Pales - CHF and Pulmonary Heart Disease Flashcards
What is the definition of CHF?
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
What does systolic failure result from?
Inadequate cardiac output
What does diastolic failure result from?
Inability of ventricles to relax and fill normally during diastole
What is forward failure?
Decrease in perfusion of tissues downstream of heart
What is backwards failure?
Backing up of blood into upstream organs
increases hydrostatic pressure and can lead to congestion/edema
What are the three main causes of dilated cardiomyopathy?
HTN
Valvular heart disease
CAD/MI
What are some causes of toxic myocarditis?
Chemotherapy
Heavy metals
Lithium
Antimalarials
Radiation causing inflammation and fibrosis
What type of failure is dilated cardiomyopathy associated with?
Systolic failure - affects heart’s ability to pump
What does HOCM stand for?
Hypertrophic Obstructive CardioMyopathy
What type of failure does HOCM result in?
Diastolic failure
The hypertrophied muscle doesn’t allow for proper filling
Why does the murmur of HOCM increase with Valsalva maneuver?
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
What is the most common cause of pulmonary HTN?
Cor pulmonale
What is the concept behind high output failure?
The normal heart is unable to pump enough blood to meet the metabolic demands of tissues
What is Class I heart failure?
Sx of HF with more than normal activity
What is Class II heart failure?
Sx of HF with ordinary activity
What is Class III heart failure? Class IIIa? Class IIIb?
Class III: Sx of HF with minimal activity
Class IIIa: no dyspnea at rest
Class IIIb: recent dyspnea at rest
What is Class IV heart failure?
Sx of HF at rest
What is Stage A heart failure?
At high risk for failure, but without structural disease
What is Stage B heart failure?
Structural changes to heart without s/sx of failure
What is Stage C heart failure?
Structural heart disease with prior or current s/sx of HF
What is Stage D heart failure?
Refractory HF requiring significant intervention
What is a good physical exam test for ascites?
Shifting dullness test
What are three things that cause large upright R wave in V1 on an EKG?
RVH
Posterior MI
RBBB
What are the EKG findings for cor pulmonale?
RVH (tall R wave in V1)
Peaked P wave in II
What type of diuretic is indicated in CHF patients?
Loop diuretics
help improve sx, but don’t decrease mortality
What classes of drug improve both sx and mortality in CHF pts?
ACE inhibitors and ARBs (Will decrease afterload and therefore increase ventricular function)
β-blockers
Aldosterone antagonists
What effect does digoxin have on HF patients?
Increases contractility
Improves sx/decreases hospitalizations
No effect on mortality
May cause arrhythmia due to heart block
What effect do β-blockers have on HF patients?
Improves sx
Prolongs life
Only used in stable pts
These would normally decrease contractility and CO, but have the opposite effect in HF pts
Which three β-blockers have been shown to reduce mortality in HF pts?
Metoprolol
Carvedilol (α/β blocker)
Bisoprolol
Mortality improvements with medication can only be achieved in pts with which type of HF?
Systolic failure
No medications for reducing mortality in R sided failure
