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Heart Failure and Cardiomyopathies Flashcards

1
Q

resistance heart must overcome to push blood out; McDonald’s straw vs a coffee stirring straw

A

afterload

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2
Q

amount of myocardial elasticity

A

contractility

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3
Q

filling pressure of the heart, the more the fill and stretch, the harder the subsequent contraction; think preparatory dip

A

preload

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4
Q

net equilibrium between filtration and reabsorption

A

Starling’s law of capillaries

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5
Q

name three drug classes that decrease HR, thus decreasing CO

A
  1. Beta-blockers
  2. CCBs
    3 Digoxin
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6
Q

Name three factors that decrease HR

A
  1. PNS (vagal stim)
  2. conduction abnormalities
  3. Drug effects
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7
Q

Name three drugs that increase HR

A
  1. Caffeine
  2. Cocaine
  3. Other sympathomimetics
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8
Q

Name three factors that increase HR

A
  1. SNS stimulation
  2. Hypovolemia
  3. Drug effects
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9
Q

Name the 7 factors the decrease preload, thus decreasing stroke volume

A
  1. hypovolemia
  2. excessive vasodilation
  3. increased intrathoracic pressure
  4. cardiac tamponade
  5. RV infarction/failure
  6. Tachyarrhythmias
  7. Loss of atrial “kick”
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10
Q

Name three factors that increase preload, thus increasing stroke volume

A
  1. heart failure
  2. hypervolemia
  3. bradydysrhythmias
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11
Q

resistance the heart must overcome to push blood out; McDonald’s straw vs coffee stirring straw

A

Afterload

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12
Q

Name the four drug classes that decrease afterload (McDonald’s straw)

A
  1. CCB
  2. Nitrates
  3. Alpha blockers
  4. Vasodilators
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13
Q

Why do calcium channel blockers decrease afterload

A

by causing vasodilation of the arterial vascular beds; make the straw bigger

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14
Q

Why do nitrates decrease afterload and preload?

A

dilate vascular smooth muscle, coronary vessels, and peripheral veins, all which lower myocardial oxygen consumption; make the straw bigger

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15
Q

Why do Alpha-blockers decrease afterload?

A

vasodilate blood vessels; make the straw bigger

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16
Q

Why do beta-blockers decrease HR?

A

inhibit beta 1 receptors, which affect the heart rate

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17
Q

Why do calcium channel blockers decrease HR?

A

prevent Ca2+ from entering the myocardial cells = decreases muscle contraction and force

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18
Q

Why does digoxin decrease HR?

A

reduces the # of electrical impulses that pass through the AV node

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19
Q

Name five factors that increase afterload, thus decreasing SV; coffee stirring straw

A
  1. vasoconstriction from SNS or vasopressin
  2. hypertension
  3. aortic valve stenosis
  4. hypercoagulability
  5. Pulmonary hypertension
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20
Q

amount of myocardial elasticity

A

contractility

21
Q

Name 4 drug classes that decrease contractility

A
  1. beta-blockers
  2. anesthetics
  3. Barbiturates
  4. Most antiarrhythmic meds
22
Q

Why do beta-blockers decrease contractility, thus decreasing SV?

A

prevent stimulation of beta 1 = decrease HR and contraction force

23
Q

Name 5 factors that decrease contractility

A
  1. myocardial ischemia/infarction
  2. Cardiomyopathies
  3. Hypoxemia
  4. Acidosis
  5. Drug effects
24
Q

Name 2 factors that increase contractility

A
  1. SNS stimulation

2. Sympathomimetic drugs

25
Name 2 causes of lymphatic obstruction/lymphadema
1. Following modified radical mastectomy and radiation | 2. Filariasis (Wuchereria bancrofti)
26
Osmotic pressure is reliant on the amount of _____
Albumin + other large plasma proteins
27
What happen to osmotic pressure if there isn't enough albumin?
decreases
28
what are the clinical presentations for Left-sided forward systolic dysfunction
fatigue, oliguria, increased HR, faint pulses, restlessness, confusion, anxiety
29
What are the clinical presentations for left-sided backward systolic dysfunction?
Dyspnea on exertion, orthopnea, cough, postural nocturnal dyspnea, cyanosis, basilar crackles
30
What is the typical cause of right sided heart failure?
Left sided heart failure
31
What are the typical causes of left sided heart failure?
CAD and hypertension
32
What are the clinical presentations for right sided forward systolic dysfunction?
fatigue, oliguria, increased HR, faint pulses, restlessness, confusion, anxiety
33
What are the clinical presentations for right sided backward systolic dysfunction
hepatomegaly, ascites, spenomegaly, anorexia, subcutaneous (peripheral) edema, jugular vein distention (JVD)
34
What labs would you order in a patient you suspect may have HF?
CBC, Electrolyte, BUN, creatinine, Liver function, Calcium, magnesium, phosphate, Thyroid, BNP
35
No limitations and asymptomatic during usual activity
New York Heart Assoc Class I
36
slight limitations and mild symptoms (dyspnea, fatigue, or chest pain) w/ ordinary activities
NY Heart Assoc Class II
37
Moderate limitations w/ symptoms noted with minimal activity
NY Heart Assoc Class III
38
Severe limitations w/ symptoms at rest
NY Heart Assoc. Class IV
39
What should you use to immediately treat the symptoms of HF?
Diuretics
40
What's the first line drug choice for immediate treatment of HF?
ACE-Is
41
What can be combined with ACE-Is for immediate treatment of HF?
Beta-blockers
42
What is/are your 1st line drug class choice for long term management of HF?
ACE-Is (1st; "-prils"; lisinopril); ARBs (1st-ish; "-artans"; losartan)
43
What is your second line drug class choice for long term management of HF?
Beta-Blockers ("-olol"; metoprolol, and -ilol"; carvedilol)
44
What is your first line drug choice for the long term management of HF in black patients?
Hydralazine + nitrates
45
Pulsus bisferiens should make you think of which type of cardiomyopathy?
Hypertrophic cardiomyopathy
46
Pulsus parvus et tarsus is associated with what type of murmur?
Aortic stenosis
47
Pulses paradoxus is characterized by:
decrease of at least 20 mm Hg in systolic blood pressure during inspiration. It is seen in both cardiac and respiratory pathologies, including cardiac tamponade, chronic obstructive pulmonary disease, and severe asthma.
48
Austin Flint murmur (A) is a low-pitched diastolic rumble best heard at the cardiac apex and is associated with what type of murmur/ valvular disease?
Aortic regurgitation

Cardiovascular (7 decks)

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