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Echo 2 > Module 3.2 : Congestive Heart Failure > Flashcards

Module 3.2 : Congestive Heart Failure Flashcards

1
Q

what is the hearts function

A
  • to produce a cardiac output sufficient to meet all physiologic demands and to generate arterial pressures sufficient to perfuse the organs
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2
Q

what is cardiac failure

A
  • a state in which the heart is unable to meet the oxygen and metabolic demands of the body
  • may be present in resting state or exertion
  • compensatory mechanisms end up making heart failure worse
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3
Q

two different classifications of CHF

A 
- left heart failure
  \+ disease of the myocardium
  \+ valves
  \+ coronary arteries 
- right heart failure
  \+ left heart failure 
  \+ disease of lung parenchyma
  \+ lung vascularity 
      - emboli
      - hypertension 
- cor pulmonale
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4
Q

two causes fo LHF

A
  • decreased myocardial function

- increased myocardial workload

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5
Q

causes of decreased myocardial function

A
  • CAD
  • myocarditis
  • cardiomyopathy
  • infiltrative disease like hemochromatosis
  • amyloidosis
  • sarcoids
  • medications
  • radiation therapy
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6
Q

causes of increased myocardial workload

A
  • hypertension
  • valvular
    + severe regurgitation/ stenosis
  • increases preload/afterload
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7
Q

two different classifications of left heart failure

A
  • forward systolic failure (reduced EF)

- backward diastolic failure (normal EF)

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8
Q

what is the most common cause of right heart failure

A
  • left heart failure
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9
Q

systolic/forward/HFrEF = physiology

A
  • Heart Failure reduced Ejection Fraction
  • EF < 40%
  • imparted ventricular contraction
  • most common from ISCHEMIC HEART DISEASE
  • 50-60% are this kind
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10
Q

diastolic/backward/ HFnEF

A
  • Heart Failure normal EF
  • EF > 55%
  • impaired ventricular relaxation
  • most common from HYPTENSION and LEFT VENTRICULAR HYPERTROPHY
  • 40-50% this kind
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11
Q

systolic heart failure

A
  • inability of the left ventricle to pump blood forward to meet metabolic demands of the body
  • decrease cardiac output
  • eventually filling pressure will rise leading to right heart failure as well
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12
Q

backwards heart failure

A
  • related to reduced compliance and possibly hypertrophy of the LV
  • seen with infiltrative myocardial disease, LVH caused by aortic stenosis, high blood pressure, advanced age
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13
Q

physiology of backwards heart failure

A
  • reduced compliance in the LV myocardium leads to increased LV and LA filing pressures
  • increased filling pressures translate the higher pressures backward into the pulmonary veins and into the lungs causing right heart failure
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14
Q

6 symptoms of left sided CHF - systolic and diastolic

A
  • dyspnea = pulmonary congestion
  • orthopnea = difficulty breathing when you’re laying down
  • parxysmal nocturnal dyspnea = stop breathing at night
  • acute pulmonary edema
  • fatigue
  • palpitations
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15
Q

7 signs of left sided CHF - systolic and diastolic

A
  • cardiomegaly = dilatation
  • ventricular heave = LV pushes against chest wall
  • 3rd heart sound = early filling
  • 4th heart sound = late filing decreased compliance
  • rales or crackles = from fluid in lungs
  • cheyne-stokes respiration = stop breathing
  • tachycardia = as output reduces HR increases
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16
Q

right sided CHF

A
  • MOST COMMON CAUSE IS LEFT SIDED HEART FAILURE
  • cannot handle high afterload
  • can also be caused by primary lung disease
    + pulmonary HTN
    + chronic obstructive pulmonary disease COPD
    + emphysema
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17
Q

7 signs right sided CHF- related to underlying disease

A
  • RVH = the right ventricular may become hypertrophied
  • murmur = pulmonary and tricuspid regurgitation
  • wheezing SOB
  • elevated jugular venous pulse
  • pitting edema
  • ascites
  • cyanosis
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18
Q

4 symptoms of right sided CHF - main symptoms related to systemic venous congestion

A
  • fatigue = when CO is reduced
  • dependent edema = angles when upright. sacral and abdomen when supine
  • liver engorgement = RUQ pain
  • anorexia or bloating = from hepatic or visceral engorgement
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19
Q

what is the gold standard for measuring pulmonary pressure

A
  • pulmonary capillary wedge pressure PCWP
  • invasive
  • echo can only estimate LAP
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20
Q

normal LAP

A

6-12

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21
Q

LAP > 18mmHg or 15mmHg

A
  • means pulmonary hypertension
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22
Q

functional CHF categories

A 
I = no symptoms or limitations in normal activity 
II = mild symptoms or some limitation with normal activity 
III = marked limitiaon in activity due to symptoms 
IV = severe limitations
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23
Q

what is venous return

A
  • amount of blood returning to the heart
24
Q

three things that affect venous return

A
  • blood volume
  • venous pressure
  • intrathoracic pressure
25
Q

what affects blood volume

A
  • body volume (obesity)
  • pregnancy
  • blood loss
26
Q

what affects venous pressure

A
  • blood volume
  • venous constriction
  • temperature reduction
27
Q

what affects intrathoracic pressure

A
  • auto regulated in normal adult
28
Q

what three things increase after load

A
  • high BP = high after load
  • aortic stenosis
  • coarctation of the aorta
29
Q

heart rate control - parasympathetic

A
  • vagus nerve
  • SA
  • AV nodes
  • slows things down
30
Q

heart rate controls - sympathetic

A
  • SA
  • AV
  • purkinjie fibers
  • speeds things up
31
Q

parasympathetic response with action potential

A
  • slow heart rate by moving the resting membrane potential to a more negative state
  • sympathetic does the opposite
32
Q

sympathetic nervous system in CHF

A
  • compensatory mechanism kick in when in CHF as the EF and BP drops
  • fight or flight response
33
Q

fight or flight response

A
  • baroreceptors in the carotid bulb sense changes in pressure and respond with constriction or relaxation of the arterial system
34
Q

three things that happen when BP (blood pressure) drops

A
  • increased HR
  • increased contractility
  • systemic vasoconstriction
35
Q

are compensatory mechanisms helpful or hurtful

A
  • both

- helpful in short term but eventually detrimental to patient

36
Q

ways to counteract the compensatory mechanisms

A
  • release of hormones
    + atrial natriuretic peptide (ANP)
    + b-type natriuretic peptide (BNP) (tested to see if someone is in CHF)
  • effects
    + water excretion, vasodilation
  • unable to fully counteract the detrimental changes
37
Q

the role of echo in CHF

A
  • determination of underlying etiology
38
Q

6 things to assess with echo for CHF

A
  • cardiac chamber size and LV/RV mass
  • systolic performance of LV and RV (EF, TAPSE, TDI, FAC)
  • assessment of diastolic filling pressures
  • determination of right sided heart pressures
  • valvular function (stenosis, regurge)
  • follow up for progression of known disease
39
Q

what is an increase in cardiac mass called

A
  • hypertrophy (eccentric)

- 141g/m^2

40
Q

what is an increase in cardia size

A
  • dilation

- ventricles and atria

41
Q

what type of hypertrophy is seen more with backward and forward HF

A
  • concentric LVH seen more in backward HF
    + walls thick but chamber normal
  • eccentric LVH seen more in forward HF
    + dilated chamber with normal walls
42
Q

how to determine right heart pressures

A
  • determine RAP with IVC sniff test
43
Q

normal RAP IVC sniff test

A
  • IVC = = 21 ; > 50% collapse

+ RAP = 3 mmHG

44
Q

abnormal RAP IVC sniff test

A
  • IVC = > 21 ; < 50% collapse

+ RAP = 15mmHg

45
Q

what is the RAP if only one criteria is met

A
  • 8 mmHg
46
Q

valvular heart disease

A
  • moderate or severe valvular regurge or stenosis can increase preload or afterload significantly
  • can place an unfit or mildly diseased heart into failure
  • assess the degree of stenosis or regurge for each value
47
Q

what does treatment of CHF depend on

A
  • underling cause and symptoms
48
Q

what are the 3 options of treatment for CHF

A 
- lifestyle 
  \+ diet, smoking, exercise, weight reduction, stress reduction 
- medication 
- pacemakers 
  \+ defibrillators, LV assist devices
49
Q

medical options for treatment spend on what

A
  • underlying etiology

- type of heart failure

50
Q

goals of medical options

A
  • mitigate symptoms to improve quality of life
  • which would improve their classification
  • BALANCE EFFECTS OF THE COMPENSATORY MECHANISMS
51
Q

diuretics

A
  • also known as water pills
  • promotes urination to decrease intravascular volume
  • decreases preload and after load
  • relieves pulmonary congestion and or pedal edema
52
Q

inotropic agents

A
  • improve contractility
  • for use in those with HFrEF
  • increases contractility = increases stroke volume by stimulation viable wall segments to contract more
  • digitalis digoxin
53
Q

ACE inhibitors

A
  • angiotensin converting enzyme BLOCKER
  • arterial and venous vasodilation effects
  • look for drugs ending in April
  • decrease artery tension
54
Q

beta blocker

A
  • slows force of contraction and heart rate
  • controversial in patient with low EF
  • may decrease SV further
  • though provides longer filling time
  • end in olol
55
Q

atrial arrhythmias

A
  • afib = most common
  • AF decreases stroke volume
  • risk of clot formation
  • ventricular arrhythmias
56
Q

treatment for arrhythmia

A
  • anti arrhythmics
  • calcium channel blockers
  • lidocaine
  • beta blockers
  • pacemakers
  • implantable cardioverter/ defibrillators
  • LV assist device
57
Q

prophylactic anticoagulation for afib

A
  • reduces risk of thrombus formation
  • heparin
  • warfarin

Echo 2 (18 decks)

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