Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardio Exam 1 > Lec 5 Heart Failure I > Flashcards

Lec 5 Heart Failure I Flashcards

1
Q

What is definition of heart failure?

A

cardiac disorder that impairs ability of ventricles to eject blood [fwd failure] or fill with blood [backward failure] or both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is equation for CO?

A

CO = HR * SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What 3 factors can affect stroke volume?

A
  • preload
  • afterload
  • contractility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are signs of systolic CHF?

A
  • decreased CO
  • decrease LVEF [left ventricular ejection fraction] < 50% normal

poor contractility
often 2ndary to ischemic heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are signs of diastolic HF?

A
  • normal LVEF [left ventricular ejection fraction]
  • high LV, RV, end-diastolic pressures

normal contractility, impaired relaxation, impaired compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If you see decreased ejection fraction (<50% normal) what possible causes of the heart failure?

A

decreased EF –> decreased contractility or increased afterload

if impaired contractility:

  • MI
  • chronic volume overload [aortic or mitral regurgitation]
  • dilated cardiomyopathy [DCM]

if increased afterload:

  • AS [aortic stenosis]
  • HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is equation for ejection fraction?

A

EF = SV / EDV

SV = EDV - ESV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If you see normal ejection fraction in heart failure what possible causes?

A

due to impaired diastolic filling

  • LV hypertrophy
  • restrictive cardiomyopathy
  • myocardial fibrosis
  • pericardial tamponade
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are 3 compensatory mech in heart failure?

A
  • frank-starling mech
  • ventricular hypertrophy
  • neurohormonal activation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does heart failure change starling curve?

A
  • in heart failure:
  • — shift right in curve [decreased contractility]
  • — move right along new HF curve [compensatory try to increase stroke volume/pressure at cost of increasing congestion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is equation for wall stress?

A

wall stress = pressure * radius / thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does ventricular hypertrophy help failing ventricle?

A

increased thickness –> decreased wall stress of ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What kind of ventricular hypertrophy if there is volume overload?

A

eccentric hypertrophy = new sarcomeres in series with old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What kind of ventricular hypertrophy if there is pressure overload?

A

concentric hypertrophy = new sarcomeres in parallel with old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What compensatory mech in HF?

A

hypertrophy –> increase ventricular mass –> increase atrial pressure

frank-starling –> increase ventricular end diastolic volume –> increase atrial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 3 neurohormonal systems that are compensatory mech in heart failure?

A
  • adrenergic nervous system [sympathetic]
  • RAAS
  • ADH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is equation for systemic vascular resistance?

A

BP [svr] = CO * TPR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are clinical symptoms of left sided heart failure?

A
  • dyspnea
  • orthopnea [SOB when lie flat]
  • cough
  • PND [Paroxysmal nocturnal dyspnea]
  • fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are clinical symptoms of right sided heart failure?

A
  • edema
  • right upper quadrant pain
  • anorexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are clinical findings of left ventricle failure?

A
  • tachycardia
  • pleural effusion
  • systolic/diastolic dysfunction [S3/S4]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are clinical findings of right ventricle failure?

A
  • JVD
  • hepatomegaly
  • peripheral edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is first heart sound [S1]? Where is it loudest?

A

mitral and tricuspid valve closure

loudest at mitral area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is 2nd heart sound [S2]?

A

aortic and pulmonary valve closure

loudest at left sternal border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is 3rd heart sound [S3]?

A

in early diastole during rapid ventricular filling phase

associated with increased filling pressure and more common in dilated ventricles

25
Q

What is 4th heart sound [S4]?

A

atrial kick

in late diastole
high atrial pressure, associated with ventricular hypertrophy

26
Q

What are 4 stages of chronic HF?

A

Stage A: high risk of HF without structural heart disease or symptoms

Stage B: heart disease with asymptomatic LV dysfunction

Stage C: prior or current symptoms of HF with structural heart disease

Stage D: advanced heart disease and severely symptomatic or refractory HF

27
Q

Why do you check CBC lab in CHF?

A

to check for anemia

28
Q

Why do you check electrolyte/creatine lab in CHF?

A

before you start high dose diuretic

29
Q

Why do you check fasting glucose lab in CHF?

A

diabetes can contribute to CHF

30
Q

Why do you check thyroid function lab in CHF?

A

thyrotoxicosis and hypothyroidism can cause CHF

31
Q

Why do you check iron lab in CHF?

A

check for hereditary hemochromatosis

32
Q

Why do you check ANA [antinuclear antibody] lab in CHF?

A

check for autoimmune [SLE = lupus]

33
Q

Why do you check viral studies in CHF?

A

check for viral myocarditis

34
Q

Why do you check BNP lab in CHF?

A

usually elevates (>400) in pt with HF

35
Q

What should you look for in HF chest xray?

A
  • cardiomegaly
  • vascular redistribution interstitial edema
  • alveolar edema
  • pleural effusion
36
Q

What should you look for in EKG in HF?

A
  • ischemic heart disease
  • 1st AV block, left anterior fascicular block
  • amylodidosis
  • idiopathic dilated cardiomyopathy [LVH]
37
Q

What should you look for in echo in HF?

A
  • get ejection fraction to help determine what type of HF

- tells you about structure/function of LV/RV and valves

38
Q

When should you do coronary artery angiogram in HF? WHat does it tell you?

A
  • in pt with HF and angina or significant ischemia or suspected CAD

measures CO, LV dysfunction, LV end diastolic pressure

39
Q

How do you treat pulmonary/systemic congestion?

A

give diuretic = get rid of fluid

40
Q

How do you treat low cardiac output in HF?

A

give vasodilator or ionotropic drugs

41
Q

What is action/use of diuretics?

A
  • promote elimination Na and water via kidney
  • reduces venous return to heart and relieves pulmonary congestion

– no mortality benefits just provides symptomatic relief

42
Q

What happens if over diuresis?

A

fall in CO

43
Q

What is action of nitrates?

A
  • venous vasodilators

- increase venous pooling, decrease venous return to heart

44
Q

What is action of hydralazine?

A
  • arteriolar vasodilators
  • decreases systemic vascular resistance [SVR]
  • decreases LV afterload
  • increases stroke volume
45
Q

What is action of ACEI/ARBs?

A

arteriolar and venous dilators

46
Q

What is action of ace inhibitors?

A
  • inhibit formation angiotensin II and decreases aldosterone

- improves Na elimination –> decreased intravascular volume

47
Q

What should you use if ace inhibitor not tolerated?

A

ARB

48
Q

What is action of beta blockers?

A

improve overall and event free survival in class 2, 3, 4 CHF

49
Q

What are contraindications of beta blockers?

A
  • HR < 60/min
  • symptomatic bradycardia
  • peripheral hypoperfusion
  • COPD/asthma
  • 2nd or 3rd degree AV block
50
Q

What is digoxin?

A

inhibits Na/K ATPase causing indirect inhibition Na/Ca exhanger

  • increases intracellular Ca
  • increased contractility
  • use to control HF symptoms
  • decrease hospitalizations in HF
  • no benefit to mortality
51
Q

What are possible inotropes in HF?

A
  • digoxin
  • phosphodiesterase inhibitiors
  • beta agonists
52
Q

What is action of spironolactone and eplerenone?

A
  • aldosterone antagonists

- increase diuresis, improve survival CHF

53
Q

What is use of implantable defibrillator in HF?

A
  • mortality of HF due to sudden cardiac death caused by arrhythmias
  • increases survival benefit esp with cardiomyopathy and LVEF
54
Q

What is use of cardiac resyncronization?

A
  • increases LV systolic function
  • increase exercise capacity
  • decrease frequency of HF exacerbation
55
Q

What do you use to treat diastolic HF dysfunction?

A
  • problem is not a weak pump its a stiff un-relaxing pump
  • treat underlying HTN or pericardiectomy
  • don’t give inotrope, be careful with diuretic
56
Q

What is acute decompensated HF?

A

fluid goes into lungs secondary to high LA pressure and pulm venous and capillary pressures

–> cardiogenic pulmonary edema

57
Q

What are causes of acute decompensated HF?

A
  • acute mechanical event: rupture chordae tendinae/acute MR
  • volume overload
  • valvular defect [aortic stenosis]
58
Q

How do you treat acute decompensated HF?

A

LMNOP

  • Loop diuretic
  • Morphine
  • nitroglycerine [vasodilator]
  • Oxygen
  • positive pressure ventilation

Cardio Exam 1 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions