

A

physical blockage preventing blood flow

50
Q

inotropic drugs used (3)

A
  1. Beta-adrenergic agonists
  2. phosphodiesterase inhibitors
  3. digitalis glycosides
51
Q

2 key components of diastolic function:

A
  1. relaxation

2. compliance

52
Q

is the process of myofibrillar dissociation, an active process requiring enzymatic action and energy to remove calcium from the cytoplasm against the concentration gradient.

A

relaxation

53
Q

is the passive property of the myocardium or of a cardiac chamber, describing (for an intact cardiac chamber) the change in volume for a given change in filling pressure, after relaxation is complete.

A

compliance

54
Q

. A low ejection fraction is generally accompanied by

A

ventricular dilatation.

55
Q

Systolic dysfunction is most often a consequence of

A

myocardial infarction (“ischemic cardiomyopathy”) or primary myocardial disease (“dilated cardiomyopathy”)

56
Q

Isolated, or primary, diastolic dysfunction occurs most commonly in the _____, as a consequence of long-standing hypertension and resulting left ventricular hypertrophy.

A

elderly

57
Q

Diastolic dysfunction may also occur as a consequence of___________, a family of genetic disorders linked to mutations of a variety of contractile proteins.

A

familial hypertrophic cardiomyopathy

58
Q

cor pulmonale a sign of

A

right heart failure

59
Q

long standing pressure-overload, as exemplified by hypertensive cardiomyopathy

A

diastolyc dysfunction

60
Q

ventricular dilatation, reduced ejection fraction, commonly referred to as

A

“systolic dysfunction”.

61
Q

hypertrophied myocyte manifests altered expression of

A

contractile proteins and of enzymes that regulate calcium movement,

62
Q

what does the adrenergic nervous system, RAAS pathway, vasopressin and endothelin do in HF?

A

these systems and substances tend to vasoconstrict; augment contractility; promote hypertrophy and interstitial fibrosis; and induce sodium and water retention.

63
Q

levels are elevated in heart failure.

A

B-type natriuretic peptide (BNP)

64
Q

effective means of preventing or reversing progressive left ventricular dilatation (ventricular remodeling) in heart failure.

A

carvedilol

65
Q

A typical regimen for such HF patients includes an

A

ACE inhibitor, beta blocker, digoxin, and diuretic.

66
Q

These agents are useful in the management of acute exacerbations of heart failure

A

vasodilators

67
Q

reduce pulmonary capillary (artery) wedge (PCW) pressure in patients with severe heart failure

A

dobutamine and milrinone

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