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ACCSAP > HF/ Cardiomyopathy > Flashcards

HF/ Cardiomyopathy Flashcards

1
Q

headaches/fatigue
OSA tx
Central apnea

A

sleep apnea
CPAP
optimize volume and GDMT

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2
Q

rapidly progressive HF, may be in refractory shock+ ventricular arrhythmias+ h/o autoimmune d/o in young, previously healthy person

A

endomyocardial biopsy to eval for giant cell myocarditis

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3
Q

VAD complications

A

Bleeding, stroke, driveline infection, RV dysfunction, and device failure/thrombosis

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4
Q

myocarditis presentation

long term

A 
mild dyspnea or chest pain that resolves spontaneously to arrhythmias and cardiogenic shock
dilated cardiomyopathy (DCM) with heart failure
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5
Q 
restrictive cardiomyopathy (amyloid, infiltrative, inflammatory, and endomyocardial processes)
hemochromatosis,  myocarditis, tachy CM, peripartum CM, takotsubo
A 
biventricular HF, severely elevated BNP, low voltage, biatrial enlargement
dilated CM (increased EDV, decreased EF, and increased eccentric myocardial mass)
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6
Q

myocarditis treatment

A

standard HF therapy, no immunosupression

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7
Q

Heart block/ ventricular arrhythmias + cardiomyopathy

A

lyme disease

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8
Q

chagas ECG

chagas echo

A

right bundle branch block, left anterior fascicular block, and atrioventricular block
ventricular dysfunction, segmental wall motion abnormalities, and apical aneurysms

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9
Q

hypersensitivity myocarditis

diagnosis

A

temporal association b/w onset of HF and new med

biopsy

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10
Q

chemo (anthracyclines, HER2 antagonists, and TKI therapy) induced cardiomyopathy definition

A

decrease in global EF/ more severe in septum
CHF signs and symptoms
LVEF drop of ≤5-55% with signs/symptoms
LVEF drop of ≤10-55% with signs/symptoms
MUGA is equivalent to echo

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11
Q

pulm htn in HFpEF

A

related to elevated left heart filling pressures

treat BP, diurese, control ventricular rate

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12
Q

hypotension in patients with obstructive CM

A

Avoid increasing contractility (will increase gradient and reduce output)
Choose agents that increase afterload (phenylephrine), alpha agonists)

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13
Q

excitation-contraction coupling

A

calcium enters cell-> calcium released from SR-> binds to troponin C-> displaces tropomyosin-> cross bridge formation

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14
Q

greatest risk factors for HF

A

hypertension and CAD

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15
Q

lifetime risk for development of HF at age 40

A

1 in 5

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16
Q

ICD in HCM

A

personal history of sudden cardiac death (SCD), ventricular fibrillation, or hemodynamically significant VT, first-degree relative with SCD, maximum wall thickness >30 mm, and one or more recent syncopal episodes, hypotension with exercise

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17
Q

HFpEF facts

A

50% of HF, as fatal as HFrEF
female, older, and hypertensive
prevalence increasing

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18
Q

torsemide> furosemide because

A

better oral bioavailability

switch if lasix is not working

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19
Q

Risk factors for anthracycline CM

A

lifetime dose, intravenous bolus admin, higher single doses, h/o of mediastinal radiation, use of other cardiotoxic agents such as cyclophosphamide, trastuzumab, and paclitaxel, female, underlying cardiovascular disease, extremes of age, increased time since therapy completion, prechemo EF <50%

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20
Q

most common viruses to cause myocarditis in the West

A

parvovirus B19 and HHV-6

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21
Q

spironolactone for HFpEF

A

TOPCAT, neutral

subgroup analysis in North American patients positive, but jury is still out

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22
Q

hypertensive acute heart failure

A

use vasodilators: nitroglycerin, isosorbide mononitrate, isosorbide dinitrate, and sodium nitroprusside, captopril?

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23
Q

Brockenbrough sign (HOCM)

A

post PVC increased contractility-> interventricular septum to anterior leaflet of mitral valve-> obstruction -> stroke volume and aortic pulse pressure falls

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24
Q

Post PVC

A

increased contractility and increased preload-> increased pressure gradient
in AS, subaortic membrane, and HOCM

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25
Q

Inotropy for palliation

end stage HF

A

continuous, intermittent has not been studied

Cardiac transplant or VAD-> continuous inotropy if not a candidate for others

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26
Q

preservation of the base and a large segment of apical ballooning, severely elevated BNP
treatment

A

takotsubo

ACEI/ BB

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27
Q

peripartum cardiomyopathy + severely reduced EF

A

anticoagulation, avoid preg

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28
Q

renal dysfunction in acute HF

A

venous congestion (hypervolemia without shock), low renal perfusion (cardiogenic shock), and dysfunctional autoregulation of the kidney

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29
Q

ventricular arrhythmias in HF

A

amiodarone, search for ischemia, electrolyte disturbances, or drug-induced QT prolongation

30
Q

high RA pressure+ blunted y descent

steep x+ y descents

A

tamponade

constriction

31
Q

survival after heart transplant

A

90% at 1 year, 70-75% at 5 years, and 50% beyond 10 years.

32
Q

myocarditis treatment

A

GDMT

33
Q

MRA indication

A

NYHA class II-IV heart failure with an LVEF of 35% or less, cr <2.5 in men and <2 in women, potassium < 5

34
Q

heart failure diagnosis

A

go by exam

35
Q

isordil/hydra

A 
AA, NYHA class III-IV heart failure and reduced EF on ACEI+ BB 
Or anyone who cannot be given ACEI/ARB
36
Q

risk factor that confers worst prognosis

A

inability to tolerate ACE inhibitors due to either hypotension or renal failure
others are hyponatremia, renal insufficiency, anemia, elevated natriuretic peptides, and elevated troponins

37
Q

RHC indication

A

ADHF-> not responding as expected

in consideration for inotropes, LVADs, transplant

38
Q

best predictors for hospital mortality in ADHF

A

blood urea nitrogen (≥43 mg/dl), followed by low SBP (<115 mm Hg), and high serum creatinine (≥2.75 mg/dl)

39
Q

Fabry’s disease

A

alpha-galactosidase A deficiency
HFpEF+ chest pain, normal coronary arteries, LV hypertrophy, and renal dysfunction
family history of HF in males, X linked

40
Q

endocardial thickening and mural thrombi as well as peripheral eosinophilia

A

Loeffler endocarditis

41
Q

HF+ atrioventricular block or ventricular arrhythmias

A

sarcoid

42
Q

5 yr mortality rate in new HF

A

50%

43
Q

ADHF in hospital diuresis

loop diuretics
bumex to lasix

A

initial IV dose should equal or exceed home dose, drip is not better
lasix, bumex (more potent)
2 mg IV bumex= 80 mg IV lasix

44
Q

beta blocker therapy complication

A

volume retention-> increase diuretic, do not decrease beta blocker

45
Q

pressure volume loop change in area
shift up/down
shift left/right

A

change in stroke volume (preload/ afterload)
change in LV stiffness
change in contractility (decreased by BB/CCB, increased by inotropy)

46
Q

Familial cardiomyopathy (different from Fabry) diagnosis

A

clinical, 3 generations affected

47
Q

myocardial remodeling in MI

Endothelin activator
prevent remodeling with

A

activation of the sympathetic nervous system+ RAAS= endothelin-1, collagen turnover, reduced nitric oxide activity, and cellular apoptosis-> increased ventricular size and sphericity, decreased contractile performance, and eventually HF
angiotension (use ACEI/ARB)
NO, ANP, and BNP

48
Q

heart failure workup

A

only get cath if you suspect CAD (for ex not in 25 yo), biopsy is not routine (get it for things like giant cell), do it for new-onset heart failure of 2 weeks to 3 months with a dilated LV and new ventricular arrhythmias, second- or third-degree heart block, or failure to respond to usual care within 1 to 2 weeks.

49
Q

CM+ high grade heart block differential

A

lyme, chagas, giant cell, sarcoid

50
Q

weird increase in o2 sat in swan

A

distal migration to pulmonary vein (RA o2 can be higher than PA depending on where it is sampled, IVC can be higher)

51
Q

prevent anthracycline CM with

A

dexrazoxane, use of liposomal anthracycline preparations, and use of prolonged continuous infusions rather than boluses, ACEI/BB if indicated?

52
Q

TIA/CVA event+ carotid artery disease

A

aspirin+ statin

no advantage of PFO closure

53
Q

risk factors for peripartum CM

Treatment

A

Advanced maternal age, multiparous status, multi-fetal gestation, African descent, history of hypertension/pre-eclampsia, and cocaine abuse
If hemodynamically stable, ACEI+BB
can consider advanced therapies if not recovering

54
Q

HFpEF diagnosis (exertional dyspnea and fatigue w/o clear hypervolemia)

A

an exaggerated elevation in systemic blood pressure and intracardiac filling pressure response to exercise, augmentation in cardiac output is blunted, lack of chronotropic response

55
Q

grade I DD

grade II DD

A

normal filling pressures, E/A ratio <0.8; DT >200 msec and averaged E/e’ ratio 2, decrease of E/A ratio of >0.5 with Valsalva; DT <160 msec, and averaged E/e’ ratio >13

moderately elevated filling pressures, Left atrial volume index >34 cc/m2, E/A ratio: 0.8-1.5; change with Valsalva >0.5, (DT) (msec): 160-200, E/e’ ratio: septal >15; lateral >12 or averaged >13.

56
Q

markers of advanced HF

A

recurrent hospitalization, narrow pulse pressure, resting tachycardia, intolerance to ACE inhibitor, dilated ventricle, and electrical instability

57
Q

CI to cardiac transplant

A

ongoing substance abuse, pulmonary hypertension, advanced age, obesity, or poor renal function

58
Q

treatment of central sleep apnea in HF

A

optimize HF treatment

59
Q

amyloid diagnosis

A

endomyocardial biopsy

60
Q

most common cause of death in first 30 days after heart transplant
first year post transplant

A

primary graft failure (older donor age, more ischemia), then infection
rejection

61
Q

best assessment of HF prognosis

A 
functional capacity (CPET)
oxygen consumption <14cc/kg/min-> transplant
62
Q

severe decompensated HF in patient awaiting transplant

A

inotropy-> LVAD

63
Q

chemo agents that cause CM

A

anthracyclines, trastuzamab (herceptin), TKIs (sunitinib)

64
Q

target BB dose

A

coreg 25 mg BID, metop sux 200 mg daily

65
Q

CI to impella
CI to IABP
CI to TandemHeart
CI to VA-ECMO

A

LV thrombus
moderate / severe AR
left atrial thrombus
severe PVD

66
Q

lower cholesterol in HF

A

worse prognosis, related to poor nutritional status/ cachexia

67
Q

HF exam+ hpi kings

A

JVP and orthopnea are most consistent w/ congestion

68
Q

HF epidemiology

A

more common in older men than women
treatment of BP in people > 80 yo significantly reduces HF
At 40 years, the lifetime risk of developing HF is 20%

69
Q

low voltage despite LVH

A

infiltrative disease (amyloid)

70
Q

recurrence of CM in recovered peri partum cm

persistent peripartum cm

A

20%, no deaths

44%, 19% risk of mortality

71
Q

HCM assessment with inconclusive echo

A

Obtain MRI, varied presentations as far as which walls are hypertrophic and clinical presentation

72
Q

Reduce HF readmissions with

A

GDMT, disease education

ACCSAP (11 decks)

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