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Cardio final > Heart Failure -Silverstein > Flashcards

Heart Failure -Silverstein Flashcards

1
Q

What is orthopnea from?

A

Central redistribution of intravascular volume

causes SOB when laying down

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2
Q

What causes paroxysmal nocturnal dyspnea?

A

reabsorption of the LE edema

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3
Q

What are some classic symptoms (ROS) of left-sided heart failure?

A

dyspnea

orthopnea

paroxysmal nocturnal dyspnea

fatigue

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4
Q

What are the common physical exam findings in heart failure?

A

pulmonary rales

S3 gallop (systolic dysfunction–> distension of the ventricle)

S4 gallop (diastolic dysfunction–> stiff ventricle)

Loud P2 (pulmonary HTN)

can also have JVD< hepatomegaly, peripheral edema, cachexia, cool extremities, cardiac wheeze and cheyne-strokes breathing)

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5
Q

What will the chest x-ray in a heart failure pt show?

A

cephalization

apical redistribution of fluid to the top of the lung

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6
Q

What does a BNP of 80 indicate? What about 400? 3000?

A

BNP600=moderate

BNP > 900=severe heart failure

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7
Q

How can you determine whether there is a reduced or preserved ejection fraction?

A

ECHO!!

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8
Q

What is the number one cause of reduced ejection fraction in the US?

A

Coronary artery disease

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9
Q

What is the gold standard for Coronary Artery Disease? Should this test be ordered for everyone?

A

gold standard=angiogram

first do EKG and ECHO and then angiogram if high probability of CAD

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10
Q

What will you get in a pressure overloaded heart?

A

Concentric hypertrophy

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11
Q

What will you get in a volume overloaded heart?

A

eccentric hypertrophy

==> dilated

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12
Q

What is the first line therapy for orthopnea related to heart failure?

A

Furosemide (loop diuretic)

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13
Q

What medication should be given for chronic therapy of HFrEF?

A

ACE inhibitor (decrease preload and after load)

balanced vasodilator:

  • dec vasoconstriction by Ag II
  • dec aldosterone-> inc Na+ elimination
  • augment bradykinin vasodilation

watch renal function

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14
Q

What can be given for heart failure pts who can’t take ACE inhibitors or who are unresponsive to them?

A

Nitrates (vasodilator) and hydralazines (decrease after load)

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15
Q

Which heart failure pts should you NOT give a beta-blocker alone to?

A

volume overloaded

should give loop diuretic AND beta blocker

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16
Q

Patients with heart failure with reduced EF are particularly at risk for which of the following?

A. Torsades de Pointes

B. Delayed after depolarizations

C. Monomorphic VT

A

Monomorphic VT

because pt has scarring/fibrosis

17
Q

What are some factors that can precipitate symptoms in pts with chronic compensated heart failure?

A
  • increased metabolic demands (fever, infection, anemia, tachycardia, hyperthyroidism, pregnancy)
  • Increased volume/preload (high Na+ diet, too much fluid, renal failure)
  • increased after load: (uncontrolled HTN, PE)
  • impaired contractility (MI, EtOH, negative inotropic meds)
  • slowed HR
18
Q

What IV medications can be used in decompensated heart failure? (5)

A

Nesiritide: recombinant BNP -> vasodilator

Dopamine: depends on dose (< 2 local renal vasodilation; 2-10 β1 inotropic; > 10 α vasoconstrict)

Dobutamine:
Beta1, Beta2 and alpha agonist; inotrope/neutral with vasodilation

Milrinone:
Phosphodiesterase inhibitor; inotrope/vasodilator–> increases cAMP and Ca2+==> increased contraction

Nitroprusside:
arterial and venous dilator via activation of guanylate cyclase in vascular smooth muscle

19
Q

What are the physical exam findings in left heart failure?

A

Loud P2 (pulmonary HTN)

S4 (decreased compliance)

cephalization on CXR

left atrial enlargement (biphasic P wave in V1)

increased left atrial P (E/e’ >15 on echo)

20
Q

What will cause heart failure with preserved EF?

A

diastolic dysfunction–> impaired filling

examples:

  • LVH
  • restrictive cardiomyopathy
  • myocardial fibrosis
  • transient myocardial ischemia
  • pericardial constriction or tamponade
21
Q

What are some causes of right sided heart failure?

A

cardiac causes:

  • *left-sided heart failure (most common)
  • pulmonary valve senosis
  • right ventricular infarction

pulmonary parenchymal diseases:

  • COPD
  • sarcoidosis
  • acute respiratory distress syndrome

pulmonary vascular diseases:

  • PE
  • primary pulmonary HTN
22
Q

What medication should be avoided in a right ventricular infarct? Why?

A

Nitroglycerin

it would further decrease the preload

Cardio final (15 decks)

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