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Q2 Clin Med Final (Cardiology, Hyperlip) > HF > Flashcards

HF Flashcards

1
Q

Hear Failure definition?

A

any structural or fxnl disorder that impairs heart’s ability to pump needed blood

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2
Q

HF underlying causes?

A

ºCAD
Ischemic cardiomyopathy
HTN

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3
Q

HF precipitating causes?

A 
Infection
Anemia
Arrhyth
Fluid overload
HTN
MI
PE
endo/myocarditis
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4
Q

HF: Left-Sided

Systolic Dysfxn definition?

A

inability to contract and expel blood

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5
Q

HF: Left-Sided

Systolic Dysfxn etiology?

A 
CAD
impaired contractility (cardiomyopathy)
high afterload (high pressure)
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6
Q

HF: Left-Sided

Diastolic Dysfxn definition?

A

inability to relax/fill

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7
Q

HF: Left-Sided

Diastolic Dysfxn etiology?

A

Ischemia
Fibrosis
Sarcoids

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8
Q

Left HF Hemodynamic changes due to?

A

Pulmonary Edema caused by ↑ pressure in:
LA
pulmonary veins
pulmonary capillaries

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9
Q

↑ in Pulmonary arterial P causes what?

A

↑ after load on RV

(P) Right HF

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10
Q

Right side of heart is what type of system?

A

low P

high compliance

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11
Q

Increase in what leads to Right-Sided issues?

A

afterload

e.g. (P) caused by pulmonary embolism, chronic pulmonary disease

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12
Q

Right HF Hemodynamic changes due to?

A 
↑  RA pressure
↑  venous P
↑  capillary P
↑  tissue fluid
↑  PERIPHERAL EDEMA
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13
Q

HF effect on:

EF?
Vent dilation?
Resting SV?
Cardiac Index?
Rest HR?
Exercise Intolerance?
A

EF 5.6cm @ ED
Rest SV <2.5L/min/m2
Rest HR 75-105/min
EI: CO ↓ 40%, SV ↓ 50%

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14
Q

NYHA HF classification system:

Class 1

A

No limit on physical activity

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15
Q

NYHA HF classification system:

Class 2

A

Sxs cause slightly ↓ physical activity

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16
Q

NYHA HF classification system:

Class 3

A

DOE (sxs w/ ADL)
Marked ↓ physical activity
Asympt at rest

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17
Q

NYHA HF classification system:

Class 4

A

Severe ↓ phy activity

Sxs at rest

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18
Q

ACC/AHA HF classification system:

Stage A

A

No structural abnorm but high risk for developing HF

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19
Q

ACC/AHA HF classification system:

Stage B

A

Structural disorder but no HF sxs

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20
Q

ACC/AHA HF classification system:

Stage C

A

Past or current sxs and structural dx

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21
Q

ACC/AHA HF classification system:

Stage D

A

end-stage HF

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22
Q

HF signs? (4)

A

Edema (2º to vol overload)
Rales @ bases
JVD
S3/4 (early)

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23
Q

HF sxs? (5)

A 
Dyspnea
Fatigue (2º to low perfusion)
Cough (nocturnal, non-productive)
Early satiety (2º to hepatic congestion)
Nocturia (2º to ↑ renal perfusion when supine)
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24
Q

Left HF presentation?

A 
Dyspnea (fluid in lungs)
Diaphoresis (sweat)
Tachypnea (fluid in lungs)
Tachycardia
Rales
S3/4
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25
Q

Right HF presentation?

A

Peripheral edema
RUQ pain
JVD
Ascites (serous fluid in peritoneum)

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26
Q

Systolic dysfxn presentation?

A 
Hx valve dx, DM, CAD
S3/4
Mitral regurge
Rales
Cardiomegaly
JVD
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27
Q

Diastolic dysfxn presentation?

A

Hx HTN, DM
S4
Rales
LVH

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28
Q

HF ddx

A 
PUD
Asthma
COPD
PNA
PE
ARDS
29
Q

HF tests: ECG?

A

= Ischemia, arrhythmia

30
Q

HF tests: Echo?

A

Syst dysfxn = EF < 40%, dilated LV

Diast dysfxn = EF >45% (normal), LVH

31
Q

HF tests: CXR?

A

= cardiomegaly, r/o pulmonary etiology

32
Q

Transudative vs exudative?

A 
Trans = fluid move in to tissue/capillary (HF)
Exud = fluid moved out of tissue/capillary
33
Q

HF tests: CBC?

A

look for anemia (can exacerbate HF)

34
Q

HF tests: CMP?

A

(Ca2+, Mg, PO4)
liver fxn
r/o DM

35
Q

HF tests: Thyroid panel?

A

hypothyroidism can exacerbate HF or present as HF

36
Q

HF tests: BNP

A

(brain-type natriuretic peptide)
= ↑ levels
use to differentiate pulmonary dz from HF

37
Q

Brain-type Natriuretic Peptide released in response to?

A

vent wall stretching

38
Q

HF management?

A

cause
risk factors
sxs
review meds for for adverse rxn

39
Q

HF goals of tx?

A

↓ preload -> ↓ congestive sxs

↓ afterload -> ↑ cardiac fxn

40
Q

HF tx:

Stage A/Class 1-3

A

ACE inhibitor

41
Q

HF tx:

Stage B-C/Class 1-3

A

ACE inhib
β block
diuretics

42
Q

HF tx:

Initial therapy for ALL pts

A

ACE inhibitor
Digoxin
diuretics

43
Q

Systolic/Diastolic dysfxn tx?

A

Treat systolic

44
Q

Diastolic dysfxn U found in who?

A

old F w/ HTN, DM

45
Q

ACE inhibitor benefits?

A

↓ morbidity and mortality

in sympt and asympt pts

46
Q

Angiotensin-receptor blockers (ARBs) benefits?

Use when?

Monitor what?

A

↓ morbidity and mortality
↓ sxs

use if can’t use ACE inhib

BP, renal fxn, electrolytes

47
Q

β blockers benefits?

A

↓ mortality

not for unstable pts

48
Q

Diuretics benefits?

A

Loop-type prefered
manage fluid overload
unproven

49
Q

Spironolactone is?

A 
Aldosterone antagonist
(K+ sparing diuretic)
50
Q

Spironolactone indicated for?

A

dyspnea at rest

post-MI w/ syst dys

51
Q

Spironolactone benefits?

A

↓ mortality

52
Q

Spironolactone side-effect?

A

(P) hyperkalemia

53
Q

Digoxin is?

A

Inotropic (contractility) agent

54
Q

Digitoxin benefits?

A

↓ sxs

↑ exercise tolerance

55
Q

Drugs that worsen HF? (6)

A 
NSAIDS
Glucophage (DM)
boner meds
TCAs (tricyclic)
Sporanox (antifung)
Tegretol (seizures, nerve pain)
56
Q

Pulmonary edema results from?

A

↑ venous P

a/w HF, MI, ischemia, mitral stenosis

57
Q

Pulmonary edema (from HF) presentation?

A

dyspnea
PRODUCTIVE cough
diaphoresis (sweat)

58
Q

Pulmonary edema exam findings?

A

rales
wheeze
rhonchi

59
Q

Pulmonary edema CXR findings?

A

Kerley B lines
edema
cardiomegaly

60
Q

Pulmonary edema Pulmonary Capillary Wedge test findings?

A

pressure elevated >25mmHg

61
Q

Pulmonary edema management?

A

“MOND”

Morphine (↓ anxiety, ↓ work of breathing)
O2 (goal >90%)
Nitrates (↓ preload, cap wedge pressure)
Diuretics (↓ fluid, congestion)

62
Q

Decompensation is?

A

worsening of HF sxs due to progression beyond tx

63
Q

Most common cause of Decompensation?

A

inadequate reduction of therapy

64
Q

Decompensation evaluation?

A

Eval for Δ in personal life
Focused cardiac exam
If no finding, labs (look for K+ Δs)

65
Q

Decompensation management?

A

“MOND tro”

Same as pulmonary except nitro instead of nitrate

Nitroglycerin (reduce preload and capillary wedge pressure)

66
Q

Most common causes of death w/ HF?

A

Decompensation (pump failure)

Malignant arrythemias

67
Q

Statins use in HF?

A

(lowers cholesterol)

2º prevention of CVD

68
Q

Most common cause of HF?

A

LV systolic dysfxn

Q2 Clin Med Final (Cardiology, Hyperlip) (8 decks)

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