HF Flashcards
1
Q
HF is defined as
A
a complex syndrome that results from any structural or function impairment of ventricular filling or blood ejection
2
Q
HF leads to tissue-hypoperfusions, resulting in
A
fatigue, dyspnea, weakness, edema, weight gain
3
Q
HFrEF is also called _______, and is classified as HF w/ EF _____
A
systolic HF, EF <40%
4
Q
HFpEF is also called _____, and is classified as HF w/ EF _____
A
diastolic HF, EF >50%
5
Q
Borderline HFpEF is when EF is ____
A
between 40-49% and symptomatic
6
Q
______ dysfunction is present in both HFrEF and HFpEF
A
diastolic
7
Q
______ and _____ are the distinguishing features between HFrEF and HFpEF, along with their responses to medical treatment
A
LV dilation patterns and remodeling
8
Q
_____ remains a useful tool, as it is easily measured via echocardiogram and serves as the main marker for determining HF risk factors, treatment, and outcomes
A
EF
9
Q
Pts with ______ are more likely to have modifiable risk factors (smoking, HLD) as well as higher incidence of MI, previous coronary intervention, CABG and PVD
A
HFrEF
10
Q
What % of HF cases are HFpEF, HFrEF, and borderline HFpEF
A
- 52% HFpEF
- 33% HFrEF
- 16% borderline HFpEF
11
Q
women are more likely to be affect by ______ (reduced or preserved EF)
A
HFpEF
12
Q
men are more likely to be affect by _____ (reduced or preserved EF)
A
HFrEF
13
Q
_______ is the main determinant of HFpEF, whereas _____ is the primary determinant of HFrEF
A
LV diastolic dysfunction (LVDD), contractile dysfunction
14
Q
the LV’s ability to fill is determined by:
A
- pulmonary venous flow
- LA function
- mitral valve dynamics
- pericardial restraint
- active & passive elastic properties of the LV
15
Q
LVDD measurements depend on _____, _____, and ______
A
HR, loading conditions, myocardial contractility
16
Q
in HFpEF, higher LV filling pressures are required to achieve normal _______
A
end-diastolic volume
17
Q
A steeper rise of the end diastolic-volume curve is indicative of
A
delayed LV relaxation and increased myocardial stiffness
18
Q
in HFpEF, LV compliance is ______ than normal
A
lower
19
Q
Is this pressure volume loop HFrEF or HFpEF
A
HFrEF
20
Q
Is this pressure volume loop HFrEF or HFpEF
A
HFpEF
21
Q
Common causes of LVDD are
A
- Age >60
- acute MI
- pressure or volume overload hypertrophy
- hypertrophic obstructive cardiomyopathy
- dilated cardiomyopathy
- restrictive cardiomyopathy
- pericardial disease (tamponade, pericarditis)
22
Q
Delays in ventricular relaxation are a form of “_______” c/b failure of the actin-myosin disassociation, which occurs due to the inadequate perfusion or dysfunctional intracellular Ca++ homeostatis
A
active stiffening
23
Q
LV relaxation depends on _______
A
afterload, which is typically elevated in HTN patients
24
Q
______ exacerbates the failure of LV relaxation
A
tachycardia
25
Profound exercise intolerance is seen with HF____EF
HFpEF
26
Most common sx of HF include
fatigue, tachypnea, dyspnea, paroxysmal nocturnal dyspnea, orthopnea, S3 gallop, JVD, peripheral edema, exercise intolerance, reduced tissue perfusion
27
symptoms more common w/ HFpEF include
paroxysmal nocturnal dyspnea, pulmonary edema, dependent edema
28
Symptoms more common w/ HFrEF include
S3 gallop
29
The initial diagnosis of ______ is often more difficult d/t patient having little/no symptoms at rest
HFpEF
HFrEF present with more symptoms at rest
30
Mean PAWP >15 mmHg at rest of 25 mmHg during exercise provides strong evidence of ______ and is a predictor of mortality
HFpEF
31
CXR of HF patient may show
pulmonary disease, cardiomegaly, pulmonary venous congestion, and interstitial or alveolar pulmonary edema
32
An early radiographic sign of LV failure and pulmonary venous HTN is
distention of the pulmonary veins in the upper lobes of the lungs
33
_________ appears as hilar or perihilar haze with ill-defined margins
perivascular edema
34
_______ produce a honeycomb pattern, which reflects _____ and may be present in HF
Kerley lines, reflect interlobular edema
35
Alveolar edema produces _________ in the lung fields, typically in a butterfly pattern
homogenous densities
36
Radiographic evidence of pulmonary edema may lag behind clinical evidence of pulm edema by up to ____ hours
12 hrs
37
What are the 3 diagnostic criteria for the ACC/AHA for HFpEF
Heart failure symptoms, LV EF >50%, evidence of LV diastolic dysfunction
38
Which biomarkers are used to trend HF
BNP and N-terminal pro-BNP
39
BNP are related to ________ wall stress, which is higher in HF___EF d/t LV dilation and eccentric remodeling
LV end-diastolic wall stress, HFrEF
40
Eccentric hypertrophy remodeling is seen in which HF
HFrEF
41
concentric hypertrophy is seen with which HF
HFpEF
relatively normal LV chamber size, and lower LV end-diastolic wall stress, allowing for lower BNP or NT-proBNP levels
42
______ are systemically released d/t myocardial damage and serve as a measure of risk prediction
Troponins
43
Both _______ and ______ represent the inflammatory component of HF
C-reactive protein (CRP) and growth differential factor-15 (GDF15)
44
The NYHA classifications of HF are based on _______ and classes range from ____
based on physical limitation, class I-IV
45
The ACC/AHA classifications of HF are based on ______ and classes range from ____
based on symptoms, class A-D
46
Survival of patients with HF__EF has improved during past 3 decades, but the mortality of HF__EF remains unchanged
HFrEF improved, HFpEF unchanged
47
Medication treatments are ineffective for HF__EF, although benefit is seen in patients with HF__EF
Ineffective for HFpEF, beneficial for HFrEF
48
HFpEF treatment is based on
mitigation of symptoms, treat associated conditions, exercise, weight loss
49
HFrEF treatment is based on
BB's and ACE-I
50
1st line drug therapy for HF is _____ and specifically which type?
loop diuretics
thiazide diuretics may be useful in pts with poorly controlled HTN to prevent the onset of HFpEF
51
B-Blockers are strongly recommended for HF___EF
HFrEF
52
Lifestyle modifications for HF management include
weight loss, aerobic fitness, salt restricted diet, control of HTN and blood glucose
53
The goal of surgical treatment for chronic HF is to
prevent ventricular remodeling and retain natural geometry of the heart
54
_______ is a tx for HF with a ventricular conduction delay (prolonged QRS)
Cardiac resynchronization therapy (CRT)
55
______ is a implantable hemodynamic monitoring system
CardioMEMS
56
50% of HF deaths are due to
sudden cardiac dysrhythmias
ICDs are implanted to prevent sudden death
57
De novo acute heart failure is when
pt presents with acute HF for the first time
58
Acute decompensated HF symptoms include
- fluid retention
- weight gain
- dyspnea
59
De novo AHF is characterized by
sudden increase in intracardiac filling pressures or acute myocardial dysfunction, leading to decreased peripheral perfusion and pulmonary edema
60
_______ is the leading cause of de novo HF
Cardiac ischemia c/b coronary occlusion
61
Less common nonischemic causes of de novo HF include
viral, drug-induced, peripartum
62
The hemodynamic profile of a patient in AHF includes
low CO, high ventricular filling pressures, and HTN or HoTN
63
1st line of treatment for AHF is
diuretics, should be given immediately in patients with fluid overload.
- furosemide, bumetanide, torsemide
- AHF patients w/ HoTN may need to be hemodynamically supported prior to diuretic therapy
64
______ is effective in rapid decreasing afterload, while _____ is commonly used as an adjunct to diuretic therapy
sodium nitroprusside, NTG
65
______ is a vasopressin receptor antagonist and is used in HF tx by doing what?
Tolvaptan; used to reduce arterial constriction, hyponatremia, and volume overload associated with AHF
66
Inotropes increase _____ which increases intracellular calcium and excitation-contraction coupling
cAMP
67
What are 2 classes of positive inotropes
- catecholamines - stimulate B-receptors on the myocardium to activate adenylyl cyclase to increase cAMP
- PDE-inhibitors (milrinone) - indirectly increase cAMP by inhibiting degredation
68
______ is an exogenous BNP
Nesiritide
binds to A- and B-type natriuretic receptors inhibiting the RAAS and promoting arterial, venous, and coronary vasodilation, decreasing LVEDP and improving dyspnea
it also induces diuresis and natriuresis, relaxes cardiac muscle and lacks any dysrhythmic effects
69
IABP improves LV coronary perfusion by _____
reducing LVEDP (reducing afterload)
70
Primary modes of placement evaluation of IABP
TEE and CXR
71
IABP degree of support varies b/o _____, ____, ____
set volume, size of balloon, ratio of supported beats
72
Overall, IABP improves cardiac output by how much
0.5-1L/min
73
IABP has limited long-term use d/t
patient has to be immobile to avoid displacing balloon
74
Impella can be used for up to ____ days
14 days
75
Peripheral VADs are support devices that can provide
extracorporeal membrane oxygenation (ECMO)
76
What is the downside to a peripheral VAD
generates heat, causing more hemolysis and lower flows
77
Central VAD/ECMO requires _______ or ____ for placement
sternotomy or thoracotomy
78
What are the benefits to central VAD/ECMO
complete ventricular decompression, avoidance of limb impairment and avoidance of SVC syndrome
79
Why are inhaled anesthetics limited in function in patients on ECMO
lungs get reduced perfusion as blood bypasses the lungs before returning to the aorta
80
Which anesthetic should be considered for pts on ECMO
TIVA
81
ECMO membranes are ______, causing many agents including _____ to become sequestered within a circuit
lipophilic, fentanyl
82
HF patients may require longer periods of ______ and have an overall increased 30 day mortality
mechanical ventilation
83
HF patients have an increased perioperative risk of developing
renal failure, sepsis, pneumonia, cardiac arrest
84
All patients with HF should have a ________ prior to surgery
comprehensive preop exam
85
Surgery should be postponed in patients experiencing
decompensation, recent change in clinical status, or in de novo acute heart failure
86
When should diuretics be held for surgery
day of surgery
87
A _____ is indicated in pts with worsening dyspnea during their preop evaluation
TTE
88
Which labs should be reviewed before surgery in patient with HF
CBC, electrolytes, liver function, coag studies.
BNP not routinely recommended
89
_____ should be interogated prior to surgery
ICDs and pacemakers
90
_______ are a group of myocardial diseases associated with mechanical and/or electrical dysfunction that usually exhibit ventricular hypertrophy or dilation
cardiomyopathies
91
Cardiomyopathies are either confined to _____ or part _____, often leading to cardiovascular death or disability
heart, systemic disorders
92
What are the 2 groups of cardiomyopathies
- primary: confined to heart muscle
- secondary: pathophysiologic cardiac involvement in the context of a multiorgan disorder
93
Hypertrophic cardiomyopathy is a type of ______
primary cardiomyopathy
94
What is the most common genetic cardiovascular disease
Hypertrophic cardiomyopathy
95
Hypertrophic cardiomyopathy is characterized by
LVH in the absence of other diseases capable of inducing ventricular hypertrophy
96
Hypertrophic cardiomyopathy usually presents with
hypertrophy of the interventricular steptum and anterolateral free wall
97
Histological features of hypertrophic cardiomyopathy include
hypertrophied myocardial cells and patchy myocardial scarring
98
Pathophysiology of hypertrophic cardiomyopathy is r/t
myocardial hypertrophy, dynamic LVOT obstruction, mitral regurg, diastolic dysfunction, myocardial ischemia, and dysrhythmias
99
The hypertrophied myocardium has a ______ relaxation time and _____ compliance
prolonged relaxation time, decreased compliance
100
______ are the cause of sudden death in young adults with hypertrophic cardiomyopathy
dysrhythmias
101
In hypertrophic cardiomyopathy, dysrhythmias are c/b _____
disorganized cellular architecture, myocardial scarring, and an expanded interstitial matrix
102
In asymptomatic patients, unexplained ______ may be the only sign of hypertrophic cardiomyopathy
LV hypertrophy
103
EKG abnormalities are seen in ____% of hypertrophic cardiomyopathy patients
75-90%
104
Which EKG abnormalities are seen in hypertrophic cardiomyopathy
high QRS volatge, ST-segment and T-wave alterations, abnormal Q waves, and LA enlargement
105
on Echocardiogram, hypertrophic cardiomyopathy may show myocardial wall thickness > ____
> 15 mm
106
What is ejection fraction usually in patient with hypertrophic cardiomyopathy?
>80%, reflecting the hypercontractility. May be reduced in terminal states
107
Medication treatment for hypertrophic cardiomyopathy includes
BBs and CCBs, diuretics if no improvement from BB and CCB
108
______ can be considered as add-on therapy in patients who remain symptomatic despite other medication treatments for hypertrophic cardiomyopathy. How does it work?
Disopyramide; has negative inotropic effect, improving LVOT obstruction and heart failure symptoms
109
_____ often develops in hypertrophic cardiomyopathy and is associated w/ increased risk of thromboembolism, HF and sudden death
A-fib
110
_____ is the most effective antidysrhythmic in hypertrophic cardiomyopathy
amiodarone
111
______ is indicated for recurrent or chronic afib
long-term anticoagulation
112
Surgical treatment for hypertrophic cardiomyopathy includes
- septal myomectomy
- cardiac cath w/ injection to induce ischemia of the septal perforator arteries
- echocardiogram-guided percutaneous septal ablation
113
______ can be inserted to counteract the systolic anterior motion of the mitral leaflet in hypertrophic cardiomyopathy
prosthetic mitral valve
114
_____ is the primary tx for patients at risk of sudden cardiac death d/t dysrhythmias
ICD placement
115
_____ is a primary myocardial disease characterized by LV or biventricular dilation, biatrial dilation, decreased ventricular wall thickness, and systolic dysfunction w/o abnormal loading conditions or CAD
dilated cardiomyopathy
116
The initial symptoms of dilated cardiomyopathy is usually
heart failure or chest pain
117
in dilated cardiomyopathy, ventricular dilation may lead to
mitral and/or tricuspid regurgitation
118
In dilated cardiomyopathy, Echocardiogram typically reveals what?
dilation of all 4 chambers, predominantly the LV, as well as global hypokinesis
119
Treatment of dilated cardiomyopathy is similar to that of
chronic HF
120
In dilated cardiomyopathy, EKG often shows
ST-segment and T-wave abnormalities and LBBB
common dysrhythmias include PVC and afib
121
______ remains the principal indication for cardiac transplant
dilated cardiomyopathy
122
Stress cardiomyopathy is also called "_______" and is a temporary primary cardiomyopathy characterized by _______ hypokinesis w/ EKG changes, however the coronary arteries remain patent
Apical ballooning syndrome, LV apical hypokinesis
123
Stress cardiomyopathy occurs due to
disruption of contractility in the LV apex while the rest of the heart has normal contractility; occurs due to physical or emotional stress
124
Common symptoms of stress cardiomyopathy include
chest pain and dyspnea
125
Stress cardiomyopathy occurs more in men or women?
women
126
Peripartum cardiomyopathy typically arises during
3rd trimester - 5 months postpartum
127
Diagnosis of peripartum cardiomyopathy is based on which 3 criteria
- development of HF in the period surrounding delivery
- absence of another explainable cause
- LV systolic dysfunction with a LVEF <45%
128
Diagnosis of peripartum cardiomyopathy include
EKG, echo, CXR, cardiac MRI, cardiac cath, endomyocardial biopsy, and BNP levels
129
_______ is the most common secondary cardiomyopathy, and other causes include
amyloidosis; other causes include hemochromatosis, sarcoidosis, and carcinoid tumors
130
Patients with secondary cardiomyopathy have low to normal ______ and can develop ______
BP, orthostatic hypotension
131
Cor pulmonale is _____ enlargement that may progress to ____ sided HF
RV, right-sided HF
132
Causes of cor pulmonale include
pulmonary HTN, myocardial disease, congenital heart disease, or any significant respiratory, connective tissue, or chronic thromboembolic disease
133
The most common cause of Cor Pulmonale is
COPD
134
Is Cor Pulmonale more common in men or women
men >50 y/o
135
EKG changes that may be seen in cor pulmonale are
signs of RA/RV hypertrophy
RA hypertrophy is suggested by peaked P waves in lead II, III, aVF
Right axis deviation and RBBB are also often seen
136
HF___EF is commonly d/t obstructive ischemic heart disease
HFrEF
137
HF__EF is increasing in prevalence and primarily the result of poor lifestyle choices and comorbidities
HFpEF
138
Management of acute heart failure includes _______ in combination with _____, _____, and/or ______
loop diuretics, combined with vasodilators, positive inotropes, and/or mechanical devices
139
________ is the most common genetic cardiac disorder. Its pathophysiology is related to the development of LVOT obstruction and ventricular dysrythmias that can cause sudden death
Hypertrophic cardiomyopathy
140
Factors that include LVOT obstruction in hypertrophic cardiomyopathy include
hypoveolemia, tachycardia, increased myocardial contractility, and decreased afterload
141
______ is the most common form of cardiomyopathy and the second most common cause of heart failure
Dilated cardiomyopathy
142
______ is RV enlargement that may progress to right heart failure. It is caused by diseases that promote pulm HTN
Cor pulmonale
143
The most important determinant of pulmonary HTN and cor pulmonale in patients with chronic lung disease is ______, the best treatment is _____
alveolar hypoxia, long-term oxygen therapy
