Heart Failure and Cardiomyopathies Flashcards
Pathophysiology of Heart Failure:
1) ___ overload
2) ___ overload
3) Myocardial ___
4) Myocardial ___
5) Restricted ___
1) Pressure
2) Volume
3) Ischemia/infarction
4) Inflammatory disease
5) diastolic filling
Adaptive Response to Failure:
- Frank-starling relationship
- Activation of ___
- Alterations in inotropic state, HR and afterload
- ___ responses
*When mechanisms become maladaptive it leads to?
- SNS
- Humoral-mediated
- myocardial remodeling
Activation of SNS: *Increases in ___
- Arteriolar constriction: -maintains BP despite decrease in ___
- redirects blood flow to ___ and ___
- Venous constriction: -increases ___
- ___ maintained by Frank-Starling relationship
- ___ release due to decrease in renal BF; this increases blood volume and ultimately CO by sodium and water retention
- HR
- CO
- coronary and cerebral system
- preload
- CO
- Renin-angiotensin aldosterone release
Other Adaptive Responses (HF):
- To increase CO: increase in ___, reduction in ___, increase in ___
- To promote BP control and protect from the effects of volume and pressure overload: Release of __ and ___
- Diuresis -Natriuresis -Vasodilation -anti-inflammation
- inhibition of RAS and SNS and cardiac remodeling
- contraction velocity
- afterload
- HR
- atrial NP and B type natriuretic peptide
Myocardial Remodeling:
- Myocardial ___
- Myocardial ___ and ___
- Increased ___ deposition
- Myocardial ___
- ___ formation
- hypertrophy
- dilation and wall thinning
- interstitial collagen deposition
- fibrosis
- Scar
Clinical Features of Heart Failure:
- ___ (orthopnea/orthopneic cough, paroxysmal nocturnal dyspnea)
- ___ due to dilation
- ___ at rest
- ***Name 9 other s/s
- dyspnea
- Atrial fibrillation
- weakness at rest
- fatigue -oliguria -edema -tachycardia -S3 gallop
- tachypnea -lung rales -hypotension -JVD
Heart Failure in a nutshell:
Decrease ___ –> ___ to increase contractility from stretched muscle fibers –> Increase ___ results in increased cardiac work –> increase ___ and ___ –> ___ falls –> Increase ___ to increase HR and SVR –> ___ falls
- contractility
- ventricle dilated
- ventricular radius
- oxygen consumption and increased cardiac work
- CO
- sympathetic outflow
- Stroke volume
Management of Heart Failure:
- ACE inhibitors/Angiotensin II receptor blockers
- Diuretics -Digoxin -Inotropes -Beta Blockers -Nesiritide
- ___ antagonists
- ___ therapy
- ___ pacing
- Assistive devices
- Aldosterone
- Vasodilator
- Biventricular
Anesthetic Management of Heart Failure:
- **The Goal is to prevent and avoid ___:
- Heart rate = ?
- Preload = ?
- Afterload = ?
- Contractility = ?
- **myocardial depression
- normal to elevated
- normal to high
- low
- increase
Anesthetic Management with Heart Failure: (+/- a-line, usually want it)
- Maintain ___, especially ___
- Hypotension treated with ___, ___, ___
- General anesthetic doses may be ___
- ___ beneficial in decreasing pulmonary congestion
- ___ ok
- Avoid ___
- medication therapy, beta blockers
- ephedrine, phenylephrine, vasopressin
- decreased
- positive pressure ventilation
- regional anesthesia ok
- fluid overload
Cardiomyopathies:
___ = Hypertrophic cardiomyopathy, Arrhythmogenic right ventricular cardiomyopathy, Left ventricular noncompaction, Glycogen storage disease, Conduction system disease (Lenegre’s Disease), Ion channelopathies-Long QT syndrome, Brugada syndrome, short QT syndrome
Genetic
Cardiomyopathies:
*___ = Dilated cardiomyopathy, Primary restrictive nonhypertrophic cardiomyopathy
*___ = Myocarditis (inflammatory cardiomyopathy-viral, bacterial, rickettsial, fungal, parasitic (Chagas’s disease)), Stress cardiomyopathy, Peripartum cardiomyopathy
- Mixed
* Acquired
Hypertrophic Cardiomyopathy: Pathophysiology = Myocardial hypertrophy --> Dynamic LV outflow tract \_\_\_ (asymmetric septal hypertrophy, systolic anterior movement of the \_\_\_ and \_\_\_) --> \_\_\_ dysfunction --> Myocardial \_\_\_ --> Dysrhythmias
- obstruction
- mitral valve and mitral regurgitation
- Diastolic
- Ischemia
Signs and Symptoms of Hypertrophic Cardiomyopathy:
6 ??????
Angina Fatigue Syncope Tachydysrhythmias Heart failure sudden death
Hypertrophic Cardiomyopathy Events Increasing Outflow Obstruction: Digitalis, Vasodilators, + Pressure Ventilation
- Beta adrenergic ___
- ___ preload
- Volume?
- Heart rate?
- BP? -___ afterload -___ myocardial contractility
- stimulation (catecholamines)
- Decreased preload
- Hypovolemia
- Tachycardia
- Hypotension
- Decreased afterload
- Increased
Inability to adequately fill or empty the ventricle?
Due to: CAD, Cardiomyopathy, Valve abnormalities, HTN, Diseases of the pericardium, pulmonary HTN (cor pulmonale)
Heart Failure
Hypertrophic Cardiomyopathy Events Decreasing Outflow Obstruction: Volatile anesthetics, Calcium entry blockers, alpha adrenergic stimul.
- Beta adrenergic ___
- ___ preload
- Volume?
- Heart rate?
- BP? -___ afterload -___ myocardial contractility
- blockade
- Increased
- Hypervolemia
- Bradycardia
- HTN
- Increased
- Decreased
Treatment of Hypertrophic Cardiomyopathy:
- Treatment of underlying cause of Cardiomyopathy
- ___
- ___
Beta blockers
Calcium channel blockers
Anesthetic Management of Patients with Hypertrophic Cardiomyopathy:
- Minimize ???
- ___ myocardial contractility depression
- ___ effects on preload and afterload
- LV outlet obstruction
- mild
- minimal effects
Anesthetic Management of Pt. with Hypertrophic Cardiomyopathy:
- A-line -___ good
- Treat hypotension with ___ (___) and ___!!!
- ___ are contraindicated
- Prompt replacement of ___ and ___
- Avoid ___
- Maintain ___
- Volatile anesthetics good
- alpha adrenergic agonists (phenylephrine) and VOLUME
- Beta adrenergic agonists
- blood and fluids
- vasodilators
- NSR
Myocardial disease with LV or biventricular dilation, systemic dysfunction, and normal LV thickness?
Dilated Cardiomyopathy
Dilated Cardiomyopathy Anesthesia: The goal is to prevent and avoid ?
1) Heart rate = ?
2) Preload = ?
3) Afterload = ?
4) Contractility = ?
Myocardial Depression
1) normal to elevated
2) normal to high
3) low
4) increase
Right ventricular enlargement with hypertrophy and/or dilation that may progress to right heart failure?
*Caused by ___ and ___
Cor pulmonale
- pulmonary hypertension
- chronic alveolar hypoxia
Cor Pulmonale Management:
- Eliminate any ?
- Reverse ___
- Improve ___
- Maintain good ___, ___ and ___
- Correct ___
- infection
- bronchospasm
- expectoration
- oxygenation, hydration and lung mechanics
- electrolyte imbalance
Cor Pulmonale Management: -Oxygenation
- Avoid ___
- Depth of anesthetic (keep deep to avoid ___)
- Bronchodilator effects of ___
- A-line
- ___ for monitoring RV function
- ___ should be avoided, otherwise ok
- Histamine releasers
- bronchospasm
- inhalational agents
- TEE
- High level block with regional
