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Health Assessment > HF > Flashcards

HF Flashcards

1
Q

HF is defined as a

A

complex syndrome that results from any structural or functional impairment of ventricular filling or blood ejection

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2
Q

HF leads to

A

to tissue hypoperfusion, fatigue, dyspnea, weakness, edema, and weight gain

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3
Q

HF may be caused by

A

structural abnormalities of the pericardium, myocardium, endocardium, heart valves, or great vessels

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4
Q

ejection fraction is the main marker for determining

A

HF risk factors, treatment, outcomes

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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

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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

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7
Q

in HFpEF, higher LV filling pressures are required to

A

to achieve normal end-diastole volume

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8
Q

A steeper rise of the end-diastolic pressure-volume curve indicates

A

delayed LV relaxation and increased myocardial stiffness

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9
Q

Reduced LV compliance and precipitates (5)

A

LA hypertension
LA systolic and diastolic dysfunction
pulmonary venous congestion
and exercise intolerance

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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.

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11
Q

LV relaxation depends on ________ , which is typically elevated in ______ patients.

A

afterload; HTN

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12
Q

t/f bradycardia exacerbates the failure of LV relaxation

A

false, tachycardia exacerbates the failure of LV relaxation

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13
Q

HFpEF or HFrEF

Profound exercise intolerance is seen with _______ despite only having a modest depression in LV systolic function

A

HFpEF

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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

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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.

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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

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17
Q

kerley lines produce what pattern and reflect what?

A

honeycomb pattern and reflect interlobar edema

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18
Q

alveolar edema produces what in what kind of pattern

A

homogenous densities in the lung fields, typically butterfly pattern

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19
Q

T/f pulm edema in radiography may lag behind clincal evidence by up to 12 hours

A

true

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20
Q

what is the ACC/AHA diagnosis criteria for LVDD

A

HF symptoms, EF > 50% and evidence of LVDD

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21
Q

HFrEF or HFpEF

BNP elevation

A

HFrEF! due to LV dilation and eccentric remodeling

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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

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23
Q

what protein represents the inflammatory component of HF

A

C-reactive protein (CRP) and growth differentiation factor- 15 (GDF-15)

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24
Q

why check trops in HF patients

A

systemically released due to myocardial damage and serve as a measure of risk prediction

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25
Q

NYHA Class I

A

no limitations and no symptoms with ordinary activity

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26
Q

NYHA Class II vs Class III

A

Class II - limitations with minimal activity
Class III - limitations with any activity

both comfortable/asymptomatic at rest

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27
Q

NYHA Class IV

A

symptomatic at rest

also a INTERMAC 4

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28
Q

ACC/AHA Class A

A

high risk no funcitonal or structural deficitis

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29
Q

ACC/AHA Class B

A

structural deficit but asymptomatic

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30
Q

ACC/AHA Class C

A

heart failure symptoms due to underlying structure heart deficit with medical management

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31
Q

ACC/AHA Class D

A

advanced disease requiring hospitalization, transplant, or palliative care

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32
Q

lifestyle treatment for CHF

A

aerobic fitness, weight loss, salt-restricted diet (DASH), HTN and blood glucose manage, smoking cessation

kahoot Q

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33
Q

HFrEF

A

HF with EF < 40%

systolic HF

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34
Q

HFpEF

A

HF with EF > 50%

diastolic HF

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35
Q

borderline HFpEF

A

HF symptoms with an EF 40-49%

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36
Q

T/F diastolic dysfunction is only present in HFrEF

A

false, diastolic dysfunction is present in both HFpEF and HFrEF

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37
Q

LV hypertrophy pattern of HFpEF

A

concentric hypertrophy

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38
Q

LV dilation pattern of HFrEF

A

eccentric hypertrophy

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39
Q

which HF is related to conditions such as HTN, DM, Afib, obestiy, metabolic syndrome, COPD, and CKD/anemia

A

HFpEF

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40
Q

which HF is associated with modifiable risk factors such as smoking and HLD

A

HFrEF

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41
Q

which HF has a higher incidence of myocardial ischemia and infarction, previous PCI, CABG, PVD

A

HFrEF

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42
Q

women are more affected by _______
men are more effected by _______

A

women - HFpEF
men - HFrEF

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43
Q

prevalence of HFrEF, HFpEF, borderline in %

A

HFpEF - 52%
HFrEF - 33 %
boderline - 16%

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44
Q

what dysfunction is the primary determinant of HFpEF

A

LV diastolic dysfunction

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45
Q

what dysfunction is the primary determinant of HFrEF

A

contractile dysfunction

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46
Q

common causes of LV diastolic dysfunction

A
  • 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
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47
Q

symptoms most common with HFpEF

A

paroxysmal nocturnal dyspnea, pulmonary edema, and dependent edema

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48
Q

symptoms most common with HFrEF

A

s3 gallop

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49
Q

mean pulmonary capillary wedge pressure > 15 mmHg at rest or >25 mmHg with exercise provides evidence of

A

HFpEF and is a predictor of mortality

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50
Q

EKG abnormalities in HF patients

A

LVH, previous MI, arrhythmias, and conduction abnormalities

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51
Q

chronic HF treatment consisting of treat associated conditions, exercise and weight loss is assoicated with which HF

A

HFpEF

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52
Q

chronic HF treatment with beta blocker and ACE-Inhibitor therapy is assoicated with which HF

A

HFrEF

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53
Q

according to ACC/ESC what medication can reduce LV filling pressures, decrease pulmonary venous congestion, and improve HF symptoms

A

loop diuretics

kahoot Q

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54
Q

when might thiazide diuretics be useful

A

poorly controlled HTN to prevent onset of HFpEF

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55
Q

beta blocker therapy is strongly recommended for

A

HFrEF!

in HFpEF BB are preseribed for other indications (HTN, Afib, MI)

kahoot Q

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56
Q

which HF uses ACE-Inhibitors as mainstay treatment

A

HFrEF

ACE-I show no benefit in HFpEF unless used for HTN

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57
Q
A
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58
Q

what can reverse LV dysfunction following an MI

A

coronary revascularization via CABG or PCI

early revascularization may prevent permenant EF reductions

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59
Q

cardiac resynchronized therapy is used for

biventricular pacing

A

HF with a ventricular conduction delay (prolonged QRS)

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60
Q

benefits of cardiac resynchonization therapy

A

more synchoronous heart contractions and improves Cardiac Output

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61
Q

when is CRT recommended

A

NYHA Class III or IV with EF < 5% and QRS duration 120-150 ms

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62
Q

risk of CRT

A

infection, misplacement, device failure

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63
Q

implantable hemodynamic monitoring allows remote observation of intracardiac pressures to

A

guide treatment and prevent decompensation

cardioMEMS - noninvasive PAP monitoring

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64
Q

implantable cardioverting-defibrillators used to prevent

A

sudden death in patients with advanced HF

50% HF deaths are due to sudden cardiac dysrhymias

kahoot Q

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65
Q

LVAD is used for

A
  • 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
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66
Q

T/F LVAD mechanical pumps can take over total or partial function of the damaged ventricle and facilitate restoration of normal hemodynamcics and perfusion

A

true

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67
Q

acute heart failure is

A

rapid onset, present with life threating conditions

may require hospitalization

68
Q

the term “acute heart failure” applies to

A

pts with worsening preexisting HF (acute decompensated HF) and first time with HF (de novo acute HF)

69
Q

acute decompensated HF symptoms

A

fluid retention, weight gain, dyspnea

result of decompensation due to inadequate compensation

70
Q

leading cause of de novo Hf

A

cardiac ischemia 2ndary to coronary occlusion

70
Q
A
71
Q

less common - nonischemic causes of de novo HF

A

viral, drug-induced (toxic) and peripartum cardiomyopathy

72
Q

de novo AHF is characterized as

A

sudden increase in intracardiac filling pressures or acute myocardial dysfunction leading to decreased peripheral perfusion and pulmonary edema

73
Q
A
74
Q

T/F de novo HF leads to long term cardiac dysfunction, despite management

A

false, managament of the underlying cause may allow for complete restoration

75
Q

hemodynamic profile of acute HF

A

low cardiac output, high ventricular filling pressures, and HTN or HTN

76
Q

1st line treatment of acute HF

A

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

kahoot Q

77
Q

what drugs can be used to reduce intravascular volume to decrease CVP and PCWP, and pulmonary congestion

A

furosemide, bumetanide, torsemide

GTT or bolus

78
Q

vasodilators are used in acute HF bc they

A

correct elevated filling pressures and reduce afterload

careful considerations w vasodilators bc of the underlying hemodynamics

79
Q

SNP is effective in rapidly decreasing

A

afterload

arterial vasodilator

80
Q

NTG is commonly used as adjunct therapy with

A

diuretic therpay

81
Q

why use tolvaptan in acute HF

vasopressin receptor antagonists

A

reduce arterial constriction, hyponatremia, and the volume overload assocaited with AHF

82
Q

what is the mainstay drug for acute HF for patietns with reduced contractility or in cardiogenic shock

A

positive inotropes!!
inotropes increase cAMP which increases intracellular calcium and exicitation contraction coupling

kahoot Q

83
Q

catecholamines MOA and examples

A

stimualate Beta receptors on myocardium to activate adenyl cyclase to increase cAMP

EPI, NE, dopamine, dobutamine

84
Q
A
85
Q

PDE-inhibitors MOA and example

A

indirectly increase cAMP by inhibiting the degradation of cAMP

milrinone

86
Q

MOA, CO, MAP, HR with EPI

A

B1 = B2 > alpha
increased increased CO, MAP, HR

87
Q

MOA, CO, MAP, HR with NE

A

A > B1 > B2
increased CO, MAP, HR stays same or decreases

88
Q

MOA, CO, MAP, HR with dobutamine

A

B1 > B2 > a
cardiac ouput stays same or decreases
**increased increase ** MAP
**increased increase ** HR

89
Q
A
90
Q

MOA, CO, MAP, HR with dopamine

A

D > B (alpha with high doses)
icnreased CO, same/lower MAP, hella increased HR

91
Q

what recombinant drug is used to inhibit RAAS and promote artial, venous, and coronary vasodilation, decreasing LVEDP and improve dyspnea

A

Nesiritide, exogenous BNP

binds to ANP and BNP receptors

kahoot Q

92
Q

based on INTERMACS scoring, what would you score a patient whos critically ill and moribound with severe symptoms at rest, and crashing

A

1- crashing

93
Q

based on INTERMACS scoring, what would you score a patient whos experiencing congestion while on inotropes

A

2- failing on inotropes

94
Q

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

A

3 - inotrope dependent

95
Q

based on INTERMACS scoring, what would you score a patient whos at home with oral therapy

A

4 - symptoms at rest

96
Q

IABP is a cyclic helium balloon that inflates duirng ____ and deflates during _____

A

inflation diastole
deflation systole

97
Q

primary modes of IABP placement confirmation

A

TEE and Xray

98
Q

IABP improve perfusion where by reducing what

A

improve LV coronary perfusion and reduce LVEDP

99
Q

full support on IABP means

A

1:1 - one inflation for every Heartbeat

100
Q

if the patient is tachycardiac while on IABP what setting is ideal (1:1) or (1:2)

kahoot Q

A

1:2 (one inflation per every 2 heartbeats)

101
Q

T/F IABP provides great improvements in Cardiac output and is useful longterm

A

false, it improves CO (0.5-1 L/min) and renders patients immobile

102
Q

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

A

up to 14 days

103
Q

impella is used as a transiton to recovery or bridge to what cardiac procedures

A

CABG
PCI
VAD
transplant

104
Q

what is the impella

A

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
Q

peripheral VAD consists of a small pump and controller but generates heat and causes

A

hemolysis and low flow ratess

kahoot Q

106
Q

if a peripheral VAD has an oxygenator it is considered

A

ECMO extracorpeal membrane oxygenation

107
Q

central VAD/ECMO has cannulation where

A

in the right atrium and aorta

108
Q

why central ECMO instead of peripheral

A

for cardiopulm support if adequate flow rates are not achievable

109
Q

benefits of central ECMO

A

complete ventricular decompression, avoidance of limb impairment, avoidance of SVC syndrome

110
Q

pts on ECMO likely have reduced ____ perfusion as blood bypasses the _____ before returning to the aorta

A

lung perfusion; lung

111
Q

anesthetic considerations for ECMO patients

A

TIVA > inhaled anesthetics

INH anesthetics may be limited by functional shunting around the lung

112
Q

T/F ECMO membrane is hydrophilic, causing many agents to be sequestered within the circuit

A

false, the circuit is lipophilic - causing agents to be sequestered within the circuit

113
Q

HF patients have an increased risk of developing

A

renal failure, sepsis, PNE, and cardiac arrest

long mechanical vent hoursl overall increased 30 day mortality

114
Q

when should surgery be postponed in HF patients

A

experiencing decompensation, recent change in clinical status, or de novo HF

115
Q

all HF should have a comprehensive preop exam to determine if they are

A

compensated or require treatment

116
Q

when are diuretics held

A

day of surgery

117
Q

are BB continued

A

yes - they reduce perioperative M&M

118
Q

are ACE-I continued

A

no - they put patients at risk for intraop Hypotension

119
Q

when is a 12-lead warranted

A

any pt with CV disease

120
Q

TTE is indicated when

A

patients with worsening dyspnea during preop eval

121
Q

preop labs for HF patient

A

CBC, BMP, LFTs, COAGS

BNP not routinely ordered

122
Q

patients with ICDs and pacemakers should have what before surgery

A

interogation of devices

123
Q

cardiomyopathies are a group of myocardial diseases assocaited with _______ and/or _______ dysfunction that usually exhibits ventricular hypertrophy or dilation

A

mechanical and or electrical

124
Q

cardiomyopathies are divided into 2 groups - primary and secondary (whats the difference)

A

primary - confined to the heart muscle
secondary - cardiac involvement in the context of a multiorgan disorder

125
Q

most common genetic CV disease

A

Hypertrophic cardiomyopathy

126
Q

hypertrophic cardiomyopathy is characterized by

A

LVH in the absence of other diseases capable of inducing ventricular hypertrophy

127
Q
A
128
Q

Hypertrophic cardiomyopathy presents with hypertrophy where in the heart

A

interventricular septum and the anterolateral free wall

histology shows hypertrophied myocardial cells & patchy myocardial scars

129
Q

hypertrophied myocardium has a prolonged _______ time and decreased ________

A

relaxation time; decreased compliance

130
Q

T/F myocardial ischemia is present in patients with hypertrophic cardiomyopathy whether or not they have CAD

A

true!

131
Q

common cause of death in young adults with HCM

A

dysrhythmias - causing sudden death

132
Q

In hypertrophic cardiomyopathy dysrhymias are caused by

A

disorganized cellular architecture, myocardial scarring, and expanded interstitial matrix

133
Q

ECHO findings of a patient with hypertrophic cardiomyopathy

EF and wall thickness

A

> 80%
echo may show myocardial wall thickness > 15 mm

in terminal states EF may be severly depressed

134
Q

EKG abnormalities in HCM include

A

high QRS voltage, ST- segment, T-wave alterations, abnormal Q waves, Left atrial enlargement

135
Q

in asymptomatic patients, what may be the only sign of HCM

A

unexplained LVH

136
Q

hypertrophic cardiomyopathy medical therapy

A

BB and CCB
pts who develop HF despite BB and CCB may show improvement with diuretics

137
Q

whats a good adjucnt in patients with hypertrophic cardiomyopathy who reamin symptomatic

A

disopyramide - negative inotrope effect improving LVOT obstruction and heart failure symptoms

138
Q

what arrythymia can develop with HCM

A

Afib
thrombembolism, HF, and sudden death

amiodorone most effective + long term anticoagulation is indicated chronic/recurrent afib

139
Q

HCM surgical treatment options for symptomatic patients

A

a prosthetic mitral valve can be inserted to counteract the anterior motion of the mitral leaflet

140
Q

surgical strategies for hypertrophic cardiomyopathy

A

septal myomectomy
cardiac cath with injection to induce ischemia of the septal perforator arteries
percutaneous septal ablation

141
Q

dilated cardiomyopathy is characterized by

A

LV or biventricular dilation, biatrial dilation, decreased ventricular wall thickness, and systolic dysfunction without abnormal loading conditions

142
Q

initial symptom of dilated cardiomyopathy

A

HF and CP

143
Q

ventricular dilation from dilated cardiomyopathy can lead to

A

mitral and or tricuspid regurgiation

144
Q

with dilated cardiomyopathy what are common things that can cause death

A

dysrhtymias, conduction abnormalities, emboli, and sudden death

145
Q

ECHO results of dilated cardiomyopathy

A

dilation of all 4 chambers, predominately the LV as well as global hypokinesis

146
Q

treatment for dilated cardiomyopathy

A

similar to that of chronic HF /anticoagulation

147
Q

EKG of dilated cardiomyopathy

A

ST-segment and T wave abnormalities and LBBB
PVC and AFib

148
Q

what is apical ballooning syndrome

A

stress cardiomyopathy

149
Q

what is stress cardiomyopathy

apical ballooning syndrome

A

temporary primary cardiomyopathy characterized by LV apical hypokinesis with ischemic EKG changes, however the coronaries remain patent

150
Q

where in the heart is there temporary dysfunction in stress cardiomyopathy

A

LV apex - while the rest of the heart has normal contractility

151
Q

symptoms of stress cardiomyopathy

A

chest pain and dyspnea

152
Q

causes of stress cardiomyopathy

A

stress (physical or emotional)
women > men

153
Q

peripartum cardiomyopathy arises when

A

3rd trimester - 5 months postpartum

154
Q

diagnosis of peripartum cardiomyopathy: 3 criteria

A
  • development of HF in period surrounding delivery
  • absence of another explainable cause
  • LV systolic dysfunction with LVEF < 45%
155
Q

diagnosis of peripartum cardiomyopathy

A

EKG, ECHO, CXR, cardiac MRI, cardiac cath, endomyocardial biopsy, BMP levels

156
Q

what is secondary cardiomyopathy

A

due to systemic disease that produce myocardial infiltration and severe diastolic dysfunction

157
Q

common cause of secondary cardiomyopathy

BONUS: Secondary causes

A

amyloidosis
secondary: hemochromatosis, sarcoidosis, carcinoid tumor

158
Q

when should diagnosis of secondary cardiomyopathy be considered

A

pts with HF but no evidence of cardiomegaly or systolic dysfunction

159
Q

secondary cardiomyopathy BP characteristics

A

low to normal BP
and can develop orthostatic hypotension

160
Q

what is cor pulmonale

A

RV enlargement (hypertrophy or dilation) that may progress to HF

kahoot Q

161
Q

causes of cor pulmonale

A

pulmonary HTN
myocardial disease
congential heart disease
respiratory, connective tissue, thromboembolic disease

162
Q

most common cause of cor pulmonale

A

COPD

163
Q

EKG changes with cor pulmonale (2)

A

RA and RV hypertrophy
peaked P waves in II, III, aVF (RA hypertrophy)
RBBB - right axis deviation

164
Q

diagnostic test for cor pulmonale

A

TEE, CXR, right heart cath

Health Assessment (16 decks)

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