Heart Failure (Light-McGroary) Flashcards
what is the most common cause of right sided heart failure?
left heart failure
common causes of this type of heart failure include ischemia, mitral/aortic valve disease, and restrictive cardiomyopathies
left sided heart failure
this type of heart failure has a higher incidence in older patients, diabetics, and women
diastolic heart failure
this type of heart failiure is often due to ischemic heart disease, hypertension, or “idiopathic”
systolic heart failure
____ cor pulmonae is due to events such as pulmonary embolism and result in the dilation of the heart, capable of causing sudden cardiac death
acute
____ cor pulmonae is due to right A/V dilation and hypertrophy and is often preceded by the development of arterial plaques and lesions
chronic
the amount of stretch on the ventricle after diastole, estimated by end diastolic pressure
preload
the load against which the heart must contract; reflects the compliance of the large arteries
afterload
All of the following are symptoms of right-sided heart failure EXCEPT:
A. Weight loss B. Anorexia C. Orthopnea D. Abdominal bloating E. Hiccups
C. Orthopena is a sign of left sided heart failure, along with dyspnea on exertion, nocturnal coughing/awakening, palpitations, hemoptysis (coughing up blood) and nocturia.
All of the following are signs of left-sided heart failure EXCEPT:
A. Hypotension B. Hepatomegaly C. Rales and gallop D. Pleural effusion E. Cool extremities
B. Hepatomegaly is a sign of right sided heart failure, along with ascites, elevated JVP, sternal lift, and peripheral edema. (More venous congestion symptoms)
True or false: when the heart responds to stress, it is capable of cell division, increasing its number of myocytes to respond to that stress.
False. A cell cannot increase its number of myocytes, they can only hypertrophy to increase the size of the existing myocytes and the number of sarcomeres.
what are the two diseases characteristic of a pressure overload state (increased afterload), in which new sarcomeres are being added in parallel to the long access of the myoctyes causing concentric hypertrophy?
HTN and valvular stenosis
what are the two diseases characteristic of a volume overload state (increased preload), in which new sarcomeres are added in series, adding to muscle fiber length and leading to ventricular dilation and hypertrophy?
valvular regurgitation and shunts
_____ hypertrophy is associated with diastolic heart failure and is characterized by increased wall thickness and decreased chamber size
pressure
_____ hypertrophy is associated with systolic heart failure and is characterized by static (or decreased) wall thickness and a dilated chamber.
volume
why are liver pathology findings associated with left ventricular failure?
the liver takes a large portion of the cardiac output, pumped from the left ventricle into stystemic circulation.
True or false: a person with stage B heart failure may be asymptomatic but has signs of heart failure on an EKG.
True.
Stage A = people at risk for developing HF
Stage B = asymptomatic with some marker for HF (previous MI, LV systolic dysfunction)
Stage C = symptomatic
Stage D = marked symptoms at rest, heavily impaired, resistant to medication
what is the only treatment we have developed for diastolic heart failure?
diuretics to decrease fluid load, and work to treat the underlying problem. most pharmacology is aimed at systolic heart failure.
how are beta blockers effective in treating heart failure?
they block the sympathetic response, reverse cardiac remodeling, and improve the ejection fraction
which beta blockers are approved for treating heart failure?
carvedilol, metoprolol succinate (long-acting), bisoprolol
this diuretic is commonly used in combination therapy for treatment of heart failure, because of its anti-fibrotic and potassium sparing effects
spironolactone
a major side effect of spironolactone that can be addressed by switching to the more aldosterone selective eplerenone
gynecomastia
what is a good medication option for reduction of afterload in patients who are intolerant of ACE inhibitors and ARBs?
vasodilators (ie, hydralazine), often combined with nitrates. this treatment combination seems to work better than ACEIs and ARBs in the african american population.
class of drugs MOST used in treatment of heart failure
loop diuretics
though this drug has been shown to reduce hospitalization, it does not reduce morbidity and is not often used due to narrow therapeutic ratio and its positive ionotropic effect
digoxin
types of drugs used most effectively for acutely decompensated HF patients or bridging patients to the next step of treatment (heart transplant)
inotropes
what is the best treatment for a patient who displays the most common presentation of heart failure, “warm and wet”, in terms of congestion and perfusion?
diuretics and vasodilators - main treatment goal is to get the excess fluid off the patient
