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Heart Failure Clinical Flashcards

1
Q

the ventricular wall tension t the end of diastole

A

preload

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2
Q

what does dehydration or hemorrhage lead to?

A

decrease in EDV ad decrease in cardiac output

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3
Q

what does increase IV infusion lead to?

A

increased volume and increased EDV increase in cardiac output

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4
Q

what is after load?

A

ventricular wall tension during contraction

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5
Q

an increase in after load results in what

A

decrease in cardiac output

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6
Q

inotropic state is what?

A

contractility

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7
Q

this is the property of heart muscle that accounts for changes in strength of contraction independent of the preload and afterload

A

contractility

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8
Q

an increase in contractility results in

A

an increase in cardiac output

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9
Q

what is the equation for stroke volume

A

end diastolic volume - end systolic volume

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10
Q

what is the equation of ejection fraction

A

stroke volume/end diastolic volume

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11
Q

what is the equation for cardiac output

A

stroke volume x heart rate

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12
Q

what are the 2 scenarios that increase after load resulting in heart failure

A

advanced aortic stenosis

uncontrolled severe hypertension

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13
Q

what are the 3 scenarios that impair contractility

A

coronary artery disease, chronic volume overload, dilated cardio myopathy

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14
Q

increased after load and impaired contractility result in what?

A

reduced ejection fraction (systolic dysfunction)

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15
Q

what are the 5 impaired diastolic filling scenarios

A

left ventricular hypertrophy, restrictive cardiomyopathy, myocardial fibrosis, transient myocardial ishcemia, pericardial constriction or tamponad

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16
Q

what percent of patients with heart failure have preserved ejection fraction?

A

one half of the patients

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17
Q

what are clinical symptoms of left sided heart failure

A

Systemic BP effects: dyspnea, orthopnea, nocturnal cough, fatigue, diaphoresis, tachycardia, loud P1, s3, s4 sounds

18
Q

what are clinical symptoms of left sided heart failure

A

venous BP effects: peripheral edema, hepatomegaly, anorexia, JVD, hepatomegaly

19
Q

most common cause of right sided heart failure

A

left sided heart failure

20
Q

what is the result of chronic pulmonary disease

A

isolated right heart failure

21
Q

pulmonary embolism and 1st degree pulmonary hypertension can be caused by what?

A

right sided heart failure

22
Q

patient has a pulmonary artery stenosis what kind of heart failure are they most likely to have?

A

right heart failure

23
Q

this class has no limitation of physical activity

A

class 1

24
Q

this class has a slight limitation of activity , dyspnea and fatigue with moderate exertion

A

class 2

25
Q

this class has marked limitation of activity dyspnea while walking upstairs SLOWLY

A

class 3

26
Q

this class has severe limitation of activity - symptoms are present even at rest

A

class 4

27
Q

can you switch classes according the NYHA

A

yes

28
Q

can you switch stages?

A

no

29
Q

stage A

A

risk of developing heart failure but has not developed structural cardiac dysfunction

30
Q

Stage B

A

has structural heart disease associated with heart failure but not had symptoms

31
Q

stage c

A

has symptoms associated with structural heart disease

32
Q

stage d

A

has structural heart disease and marked heart failure despite medical therapy and intervention

33
Q

what can you expect to see on chest radiography of heart failure

A

kerley B lines, upper zone vascular redistribution, cardiomegaly, enlarged azygous

34
Q

what lab study should you do ?

A

assay for BNP indicatory of LV dysfunction

35
Q

what is the prognosis for class III

A

1 year 40%

36
Q

what do most patients die suddenly of?

A

ventricular arrythmias

37
Q

increased TNF alpha, Btype natruretic peptide, RAA system mediators are indicative of what?

A

poor prognosis

38
Q

when should you use diuretics?

A

preserved EF treatment goals (impaired diastolic filling)

39
Q

when are beta blockers appropriate?

A

heart failure due to augmented CO, decreased HR and decreased sympathetic effects at heart

40
Q

when are beta blockers inappropriate

A
  • systolic dysfunction due to negative ionotropic effects
41
Q

what is cardiac resynchronization therapy

A

simultaneous biventricular pacing, achieved through a pacemaker

42
Q

What are the 3 qualities that candidates for CRT have?

A

LV dysfunction EF , 35%, prolonged QRS (LBBB), meds not helping

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