HF Flashcards
(165 cards)
1
Q
HF is defined as a
A
complex syndrome that results from any structural or functional impairment of ventricular filling or blood ejection
2
Q
HF leads to
A
to tissue hypoperfusion, fatigue, dyspnea, weakness, edema, and weight gain
3
Q
HF may be caused by
A
structural abnormalities of the pericardium, myocardium, endocardium, heart valves, or great vessels
4
Q
ejection fraction is the main marker for determining
A
HF risk factors, treatment, outcomes
5
Q
the LV’s ability ot fill is determined by (5)
A
Pulmonary venous blood flow
LA function
mitral valve dynamics
pericardial restraint
active and passive elastic properties of the LV
6
Q
LV diastolic function is normal when
A
factors combine to provide an LVEDV (preload) sufficient cardiac output for cellular metabolism without elevating pulmonary venous and LA pressures
7
Q
in HFpEF, higher LV filling pressures are required to
A
to achieve normal end-diastole volume
8
Q
A steeper rise of the end-diastolic pressure-volume curve indicates
A
delayed LV relaxation and increased myocardial stiffness
9
Q
Reduced LV compliance and precipitates (5)
A
LA hypertension
LA systolic and diastolic dysfunction
pulmonary venous congestion
and exercise intolerance
10
Q
Delays in relaxation are a form of “active stiffening” caused by
A
failure of the actin-myosin dissociation due to inadequate perfusion or dysfunctional intracellular Ca++ homeostasis.
11
Q
LV relaxation depends on ________ , which is typically elevated in ______ patients.
A
afterload; HTN
12
Q
t/f bradycardia exacerbates the failure of LV relaxation
A
false, tachycardia exacerbates the failure of LV relaxation
13
Q
HFpEF or HFrEF
Profound exercise intolerance is seen with _______ despite only having a modest depression in LV systolic function
A
HFpEF
14
Q
Prolonged compression of the coronary arteries restricts diastolic coronary blood flow, which contributes to
A
subendocardial ischemia and a further reduction in exercise tolerance
15
Q
The most common signs of HF are
A
fatigue
tachypnea
dyspnea
paroxysmal nocturnal dyspnea
orthopnea
S3 gallop
JVD
peripheral edema
exercise intolerance
and reduced tissue perfusion.
16
Q
where on CXR is an early indicator of LV failure and pulmonary venous HTN
A
distention of pulmonary veins in the upper lobes of the lung
17
Q
kerley lines produce what pattern and reflect what?
A
honeycomb pattern and reflect interlobar edema
18
Q
alveolar edema produces what in what kind of pattern
A
homogenous densities in the lung fields, typically butterfly pattern
19
Q
T/f pulm edema in radiography may lag behind clincal evidence by up to 12 hours
A
true
20
Q
what is the ACC/AHA diagnosis criteria for LVDD
A
HF symptoms, EF > 50% and evidence of LVDD
21
Q
HFrEF or HFpEF
BNP elevation
A
HFrEF! due to LV dilation and eccentric remodeling
22
Q
HFrEF or HFpEF
BNP lower
A
HFpEF! associated with concentric hypertrophic, relatively normal LV chamber size and lower end-diastolic wall stress allowing for lower BNP
23
Q
what protein represents the inflammatory component of HF
A
C-reactive protein (CRP) and growth differentiation factor- 15 (GDF-15)
24
Q
why check trops in HF patients
A
systemically released due to myocardial damage and serve as a measure of risk prediction
25
NYHA Class I
no limitations and no symptoms with ordinary activity
26
NYHA Class II vs Class III
Class II - limitations with minimal activity
Class III - limitations with **any** activity
| both comfortable/asymptomatic at rest
27
NYHA Class IV
symptomatic at rest
| also a INTERMAC 4
28
ACC/AHA Class A
high risk no funcitonal or structural deficitis
29
ACC/AHA Class B
structural deficit but asymptomatic
30
ACC/AHA Class C
heart failure symptoms due to underlying structure heart deficit with medical management
31
ACC/AHA Class D
advanced disease requiring hospitalization, transplant, or palliative care
32
lifestyle treatment for CHF
aerobic fitness, weight loss, salt-restricted diet (DASH), HTN and blood glucose manage, smoking cessation
## Footnote
kahoot Q
33
HFrEF
HF with EF < 40%
| systolic HF
34
HFpEF
HF with EF > 50%
| diastolic HF
35
borderline HFpEF
HF symptoms with an EF 40-49%
36
T/F diastolic dysfunction is only present in HFrEF
false, diastolic dysfunction is present in both HFpEF and HFrEF
37
LV hypertrophy pattern of HFpEF
concentric hypertrophy
38
LV dilation pattern of HFrEF
eccentric hypertrophy
39
which HF is related to conditions such as HTN, DM, Afib, obestiy, metabolic syndrome, COPD, and CKD/anemia
HFpEF
40
which HF is associated with modifiable risk factors such as smoking and HLD
HFrEF
41
which HF has a higher incidence of myocardial ischemia and infarction, previous PCI, CABG, PVD
HFrEF
42
women are more affected by _______
men are more effected by _______
women - HFpEF
men - HFrEF
43
prevalence of HFrEF, HFpEF, borderline in %
HFpEF - 52%
HFrEF - 33 %
boderline - 16%
44
what dysfunction is the primary determinant of HFpEF
LV diastolic dysfunction
45
what dysfunction is the primary determinant of HFrEF
contractile dysfunction
46
common causes of LV diastolic dysfunction
* age > 60
* acute myocardial ischemia
* myocardial stunnning/infarction
* ventricular remodeling after infarction
* pressure-volume overload hypertrophy (aortic valve stenosis/essential HTN)
* volume overload hypertrophy (aortic/mitral valve regurg)
* hypertrophic obstructive, dilated, restrictive cardiomyopathy
* pericardial disease
47
symptoms most common with HFpEF
paroxysmal nocturnal dyspnea, pulmonary edema, and dependent edema
48
symptoms most common with HFrEF
s3 gallop
49
mean pulmonary capillary wedge pressure > 15 mmHg at rest or >25 mmHg with exercise provides evidence of
HFpEF and is a predictor of mortality
50
EKG abnormalities in HF patients
LVH, previous MI, arrhythmias, and conduction abnormalities
51
chronic HF treatment consisting of treat associated conditions, exercise and weight loss is assoicated with which HF
HFpEF
52
chronic HF treatment with beta blocker and ACE-Inhibitor therapy is assoicated with which HF
HFrEF
53
according to ACC/ESC what medication can reduce LV filling pressures, decrease pulmonary venous congestion, and improve HF symptoms
loop diuretics
## Footnote
kahoot Q
54
when might thiazide diuretics be useful
poorly controlled HTN to prevent onset of HFpEF
55
beta blocker therapy is strongly recommended for
HFrEF!
| in HFpEF BB are preseribed for other indications (HTN, Afib, MI)
## Footnote
**kahoot Q**
56
which HF uses ACE-Inhibitors as mainstay treatment
HFrEF
| ACE-I show no benefit in HFpEF unless used for HTN
57
58
what can reverse LV dysfunction following an MI
coronary revascularization via CABG or PCI
| early revascularization may prevent permenant EF reductions
59
cardiac resynchronized therapy is used for
| biventricular pacing
HF with a ventricular conduction delay (prolonged QRS)
60
benefits of cardiac resynchonization therapy
more synchoronous heart contractions and improves Cardiac Output
61
when is CRT recommended
NYHA Class III or IV with EF < 5% and QRS duration 120-150 ms
62
risk of CRT
infection, misplacement, device failure
63
implantable hemodynamic monitoring allows remote observation of intracardiac pressures to
guide treatment and prevent decompensation
| cardioMEMS - noninvasive PAP monitoring
64
implantable cardioverting-defibrillators used to prevent
sudden death in patients with advanced HF
| 50% HF deaths are due to sudden cardiac dysrhymias
## Footnote
**kahoot Q**
65
LVAD is used for
* temporary ventricular assistance while heart is recovering
* patients awaiting heart transplant
* patients on inotropes or IABP with potentially reversible medical conditions
* advanced HF not candidates for transplant
66
T/F LVAD mechanical pumps can take over total or partial function of the damaged ventricle and facilitate restoration of normal hemodynamcics and perfusion
true
67
acute heart failure is
rapid onset, present with life threating conditions
| may require hospitalization
68
the term "acute heart failure" applies to
pts with worsening preexisting HF (acute decompensated HF) and first time with HF (de novo acute HF)
69
acute decompensated HF symptoms
fluid retention, weight gain, dyspnea
| result of decompensation due to inadequate compensation
70
leading cause of de novo Hf
cardiac ischemia 2ndary to coronary occlusion
70
71
less common - nonischemic causes of de novo HF
viral, drug-induced (toxic) and peripartum cardiomyopathy
72
de novo AHF is characterized as
sudden increase in intracardiac filling pressures or acute myocardial dysfunction leading to decreased peripheral perfusion and pulmonary edema
73
74
T/F de novo HF leads to long term cardiac dysfunction, despite management
false, managament of the underlying cause may allow for complete restoration
75
hemodynamic profile of acute HF
low cardiac output, high ventricular filling pressures, and HTN or HTN
76
1st line treatment of acute HF
diuretics - should be given immediately in fluid over to mitigate symptoms and decrease mortality
| patients w HypoTN/cardiogenic shock need HD support prior to diuretics
## Footnote
**kahoot Q**
77
what drugs can be used to reduce intravascular volume to decrease CVP and PCWP, and pulmonary congestion
furosemide, bumetanide, torsemide
| GTT or bolus
78
vasodilators are used in acute HF bc they
correct elevated filling pressures and reduce afterload
| careful considerations w vasodilators bc of the underlying hemodynamics
79
SNP is effective in rapidly decreasing
afterload
| arterial vasodilator
80
NTG is commonly used as adjunct therapy with
diuretic therpay
81
why use tolvaptan in acute HF
| vasopressin receptor antagonists
reduce arterial constriction, hyponatremia, and the volume overload assocaited with AHF
82
what is the mainstay drug for acute HF for patietns with reduced contractility or in cardiogenic shock
positive inotropes!!
inotropes increase cAMP which increases intracellular calcium and exicitation contraction coupling
## Footnote
**kahoot Q**
83
catecholamines MOA and examples
stimualate Beta receptors on myocardium to activate adenyl cyclase to increase cAMP
| EPI, NE, dopamine, dobutamine
84
85
PDE-inhibitors MOA and example
indirectly increase cAMP by inhibiting the degradation of cAMP
| milrinone
86
MOA, CO, MAP, HR with EPI
B1 = B2 > alpha
**increased increased** CO, MAP, HR
87
MOA, CO, MAP, HR with NE
A > B1 > B2
increased CO, MAP, HR stays same or decreases
88
MOA, CO, MAP, HR with dobutamine
B1 > B2 > a
cardiac ouput stays same or decreases
**increased increase ** MAP
**increased increase ** HR
89
90
MOA, CO, MAP, HR with dopamine
D > B (alpha with high doses)
icnreased CO, same/lower MAP, hella increased HR
91
what recombinant drug is used to inhibit RAAS and promote artial, venous, and coronary vasodilation, decreasing LVEDP and improve dyspnea
Nesiritide, exogenous BNP
| binds to ANP and BNP receptors
## Footnote
**kahoot Q**
92
based on INTERMACS scoring, what would you score a patient whos critically ill and moribound with severe symptoms at rest, and crashing
1- crashing
93
based on INTERMACS scoring, what would you score a patient whos experiencing congestion while on inotropes
2- failing on inotropes
94
based on INTERMACS scoring, what would you score a patient whos at home with a continuous dobutamine infusion, with variable symptoms at rest and variable activity tolerence
3 - inotrope dependent
95
based on INTERMACS scoring, what would you score a patient whos at home with oral therapy
4 - symptoms at rest
96
IABP is a cyclic helium balloon that inflates duirng ____ and deflates during _____
inflation diastole
deflation systole
97
primary modes of IABP placement confirmation
TEE and Xray
98
IABP improve perfusion where by reducing what
improve LV coronary perfusion and reduce LVEDP
99
full support on IABP means
1:1 - one inflation for every Heartbeat
100
if the patient is tachycardiac while on IABP what setting is ideal (1:1) or (1:2)
| **kahoot Q**
1:2 (one inflation per every 2 heartbeats)
101
T/F IABP provides great improvements in Cardiac output and is useful longterm
false, it improves CO (0.5-1 L/min) and renders patients immobile
102
the impella is a VAD that is placed percutaneously to reduce LV strain and myocardial work in the setting of acute HF - how long can it be utilized
up to 14 days
103
impella is used as a transiton to recovery or bridge to what cardiac procedures
CABG
PCI
VAD
transplant
104
what is the impella
mini rotary blood pump inserted in femoral artery, advanced into the aortic valve and is situated in the LV
the pump draws blood **continuouly** from the LV through distal port and ejects it into the ascending aorta
| flows > 3.5L/min
105
peripheral VAD consists of a small pump and controller but generates heat and causes
hemolysis and low flow ratess
## Footnote
**kahoot Q**
106
if a peripheral VAD has an oxygenator it is considered
ECMO extracorpeal membrane oxygenation
107
central VAD/ECMO has cannulation where
in the right atrium and aorta
108
why central ECMO instead of peripheral
for cardiopulm support if adequate flow rates are not achievable
109
benefits of central ECMO
complete ventricular decompression, avoidance of limb impairment, avoidance of SVC syndrome
110
pts on ECMO likely have reduced ____ perfusion as blood bypasses the _____ before returning to the aorta
lung perfusion; lung
111
anesthetic considerations for ECMO patients
TIVA > inhaled anesthetics
| INH anesthetics may be limited by functional shunting around the lung
112
T/F ECMO membrane is hydrophilic, causing many agents to be sequestered within the circuit
false, the circuit is lipophilic - causing agents to be sequestered within the circuit
113
HF patients have an increased risk of developing
renal failure, sepsis, PNE, and cardiac arrest
| long mechanical vent hoursl overall increased 30 day mortality
114
when should surgery be postponed in HF patients
experiencing decompensation, recent change in clinical status, or de novo HF
115
all HF should have a comprehensive preop exam to determine if they are
compensated or require treatment
116
when are diuretics held
day of surgery
117
are BB continued
yes - they reduce perioperative M&M
118
are ACE-I continued
no - they put patients at risk for intraop Hypotension
119
when is a 12-lead warranted
any pt with CV disease
120
TTE is indicated when
patients with worsening dyspnea during preop eval
121
preop labs for HF patient
CBC, BMP, LFTs, COAGS
| BNP not routinely ordered
122
patients with ICDs and pacemakers should have what before surgery
interogation of devices
123
cardiomyopathies are a group of myocardial diseases assocaited with _______ and/or _______ dysfunction that usually exhibits ventricular hypertrophy or dilation
mechanical and or electrical
124
cardiomyopathies are divided into 2 groups - primary and secondary (whats the difference)
primary - confined to the heart muscle
secondary - cardiac involvement in the context of a multiorgan disorder
125
most common genetic CV disease
Hypertrophic cardiomyopathy
126
hypertrophic cardiomyopathy is characterized by
LVH in the absence of other diseases capable of inducing ventricular hypertrophy
127
128
Hypertrophic cardiomyopathy presents with hypertrophy where in the heart
interventricular septum and the anterolateral free wall
| histology shows hypertrophied myocardial cells & patchy myocardial scars
129
hypertrophied myocardium has a prolonged _______ time and decreased ________
relaxation time; decreased compliance
130
T/F myocardial ischemia is present in patients with hypertrophic cardiomyopathy whether or not they have CAD
true!
131
common cause of death in young adults with HCM
dysrhythmias - causing sudden death
132
In hypertrophic cardiomyopathy dysrhymias are caused by
disorganized cellular architecture, myocardial scarring, and expanded interstitial matrix
133
ECHO findings of a patient with hypertrophic cardiomyopathy
*EF and wall thickness*
> 80%
echo may show myocardial wall thickness > 15 mm
| in terminal states EF may be severly depressed
134
EKG abnormalities in HCM include
high QRS voltage, ST- segment, T-wave alterations, abnormal Q waves, Left atrial enlargement
135
in asymptomatic patients, what may be the only sign of HCM
unexplained LVH
136
hypertrophic cardiomyopathy medical therapy
BB and CCB
*pts who develop HF despite BB and CCB may show improvement with diuretics*
137
whats a good adjucnt in patients with hypertrophic cardiomyopathy who reamin symptomatic
disopyramide - negative inotrope effect improving LVOT obstruction and heart failure symptoms
138
what arrythymia can develop with HCM
Afib
thrombembolism, HF, and sudden death
## Footnote
amiodorone most effective + long term anticoagulation is indicated chronic/recurrent afib
139
HCM surgical treatment options for symptomatic patients
a prosthetic mitral valve can be inserted to counteract the anterior motion of the mitral leaflet
140
surgical strategies for hypertrophic cardiomyopathy
septal myomectomy
cardiac cath with injection to induce ischemia of the septal perforator arteries
percutaneous septal ablation
141
dilated cardiomyopathy is characterized by
LV or biventricular dilation, biatrial dilation, decreased ventricular wall thickness, and systolic dysfunction without abnormal loading conditions
142
initial symptom of dilated cardiomyopathy
HF and CP
143
ventricular dilation from dilated cardiomyopathy can lead to
mitral and or tricuspid regurgiation
144
with dilated cardiomyopathy what are common things that can cause death
dysrhtymias, conduction abnormalities, emboli, and sudden death
145
ECHO results of dilated cardiomyopathy
dilation of all 4 chambers, predominately the LV as well as global hypokinesis
146
treatment for dilated cardiomyopathy
similar to that of chronic HF /anticoagulation
147
EKG of dilated cardiomyopathy
ST-segment and T wave abnormalities and LBBB
PVC and AFib
148
what is apical ballooning syndrome
stress cardiomyopathy
149
what is stress cardiomyopathy
| apical ballooning syndrome
temporary primary cardiomyopathy characterized by LV apical hypokinesis with ischemic EKG changes, **however the coronaries remain patent**
150
where in the heart is there temporary dysfunction in stress cardiomyopathy
LV apex - while the rest of the heart has normal contractility
151
symptoms of stress cardiomyopathy
chest pain and dyspnea
152
causes of stress cardiomyopathy
stress (physical or emotional)
women > men
153
peripartum cardiomyopathy arises when
3rd trimester - 5 months postpartum
154
diagnosis of peripartum cardiomyopathy: 3 criteria
* development of HF in period surrounding delivery
* absence of another explainable cause
* LV systolic dysfunction with LVEF < 45%
155
diagnosis of peripartum cardiomyopathy
EKG, ECHO, CXR, cardiac MRI, cardiac cath, endomyocardial biopsy, BMP levels
156
what is secondary cardiomyopathy
due to systemic disease that produce myocardial infiltration and severe diastolic dysfunction
157
common cause of secondary cardiomyopathy
| BONUS: Secondary causes
**amyloidosis**
secondary: hemochromatosis, sarcoidosis, carcinoid tumor
158
when should diagnosis of secondary cardiomyopathy be considered
pts with HF but no evidence of cardiomegaly or systolic dysfunction
159
secondary cardiomyopathy BP characteristics
low to normal BP
and can develop orthostatic hypotension
160
what is cor pulmonale
RV enlargement (hypertrophy or dilation) that may progress to HF
## Footnote
**kahoot Q**
161
causes of cor pulmonale
pulmonary HTN
myocardial disease
congential heart disease
respiratory, connective tissue, thromboembolic disease
162
most common cause of cor pulmonale
COPD
163
EKG changes with cor pulmonale (2)
RA and RV hypertrophy
peaked P waves in II, III, aVF (RA hypertrophy)
RBBB - right axis deviation
164
diagnostic test for cor pulmonale
TEE, CXR, right heart cath
