Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Medicine II > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Heart failure is an impaired ability of the heart to either _______ or _______.

A

relax or pump blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

impaired LV contractile function is known clinically as…

A

systolic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

abnormal LV cardiac relaxation, stiffness or impaired filling is known clinically as…

A

diastolic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

T or F

Systolic dysfunction causes diastolic dysfunction.

A

F. one doesn’t cause the other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

can systolic and diastolic dysfunction coexist?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Generally, isolated right heart pathology suggests an issue with what system?

A

pulmonary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

pulmonary hypertension can contribute to what type of cardiac dysfunction?

A

right ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

LHF, HFrEF is systolic or diastolic?

A

systolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

LHF HFpEF is systolic or diastolic?

A

diastolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what does ejection fraction measure?

A

ability of ventricles to eject blood/ventricular function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The below factors have a positive impact on what factor of stroke volume? Preload, Afterload, Contractility or HR?

Increased venous return

increased filling time

increased ventricular compliance

increased filling pressure

A

increased preload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The below factors have a positive impact on what factor of stroke volume? Preload, Afterload, Contractility or HR?

increased peripheral vascular resistance

increased aortic pressure

decreased arterial wall compliance

A

increased afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The below factors have a positive impact on what factor of stroke volume? Preload, Afterload, Contractility or HR?

SNS stimulation leading to inotropy

A

increased contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The below factors have a positive impact on what factor of stroke volume? Preload, Afterload, Contractility or HR?

SNS stimulation leading to chronotropy

A

HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Abrupt damage to myocardium can occur in what condition?

A

MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What two factors cause gradual damage to the myocardium leading to HF?

A

Increased pressure

Increased volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Progressive damage to myocardium causes what two changes to the heart?

A

cardiac remodeling

declining heart function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Decreased perfusion to the kidneys leads to what two physiologic changes which lead to CHF?

A

overactive RAAS system

SNS stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

The progression of heart disease can be visualized as a cycle. What are the steps of this cycle?

A

heart disease

LEADING TO

decreased CO

LEADING TO

neurohormonal stimulation

LEADING TO

vasoconstriction and sodium retention

LEADING TO

increased resistance and ventricular dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

A pt. presents with the following findings. What type of HF do you suspect?

  • clinical S/S of HF
  • reduced LVEF (40% or less)
  • increased LV ESV/EDV
A

HFrEF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

HFrEF is also known as…

A

systolic heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In HFrEF, _______ overload leads to ________ dilation and _________ remodeling

A

volume overload

chamber dilation

eccentric remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

HFrEF is caused by impaired contractility and high afterload. What conditions impair contractility and increase afterload?

A

Contractility: CAD, cardiomyopathy

Afterload: HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the normal range for LVEF?

A

50-55%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

HFpEF is systolic or diastolic dysfunction?

A

Diastolic Dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Impaired LV relaxation and decreased LV compliance lead to…

A

diastolic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What happens to the LVEF and EDV in HFpEF?

A

normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When the LV increases its dependence on atrial contraction for filling, what results?

A

left atrial enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

HFrEF is a ______ overload, while HFpEF is a ________ overload

A

rEF: volume overload

pEF: pressure overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what type of cardiac remodeling is seen in HFpEF?

A

concentric remodeling/hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What risk factors do HFpEF and HFrEF have in common?

A

old age

HTN

CAD

DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Patients with HFpEF compared to HFrEF tend to…

A

be older

have HTN

overweight

women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the most common cause of right heart failure?

A

LHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

The right heart is a low pressure, high compliance system, meaning it does not tolerate increases in ______

A

afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What conditions cause increased afterload in the right heart?

A

PE

chronic pulmonary disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the MC cause of heart failure?

A

CAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

A patient with CAD presents with the following sxs. What should you immediately suspect?

dyspnea

fatigue/weakness

dependent edema

weight gain

nocturnal, nonproductive cough

nocturia

A

heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the progression of dyspnea as heart failure worsens?

A

DOE

to

orthopnea

to

PND

to

dyspnea at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

HF has many of the normal cardiovascular risk factors like CAD, PVD, DM, HTN, and obesity.

What endocrine disorders contribute to HF?

A

pheochromocytoma

thyroid abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is an early finding in decompensation in patients with HF?

A

S3/S4 gallop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What findings should you expect to see on cardiac physical exam of patients with HF?

A

elevated JVD

Displaced PMI

S3/S4 gallop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What findings should you expect to see on skin physical exam of patients with HF?

A

edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What findings should you expect to see on pulmonary physical exam of patients with HF?

A

Crackles at the bases

44
Q

What findings should you expect to see on abdominal physical exam of patients with HF?

A

hepatomegaly

hepatojugular reflux

45
Q

LHF can present with the following S/S that are caused by…

activity intolerance

fatigue

altered mental status

A

decreased CO

46
Q

LHF can present with the following S/S that are caused by…

cyanosis/hypoxia

cough with frothy sputum

orthopnea

PND

A

pulmonary congestion

47
Q

RHF can present with the following S/S that are caused by…

dependent edema

ascites

JVD

anorexia

GI distress

Hepatomegaly

A

congestion of peripheral tissues

48
Q

A 70 year old smoker with a 20 pack year hx an DM presents with the following sxs. What should you immediately include in your DDx?

  • dysnea on exertion
  • diaphoresis
  • tachypnea
  • tachycardia
  • rales/crackles
  • S3 or S4
A

LHF

49
Q

You are seeing a patient who has LHF. They report new onset of the following sxs. What should you immediately suspect?

  • edema
  • RUQ pain
  • JVD
  • Ascites
A

RHF

50
Q

A patient presents with risk factors for heart disease and a CC of fatigue and weight gain.

PE findings are as follows:

Lungs: crackles at base, dyspnea, dry cough

Cardiac: tachycardia,

Skin: diaphoresis, edema.

What diagnostic studies do you want to order?

A

ECG

Echo

CXR

51
Q

In patients suspected of HF, EKG evaluates for…

A

ischemia, arrhythmias

52
Q

You suspect a pt. has HF. You order an EKG, which comes back normal. This finding makes what cardiac condition unlikely?

A

systolic dysfunction

53
Q

What can assist in evaluating for arrhythmia in patients suspected of HF?

A

holter monitor

54
Q

What makes echo the most important diagnostic in evaluation of HF?

A

EF evaluation

55
Q

On echo, systolic dysfunction can be suspected when what is visualized?

A

dilated left ventricle

56
Q

On echo, diastolic dysfunction can be suspected when what is visualized?

A

left ventricular hypertrophy

57
Q

What findings on CXR are suggestive of HF?

A

cardiomegaly

cephalization of pulmonary vessels

kerley b-lines

pleural effusion

58
Q

In patients with HF, exercise EKG is helpful in evaluating what?

A

degree of functional impairment

ID of ischemic disease

59
Q

Is cardiac catheterization routine in evaluation of HF?

A

no

60
Q

What labs can be ordered to help evaluate HF?

A

cardiac enzymes

CBC

CMP (electrolytes, renal fxn, glucose, liver fxn)

BNP

NT-proBNP

61
Q

cardiac enzymes are ordered for what reason?

A

evaluate for acute ischemia

62
Q

why is a CBC useful in HF evaluation?

A

anemia, infx can exacerbate HF

63
Q

What are BNP and NT-proBNP useful for?

A

diagnosing HF

Risk stratification

guiding Tx

64
Q

Who should have natriuretic peptide biomarkers measured, according to 2017 ACC/AHA/HFSA guidelines

A

pts w/ dyspnea to support HF dx

chronic HF on admission to hospital

65
Q

Why would iron studies be useful in HF?

A

evaluate hemochromatosis as underlying cause

66
Q

What could a thyroid panel tell you that is helpful for HF?

A

hypothyroidism can present as and exacerbate HF

67
Q

what foods can help moderate risk for heart failure?

A

breakfast cereals

fruits/veggies

68
Q

How much exercise will moderate risk for HF?

A

5+ times per week

69
Q

how much EtOH consumption is acceptable to lower risk of HF?

A

5-14 drinks/week

70
Q

What is the recommended initial therapy for HFrEF?

A

ACE-I

Diuretics

71
Q

What is the recommended initial therapy for HFpEF?

A

ID and Tx of comorbid conditions

diuretics for sx releif

72
Q

What type of dysfunction is more common in elderly females with HTN/DM

A

diastolic dysfunction

73
Q

DOC diuretic for HF?

A

furosemide (lasix)

74
Q

Diuretic therapy in HF has a goal of what?

A

reducing dyspnea, edema, fluid overload

75
Q

What must be monitored with diuretic therapy?

A

renal function, electrolytes.

hypokalemia can occur

76
Q

What drug is shown to reduce morbidity and mortality in symptomatic and asymptomatic HF?

A

ACE-I

77
Q

What is the approach to dosing with ACE-I in HF?

A

titrate… start low, go slow

78
Q

ACE-Is and ARBs have what effect that is beneficial for treating HF?

A

reduce afterload

79
Q

If an ACE-I isn’t tolerated due to cough, what can be substituted?

A

ARBs

80
Q

What should be monitored with ACEs and ARBs?

A

BP, renal fxn, electrolytes

81
Q

Which beta blockers improve morbidity and mortality for class II and III HF?

A

carvedilol, bisoprolol, metoprolol

82
Q

Describe the dosing regimen for beta blockers…

A

dose slowly and only if clinically stable. start with ACE-I first.

83
Q

What is the main side effect of beta blockers?

A

bradycardia

84
Q

patients with chronic symptomatic HFrEF Class II or III who tolerate an ACE-I or ARB should replace with…

A

ARNI (entresto)

85
Q

patients with at-rest dyspnea w/in last 6 months, or post-MI with systolic dysfunction can be treated with what drug?

A

Mineralcorticoid receptor antagonist (aldosterone antagonist + potassium-sparing diuretic)

86
Q

What needs to be monitored when prescribing an MRA?

A

electrolytes, fluid balance, renal function

87
Q

A patient with HF cannot take an ACE, ARB, or ARNI. What can be prescribed?

A

hydralazine plus isosorbide dinitrate

88
Q

Hydralazine does what?

Isosorbide does what?

A

Hydralazine: vasodilation

Isosorbide dinitrate: decreased O2 demand, decreased preload

89
Q

This drug can be used in patients with accompanying atrial fibrillation

A

Digoxin

90
Q

Digoxin is what glass of drugs?

A

Inotropic agent

91
Q

Which drug enhances exercise tolerance?

A

digoxin

92
Q

How should digoxin dosing be approached and what serum levels must be maintained?

A

low dose, titrate.

serum .5-.8ng/mL

93
Q

are statins helpful in tx for HF?

A

no

94
Q

When can you continue statin therapy with HF?

A

if already on for a different indication

95
Q

What is a major predictor of high mortality in HF?

A

loss of ADLs

96
Q

Education on heart failure should be direct at whom?

A

patient and family

97
Q

Where should HF pts be treated?

A

specific heart failure clinic

98
Q

What are the most common causes of death in heart failure patients

A

decompensation/pump failure and arrhythmia

99
Q

cardiogenic pulmonary edema is most often a result of…

A

ADHF (MI, ischemia, mitral stenosis)

100
Q

A patient presents with:

dyspnea

productive cough with pink frothy sputum

diaphoresis

abnormal breath sounds

What do you suspect?

A

cardiogenic pulmonary edema

101
Q

On CXR with cardiogenic pulmonary edema, what do you expect to find?

A

kerley b lines

edema

cardiomegaly

102
Q

What is typically elevated in cardiogenic edema?

A

pulmonary capillary wedge

103
Q

A patient presents to the clinic with the following sxs…what are these concerning for?

cough

dyspnea

fatigue

rapid peripheral edema

orthopnea/PND

A

Acute decompensated heart failure

104
Q

A PE of a patient reveals the following… what is this immediately concerning for?

HTN

JVD

Tachypnea

Accessory muscle use

crackles

Tachycardia

S3/S4

New murmur

LE edema

A

acute decompensated heart failure

105
Q

What is the workup for ADHF>

A 
ECG
CXR
pulseox
ABGs
CBC
electrolytes
renal/liver function
cardiac enzymes
BNP
Echo
106
Q

How is ADHF treated?

A

hospital admission with telemetry

supp O2, sats >90%

diuretics

nitro

107
Q

what electrolyte should be monitored in ADHF?

A

potassium

Clinical Medicine II (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions