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TxPlan/MedComplex/SpecNeeds > MedComplex-CardioVascular2 > Flashcards

MedComplex-CardioVascular2 Flashcards

1
Q

What is Congestive Heart Failure? Failure of the heart ________.

A

as a pump

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2
Q

What is the leading discharge diagnosis in hospitalized pt’s over 65 years of age?

A

Congestive heart failure

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3
Q

CHF is a very common condition with a poor prognosis, with a mortality of more than ___% in less than FIVE years.

A

50% holy Shit!

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4
Q

CHF is the underlying or contributing cause of death of an estimated ________ individuals annually in the U.S. and for which about _______ patients are currently being treated.

A

300,000…2 million

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5
Q

The heart has an amazing capacity to adjust its activity to meet the body’s varying needs and acts to maintain ______ pressure and perfusion of vital organs.

A

arterial

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6
Q

In CHF: The output declines during ____, and markedly increases during ______ by the use of the Cardiac Reserve.

A

sleep…exercise

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7
Q

Persons with CHF, even at rest, must use their cardiac ______.

A

reserve

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8
Q

WHAT ARE THE THREE COMPENSATORY MECHANISMS used to prevent CHF?

A

1.Increased Sympathetic Stimulation 2.Fluid Retention 3.Cardiac Muscle Hypertrophy

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9
Q

CHF Comp. Mech #1: Increased Sympathetic Stimulation-Increases both the heart rate and myocardial contractility by release of _________.

A

Norepinephrine

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10
Q

CHF Comp. Mech #1: Increased Sympathetic Stimulation- In severe CHF, the hearts metabolic needs increase with the increased sympathetic stimulation, leading to myocardial ischemia and _______ when the coronary blood flow is not adequate to meet the hearts needs.

A

Angina

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11
Q

CHF Comp. Mech #2: Fluid Retention - As cardiac output starts to fall to a point where renal blood flow is decreased, the _____ is activated, increasing the ______ and _____ retention.

A

RAS…sodium and water

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12
Q

CHF Comp. Mech #2: Fluid Retention - The fluid retained by the _______ causes a progressive increase in the vascular volume with an accompanying increase in ______ return to the heart, leading to increased filling and stretching of the myocardium (chamber dilation)

A

kidneys…venous

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13
Q

CHF Comp. Mech #2: Fluid Retention - The increased _____ or dilation helps to sustain cardiac performance by enhancing contractility.

A

preload

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14
Q

CHF Comp. Mech #2: Fluid Retention - The increase in vascular volume, as failure progresses, leads to _____.

A

edema

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15
Q

CHF Comp. Mech #3: Cardiac Muscle Hypertrophy- It is a compensatory response of the myocardium to increased _______ work.

A

mechanical

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16
Q

CHF Comp. Mech #3: Cardiac Muscle Hypertrophy- Volume-__________ ventricles develop hypertrophy accompanied by dilation with increased ventricular diameters.

A

overloaded

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17
Q

CHF Comp. Mech #3: Cardiac Muscle Hypertrophy- The hearts usually range up to about _____ grams.

A

600g (normal about 300f, 450m)

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18
Q

CHF-the myocardial hypertrophy, along with the increased SNS stimulation, may lead to _______ or angina of the heart

A

ischemia

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19
Q

Pathophys of CHF-Characterized by diminished cardiac output (________ failure) or damming back of blood in the venous system (_______ failure), or both.

A

forward…backward

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20
Q

Pathophys of CHF - ______ failure impairs movement of blood into the vessels emerging from the heart.

A

forward

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21
Q

Pathophys of CHF- Backward failure allows blood to accumulate in the vessels or heart chambers located behind the failing ______ and results in congestion of the pulmonary and venous system circulation.

A

ventricles

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22
Q

LEFT Heart Failure-Pathophysiology - Most often caused by ischemic heart disease, ____, aortic and mitral valve disease, and non-ischemic myocardial disease (myocarditis)

A

HYPERTENSION

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23
Q

LEFT Heart Failure-Pathophysiology - The morphologic and clinical effects primarily results from progressive damming of blood within the _______ circulation and the consequences of diminished peripheral blood flow.

A

pulmonary

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24
Q

LEFT Heart Failure-Pathophysiology - The left ______ is usually hypertrophied with massive chamber dilation, with secondary enlargement of the left ______.

A

ventricle…atrium

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25
Q

LEFT Heart Failure-Pathophysiology -The enlargement may cause _________ with blood stasis and possible _______ formation with the chance of emboli.

A

atrial fibrillation…thrombis

26
Q

Left Heart Failure-Lung Findings: Increased pressure in the ________ is transmitted retrograde to the capillaries and arteries, resulting in pulmonary congestion and edema with heavy, wet lungs.

A

pulmonary veins

27
Q

Left Heart Failure-Lung Findings: There is edematous widening of the alveolar _______ and accumulation of edematous fluid in the alveolar spaces.

A

septae

28
Q

Left Heart Failure-Lung Findings: When iron-containing hemoglobin from erythrocytes leak from the congested capillaries into the alveoli, the RBC’s are phagocytized by alveolar macrophages and are converted to ________ within the edematous fluid.

A

hemosiderin

29
Q

Left Heart Failure-Lung Findings: The accumulated fluid causes cough, fatigue, limb weakness, and ______ (breathlessness) on exertion, along with orthopnea which is dyspnea on lying down, relieved by sitting or standing.

A

dyspnea

30
Q

Which side of the heart having congestive heart failure will we see hemosiderin-laden macrophages?

A

left sided heart failure (with macrophages in the lungs)

31
Q

Left Heart Failure: The decreased cardiac output causes a reduction in _____ perfusion, activating the RAS, inducing retention of salt and water, expanding the blood volume, which contributes to the ________ edema.

A

renal…pulmonary

32
Q

Left Heart Failure: In far-advanced CHF, the cerebral hypoxia may give rise to hypoxic ___________ with stupor, loss of consciousness, restlessness and possible coma.

A

encephalopathy

33
Q

Right Heart Failure: WHAT IS THE NUMBER 1 REASON for right heart failure? (THIS WILL BE ON EXAM)

A

secondary consequence of left heart failure

34
Q

Right heart failure causes congestion of the ________ and _______.

A

peripheral organs and extremities

35
Q

Which side of congestive heart failure can lead to NUT-MEG liver?

A

right sided CHF

36
Q

In nut-meg liver, the congestion is around which part of the histological anatomy of the liver?

A

central veins

37
Q

Right Heart Failure: The failure leads to an elevated pressure in the _____ veins and it’s tributaries.

A

PORTAL

38
Q

Right Heart Failure: The congestion produces a tense, enlarged spleen (congestive splenomegaly), with a weight up to _____ grams.

A

600g (normally 150-200g)

39
Q

Right Heart Failure: Pressure in the abdominal veins may lead to the accumulation of fluid within the abdomen (_______)

A

ascites

40
Q

Right Heart Failure: More pronounced in the ______ extremities and in the area over the sacrum.

A

LOWER

41
Q

Right Heart Failure: There is also prominent ankle (pedal) and ________ edema. The external jugular vein becomes distended, visualized as _________.

A

pretibial…JVD (Jugular Veinous Distension)

42
Q

RIGHT Heart Failure:Yes, ________ effusions (>1liter) may appear and can cause a partial atelectasis.

A

pleural

43
Q

Causes of primary HTN: What % of HTN is classified as primary? What is the specific cause for this HTN?

A

90%…no specific cause

44
Q

Causes of primary HTN: What are the 7 risk factors for primary HTN?

A

1.Old Age 2.Race 3.Stress 4.Genetics 5.Salt 6.Obesity 7. RAS malfxn

45
Q

Causes of primary HTN: Race: Hypertension is more common and more severe in the _____ race-reason UNKOWN

A

black

46
Q

Causes of primary HTN: Genetics: Hypertension is more frequently seen among members of the same families and persons with a positive family medical history are ____ times more likely to develop essential HTN. With the presence of OTHER risk factors, it becomes ___ times more likely.

A

2x…3-4x

47
Q

Causes of primary HTN: Excess Salt Intake: does not cause HTN in all persons, nor does the reduction reduce the BP. May be due to increased vascular ________.

A

resistance

48
Q

Causes of secondary HTN: What are the 7 underlying causes?

A

1.Pregnancy 2.Kidney Disease 3.Vascular Disorder (ArterioSclerosis) 4.PheoChromoCytoma 5.EtOH 6.MEDS 7.Brain Lesions

49
Q

Causes of secondary HTN: WHAT IS THE MOST COMMON CAUSE OF SECONDARY HTN?

A

KIDNEY DISEASE. I DONT KNOW WHAT IM YELLING ABOUT!

50
Q

Causes of secondary HTN: Pheochromocytoma: A tumor of the __________, produces and secretes Catecholamines (Norepinephrine and Epinephrine),

A

adrenal medulla

51
Q

Causes of secondary HTN: Alcohol Consumption: Regular consumption of ______ or more drinks per day increases the risk.

A

three

52
Q

Causes of secondary HTN: Medications: Such as oral _________, and certain nasal decongestants, may also increase the BP

A

oral contraceptives

53
Q

________ HTN: is an ACCELERATED and potentially fatal form of Hypertension that develops in __-__% of patients with primary or secondary HTN.

A

MALIGNANT…5-10%

54
Q

EXAM QUESTION: Malignant HTN It is a disease of middle-aged adults around the age of _____, WHICH GENDER?, particularly WHICH AGE,SEX,AND RACE??, as well as persons with previous chronic renal disease and toxemia of pregnancy.

A

40…males much more than females…YOUNG BLACK MEN

55
Q

Malignant HTN: About HALF of the patients have an antecedent history of benign _______ and ________

A

hypertension and nephrosclerosis

56
Q

Malignant HTN: Characterized by marked elevation in BP with DIASTOLIC pressures greater than ____mm Hg, encephalopathy, renal disorders, vascular changes, and papilledema

A

130mm

57
Q

Malignant HTN: Related to injury to the _______ because of the high pressures causing leakage of plasma into the injured walls resulting in fibrinoid necrosis.

A

endothelium

58
Q

Malignant HTN: the size of the kidneys vary with the duration of the disease. The cut surface reveals obscured corticomedullary junctions with small red _______ areas of hemorrhage.

A

punctate

59
Q

What are the two most important features of hypertensive retinopathy?

A

1.AV Nicking 2.Cotton Wool Spots

60
Q

HTN MEDS: _________ may be a side-effect of certain calcium channel blockers (________ or ________), leading to pain and difficulty chewing

A

Gingival Hyperplasia…. (Nifedipine or Procardia)

61
Q

What are the four most affected tissues/organs in HTN?

A

1.Heart 2.Kidney 3.Vessles 4.Brain

TxPlan/MedComplex/SpecNeeds (21 decks)

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