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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
Q

Dilated cardiomyopathy due to valvular heart disease

A

Aortic regurg -> Increased in EDV/preload -> Increase workload -> LVH -> Left ventricular dilatation -> Systolic dysfunction

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26
Q

Infective myocarditis

A

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

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27
Q

Non-infective myocarditis

A

Toxins or autoimmune/CTD associated

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28
Q

Toxic Myocarditis

A

Alcohol

Cocaine

Chemotherapy - Doxorubicin (Adriamycin)
Heavy metals (copper, iron, lead)
Lithium
Malaria drugs
Radiation

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29
Q

Immune/Connective Tissue Myocarditis

A

Giant Cell Myocarditis
PM/DM
SLE/RA

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30
Q

Cocaine and the myocardium

A

May cause vasospasm leading to MI (widespread vasospam -> can be bilateral MI)
May cause arrhythmia
May cause drug-induced myocarditis/cardiomyopathy -> released catecholamines

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31
Q

Alcoholic cardiomyopathy

A

Chronic use

Direct toxic effect

Different from beriberi disease, although thiamine deficiency is frequent in alcoholics

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32
Q

Peripartum cardiomyopathy

A

Last month of pregnancy to 5 months after

Immune mediated

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33
Q

Takotsubo Cardiomyopathy

A

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

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34
Q

Hypertrophic Cardiomyopathy - Genetic (HOCM)

A

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
Q

HOCM Clinical Manifestations

A

Usually affects younger people

SOB, chest pain, syncope, arrythmias (afib, ventricular, sudden death,) systolic murmur LSB

36
Q

How does HOCM murmur change with squating?

A

Decreases

Increases with valsalva and upright position

37
Q

Non-genetic hypertrophic cardiomyopathy

A

Hypertensive

Aortic-stenosis related

38
Q

HTN hypertrophy vs genetic

A

More generalized thickening with no disproportional involvement of the septum

39
Q

Aortic stenosis hypertrophy

A

More left sided

40
Q

Non-genetic hypertrophic cardiomyopathy symptoms

A

Obstruction - syncope and chest pain

Diastolic dysfunction - SOB, edema

41
Q

Restrictive cardiomyopathy

A

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
Q

Pulmonary vs systemic pressure

A

Much lower

20/10 vs 120/80

Flow is the same because resistance is much lower

43
Q

Pulmonary HTN

A

Increased pulmonary pressure

44
Q

Idiopathic Pulmonary HTN

A

Uncommon - arterial problem

F>M

age 30-50

Poor survival

45
Q

Pulmonary HTN - left to right shunt

A

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
Q

Drug associated pulmonary HTN

A

Fenfluramine - directly effects pulmonary vasculature and damages right valves

Amphetamines

Cocaine

47
Q

Pulmonary HTN due to left sided heart problems

A

Left ventricular failure -> Increase LV volume and pressure -> Increase LA volume and pressure -> Increase pulmonary artery pressure -> RVH -> RV failure

48
Q

Most common cause of pulmonary HTN

A

Pulmonary disease -> Pulmonary HTN -> Increase RV afterload -> RVH -> RV failure

49
Q

Pulmonary Embolism

A

Usually from lower extremeties

Can also come from UE, heart, and abdominal veins

Increase pulmonary artery pressure which increases RV afterload

50
Q

High Output Failure

A

Normal heart

Increase metabolic demand isn’t met by pumping ability of heart OR excessive blood flow overwhelms the pump

51
Q

Increased metabolic demand not met by CO

A

Thyrotoxicosis

52
Q

Excessive blood flow overwhelming the pump

A

Anemia - blood is less viscous and moves at higher velocity

AV fistula

Conditions decreasing peripheral resistance (Beri-beri, sepsis)

53
Q

Left sided CHF clinical manifestations

A

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
Q

Right sided CHF clinical manifestations

A

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
Q

NYHA Functional classification

A

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
Q

Stage A of heart failure

A

At high Risk for Heart Failure, but without structural heart disease

57
Q

Stage B of heart failure

A

Structural Heart Disease, but without symptoms or signs of heart failure

58
Q

Stage C of heart failure

A

Structural Heart Disease, with prior or current symptoms of heart failure

59
Q

Stage D of heart failure

A

Heart failure requiring intervention

60
Q

VS of CHF

A

BP may be low

Tachycardia

Tachypnea and hypoxia

61
Q

CHF findings in the neck

A

JVD

Hepato-jugular reflex

Thyroid enlargement - toxic goiter

62
Q

CHF findings in the lungs

A

Crackles/rales: b/l, higher is worse

Sometimes decreased sounds at base

Dullness to percussion

Tactile fremitus

63
Q

Increased tactile fremitus

A

Alveolar and interstitial edema

64
Q

Decreased tacile fremitus

A

Bilateral pleural effusion

65
Q

Heart palpations with CHF

A

PMI displaced if LV enlarged

Parasternal heave if RV enlarged

Arrhythmia is uncommon

66
Q

Heart ascultations with CHF

A

S1 diminished if poor LV function

P2 accentuated with pulmonary HTN

S3 with poor EF

S4 with diastolic dysfunction

Murmurs indicate valvular problem

67
Q

CHF findings in the abdomen

A

Distension

Ascites

68
Q

CHF findings in LE

A

Dependent pitting edema

69
Q

CHF EKG findings

A

Signs of LVH

Signs of RVH

Signs of biventricular hypertrophy

Afib

Ventricular ectopy

70
Q

EKG finding of cor pulmonale

A

Tall p wave

V1 is upward

71
Q

BNP

A

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
Q

Chest xray findings in CHF

A

Very big heart

Infiltrates

Pleural effusions, full fuzzy hilum, basal congestion

Kerley B lines

73
Q

What does echocardiogram look at?

A

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
Q

Diuretics for CHF

A

*Loops

Help with congestion

Improve symptoms but not mortality

May worsen renal function

75
Q

ACEI for CHF

A

Decrease afterload to increase ventricular function

Improve symptoms AND mortality

76
Q

ARBs and CHF

A

Decrease afterload

Improve symptoms and mortality

77
Q

Digoxin for CHF

A

Increase contractility

Improve symptoms only

May cause arrhythmia

78
Q

B blockers with CHF

A

Used only with low EF
Improves symptoms and prolongs life

Only in stable patients

Decreases contractility and CO

79
Q

B blockers that effect mortality in CHF

A

Metoprolol Succinate

Carvedilol

Bisoprolol

80
Q

Why do B blockers work in HF?

A

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
Q

Aldosterone agonists and cardiac death

A

Diuretic

Decrease mortality

82
Q

Nitrates and CHF

A

Decrease preload (and afterload)

Decrease mortality

Improve symptoms

83
Q

Hydralazine and CHF

A

Decrease afterload

84
Q

Mortality improvements occur in which CHF patients?

A

Those with decreased systolic function and ejection fraction

CV II Exam 3 (13 decks)

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