Pales - CHF and Pulmonary Heart Disease

Question 1

What is the definition of CHF?

Answer 1

Clinical syndrome where abnormality of cardiac structure or function results in inability of heart to eject or fill with blood at a rate sufficient to meet demands of metabolizing tissues

Question 2

What does systolic failure result from?

Answer 2

Inadequate cardiac output

Question 3

What does diastolic failure result from?

Answer 3

Inability of ventricles to relax and fill normally during diastole

Question 4

What is forward failure?

Answer 4

Decrease in perfusion of tissues downstream of heart

Question 5

What is backwards failure?

Answer 5

Backing up of blood into upstream organs

increases hydrostatic pressure and can lead to congestion/edema

Question 6

What are the three main causes of dilated cardiomyopathy?

Answer 6

HTN

Valvular heart disease

CAD/MI

Question 7

What are some causes of toxic myocarditis?

Answer 7

Chemotherapy

Heavy metals

Lithium

Antimalarials

Radiation causing inflammation and fibrosis

Question 8

What type of failure is dilated cardiomyopathy associated with?

Answer 8

Systolic failure - affects heart’s ability to pump

Question 9

What does HOCM stand for?

Answer 9

Hypertrophic Obstructive CardioMyopathy

Question 10

What type of failure does HOCM result in?

Answer 10

Diastolic failure

The hypertrophied muscle doesn’t allow for proper filling

Question 11

Why does the murmur of HOCM increase with Valsalva maneuver?

Answer 11

Because HOCM is obstructive, decreased volume of blood will make it easer for obstruction to occur. Valsalva decreases venous return to heart, thereby increasing systolic murmur of HOCM

Question 12

What is the most common cause of pulmonary HTN?

Answer 12

Cor pulmonale

Question 13

What is the concept behind high output failure?

Answer 13

The normal heart is unable to pump enough blood to meet the metabolic demands of tissues

Question 14

What is Class I heart failure?

Answer 14

Sx of HF with more than normal activity

Question 15

What is Class II heart failure?

Answer 15

Sx of HF with ordinary activity

Question 16

What is Class III heart failure? Class IIIa? Class IIIb?

Answer 16

Class III: Sx of HF with minimal activity

Class IIIa: no dyspnea at rest

Class IIIb: recent dyspnea at rest

Question 17

What is Class IV heart failure?

Answer 17

Sx of HF at rest

Question 18

What is Stage A heart failure?

Answer 18

At high risk for failure, but without structural disease

Question 19

What is Stage B heart failure?

Answer 19

Structural changes to heart without s/sx of failure

Question 20

What is Stage C heart failure?

Answer 20

Structural heart disease with prior or current s/sx of HF

Question 21

What is Stage D heart failure?

Answer 21

Refractory HF requiring significant intervention

Question 22

What is a good physical exam test for ascites?

Answer 22

Shifting dullness test

Question 23

What are three things that cause large upright R wave in V1 on an EKG?

Answer 23

RVH

Posterior MI

RBBB

Question 24

What are the EKG findings for cor pulmonale?

Answer 24

RVH (tall R wave in V1)

Peaked P wave in II

Question 25

What type of diuretic is indicated in CHF patients?

Answer 25

Loop diuretics

help improve sx, but don’t decrease mortality

Question 26

What classes of drug improve both sx and mortality in CHF pts?

Answer 26

ACE inhibitors and ARBs (Will decrease afterload and therefore increase ventricular function)

β-blockers

Aldosterone antagonists

Question 27

What effect does digoxin have on HF patients?

Answer 27

Increases contractility

Improves sx/decreases hospitalizations

No effect on mortality

May cause arrhythmia due to heart block

Question 28

What effect do β-blockers have on HF patients?

Answer 28

Improves sx

Prolongs life

Only used in stable pts

These would normally decrease contractility and CO, but have the opposite effect in HF pts

Question 29

Which three β-blockers have been shown to reduce mortality in HF pts?

Answer 29

Metoprolol

Carvedilol (α/β blocker)

Bisoprolol

Question 30

Mortality improvements with medication can only be achieved in pts with which type of HF?

Answer 30

Systolic failure

No medications for reducing mortality in R sided failure