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CV II Exam 3 > Heart Failure, Myocarditis, Cardiomyopathies, and Pulmonary Hypertension > Flashcards

Heart Failure, Myocarditis, Cardiomyopathies, and Pulmonary Hypertension Flashcards

1
Q

CHF Syndrome

A

CHF is a syndrome - not a disease

Something else is causing the heart failure

Constellation of signs and symptoms occurring with different diseases

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2
Q

CHF Definition

A

Clinical Syndrome in which an abnormality of cardiac structure or function is responsible for the inability of the heart to eject or fill with blood at a rate sufficient to meet the demands of the metabolizing tissues **Pump failure

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3
Q

Systolic components of heart failure

A

Myocardial - how strong

Preload - increase stretch increases work and pressure

Afterload - resistance against contraction

Fast HR - not enough time to fill

Slow HR - decrease CO

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4
Q

Diastolic component of heart failure

A

Impaired relaxation (function) - ischemia

Impaired compliance (anatomy) - hypertrophy, HTN

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5
Q

High output failure

A

Normal heart function with:

Increased metabolic demand

Increased peripheral blood flow from decreased PVR

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6
Q

Pathophysiology

A

Not just volume/pump problem, it involves increased stimulation of autonomics

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7
Q

Heart failure classifications

A

Systolic vs. Diastolic Heart Failure

Low Output vs. High Output Heart Failure

Left vs. Right vs. Biventricular failure

Acute vs. Chronic Heart Failure

Forward vs. Backward Heart Failure

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8
Q

Systolic heart failure

A

Inadequate Cardiac Output/Ejection Fraction

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9
Q

CO

A

SVxHR

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10
Q

SV

A

EDV-ESV

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11
Q

EF

A

SV/ESV

Should be around 55%

Used to measure level of failure

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12
Q

Diastolic heart failure

A

Inability of the ventricles to relax and fill normally with blood during diastole

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13
Q

Forward failure

A

Seen especially with left sided heart problems

Decrease in perfusion of the organs/tissues downstream from the heart

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14
Q

Backward failure

A

“backing up” of the blood into the organs upstream -> increasing hydrostatic pressure -> leads to congestion/edema

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15
Q

Left sided heart failure

A

Caused by: CAD/MI, Aortic/Mitral valve problems, HTN, cardiomyopathies

Forward (systemic) and backward (pulmonary congestion) failure symptoms

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16
Q

Right sided heart failure

A

Caused by: pulmonary disease, tricuspid/pulmonary valves, pulmonary HTN, pulmonary emboli

Backward failure symptoms

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17
Q

Biventricular Failure

A

End result of left and right failure

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18
Q

Acute heart failure

A

Sudden and severe event (MI, Chordae rupture, PE)

Mostly forward failure

Flash pulmonary edema

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19
Q

Chronic heart failure

A

Progresses slowly

Has exacerbation

Mostly backward failure

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20
Q

Causes of heart failure

A
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21
Q

Cardiomyopathy

A

Often left heart effected

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22
Q

Dilated cardiomyopathy due to CAD/MI

A

Due to death or functional ischemic dysfunction of myocardial tissue due to complete or partial blockage of coronary arteries

Degree of dysfunction depends on the percent of myocardium affected

Ischemic cardiomyopathy

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23
Q

Ischemic vs non-ischemic

A

Need to send to cath lab if ischemic to fix block in blood flow

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24
Q

Dilated cardiomyopathy due to HTN

A

HTN -> increased cardiac workload -> LVH -> diastolic dysfunction -> ventricular dilatation -> systolic dysfunction

Younger people - increased peripheral resistance

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25
Dilated cardiomyopathy due to valvular heart disease
Aortic regurg -\> Increased in EDV/preload -\> Increase workload -\> LVH -\> Left ventricular dilatation -\> Systolic dysfunction
26
Infective myocarditis
Main cause dilated cardiomyopathy - especially in younger people Caused by many things - mostly viral Febrile illness or URI usually beforehand Can be acute or gradual
27
Non-infective myocarditis
Toxins or autoimmune/CTD associated
28
Toxic Myocarditis
Alcohol Cocaine Chemotherapy - Doxorubicin (Adriamycin) Heavy metals (copper, iron, lead) Lithium Malaria drugs Radiation
29
Immune/Connective Tissue Myocarditis
Giant Cell Myocarditis PM/DM SLE/RA
30
Cocaine and the myocardium
May cause vasospasm leading to MI (widespread vasospam -\> can be bilateral MI) May cause arrhythmia May cause drug-induced myocarditis/cardiomyopathy -\> released catecholamines
31
Alcoholic cardiomyopathy
Chronic use Direct toxic effect Different from beriberi disease, although thiamine deficiency is frequent in alcoholics
32
Peripartum cardiomyopathy
Last month of pregnancy to 5 months after Immune mediated
33
Takotsubo Cardiomyopathy
Stress cardiomyopathy Apical Ballooning Syndrome Broken Heart Syndrome 80% women Catecholamine excess, coronary artery vasospasm, microvascular dysfunction OR dynamic mid-cavity or left ventricular outflow tract obstruction which may contribute to apical balooning Present with CP, SOB, syncope -\> Echo shows ballooning
34
Hypertrophic Cardiomyopathy - Genetic (HOCM)
Unrelated to any pressure or volume overload Autosomal Dominant (myosin heavy chains, calcium handling) Septum often disproportionally involved Subaortic stenosis usually present Mostly diastolic dysfunction
35
HOCM Clinical Manifestations
Usually affects younger people SOB, chest pain, syncope, arrythmias (afib, ventricular, sudden death,) systolic murmur LSB
36
How does HOCM murmur change with squating?
Decreases Increases with valsalva and upright position
37
Non-genetic hypertrophic cardiomyopathy
Hypertensive Aortic-stenosis related
38
HTN hypertrophy vs genetic
More generalized thickening with no disproportional involvement of the septum
39
Aortic stenosis hypertrophy
More left sided
40
Non-genetic hypertrophic cardiomyopathy symptoms
Obstruction - syncope and chest pain Diastolic dysfunction - SOB, edema
41
Restrictive cardiomyopathy
Mostly diastolic dysfunction - bad filling Primary (genetic) is uncommon Secondary: infiltrative disease (amyloidosis, sarcoidosis,) storage disease, metabolic disorders, fibrosis (radiation,) endomyocardic (Loffler's, fibrosis)
42
Pulmonary vs systemic pressure
Much lower 20/10 vs 120/80 Flow is the same because resistance is much lower
43
Pulmonary HTN
Increased pulmonary pressure
44
Idiopathic Pulmonary HTN
Uncommon - arterial problem F\>M age 30-50 Poor survival
45
Pulmonary HTN - left to right shunt
Due to heart defects: VSD, PDA, ASD, AVSD Blood moves from high pressure to low pressure system increasing blood that goes to pulmonary s
46
Drug associated pulmonary HTN
Fenfluramine - directly effects pulmonary vasculature and damages right valves Amphetamines Cocaine
47
Pulmonary HTN due to left sided heart problems
Left ventricular failure -\> Increase LV volume and pressure -\> Increase LA volume and pressure -\> Increase pulmonary artery pressure -\> RVH -\> RV failure
48
Most common cause of pulmonary HTN
Pulmonary disease -\> Pulmonary HTN -\> Increase RV afterload -\> RVH -\> RV failure
49
Pulmonary Embolism
Usually from lower extremeties Can also come from UE, heart, and abdominal veins Increase pulmonary artery pressure which increases RV afterload
50
High Output Failure
Normal heart Increase metabolic demand isn't met by pumping ability of heart OR excessive blood flow overwhelms the pump
51
Increased metabolic demand not met by CO
Thyrotoxicosis
52
Excessive blood flow overwhelming the pump
Anemia - blood is less viscous and moves at higher velocity AV fistula Conditions decreasing peripheral resistance (Beri-beri, sepsis)
53
Left sided CHF clinical manifestations
Paroxysmal Nocternal dyspnea Elevated pulmonary wedge pressure Pulmonary congestion (cough, crackles, wheezes, blood-tinged sputum, tachypnea) Restlessness Confusion Orthopnea, hypotension Tachycardia Exertional dyspnea, exercise intolerance Fatigue, weakness Cyanosis Organ failure: cardiac ischemia, watershed infarcts, renal failure, bowel ischemia, shock liver
54
Right sided CHF clinical manifestations
Fatigue Increase peripheral venous pressure Ascites Enlarged liver (nutmeg liver) and spleen Distended jugular Anorexia, GI distress (intestinal congestion) Weight gain Dependent edema Can be secondary to pulmonary problem
55
NYHA Functional classification
Class I: Symptoms with more than ordinary activity Class II: Symptoms with ordinary activity Class III: Symptoms with minimal activity Class IV: Symptoms at rest
56
Stage A of heart failure
At high Risk for Heart Failure, but without structural heart disease
57
Stage B of heart failure
Structural Heart Disease, but without symptoms or signs of heart failure
58
Stage C of heart failure
Structural Heart Disease, with prior or current symptoms of heart failure
59
Stage D of heart failure
Heart failure requiring intervention
60
VS of CHF
BP may be low Tachycardia Tachypnea and hypoxia
61
CHF findings in the neck
JVD Hepato-jugular reflex Thyroid enlargement - toxic goiter
62
CHF findings in the lungs
Crackles/rales: b/l, higher is worse Sometimes decreased sounds at base Dullness to percussion Tactile fremitus
63
Increased tactile fremitus
Alveolar and interstitial edema
64
Decreased tacile fremitus
Bilateral pleural effusion
65
Heart palpations with CHF
PMI displaced if LV enlarged Parasternal heave if RV enlarged Arrhythmia is uncommon
66
Heart ascultations with CHF
S1 diminished if poor LV function P2 accentuated with pulmonary HTN S3 with poor EF S4 with diastolic dysfunction Murmurs indicate valvular problem
67
CHF findings in the abdomen
Distension Ascites
68
CHF findings in LE
Dependent pitting edema
69
CHF EKG findings
Signs of LVH Signs of RVH Signs of biventricular hypertrophy Afib Ventricular ectopy
70
EKG finding of cor pulmonale
Tall p wave V1 is upward
71
BNP
Hormone from ventricles - hypotensive effect Marker of CHF High false positives, increased with several other conditions \*\*Doesn't rule out other causes of dyspnea Chronic elevation in cardiomyopathy
72
Chest xray findings in CHF
Very big heart Infiltrates Pleural effusions, full fuzzy hilum, basal congestion Kerley B lines
73
What does echocardiogram look at?
Size of the heart chambers Thickness of the walls Contractility - Ejection fraction, wall motion abnormality Septal defects Valvular structures and their integrity Intracardiac structures (clots, tumors) Diastolic dysfunction Pulmonary pressures
74
Diuretics for CHF
\*Loops Help with congestion Improve symptoms but not mortality May worsen renal function
75
ACEI for CHF
Decrease afterload to increase ventricular function Improve symptoms AND mortality
76
ARBs and CHF
Decrease afterload Improve symptoms and mortality
77
Digoxin for CHF
Increase contractility Improve symptoms only May cause arrhythmia
78
B blockers with CHF
Used only with low EF Improves symptoms and prolongs life Only in stable patients Decreases contractility and CO
79
B blockers that effect mortality in CHF
Metoprolol Succinate Carvedilol Bisoprolol
80
Why do B blockers work in HF?
Upregulate beta receptors improving inotropic and chronotropic responsiveness of the myocardium Decrease afterload (decrease vasoconstriction) Increase LV remodeling Reduce consumption of oxygen Decrease premature beats and sudden cardiac death
81
Aldosterone agonists and cardiac death
Diuretic Decrease mortality
82
Nitrates and CHF
Decrease preload (and afterload) Decrease mortality Improve symptoms
83
Hydralazine and CHF
Decrease afterload
84
Mortality improvements occur in which CHF patients?
Those with decreased systolic function and ejection fraction

CV II Exam 3 (13 decks)

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