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PAR2021 Cardiology > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What happens during systolic heart failure

A

LV weakened and muscle cant contract as well

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2
Q

What happens during Diastolic heart failure

A

LV muscle thickens and can’t relax normally

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3
Q

Define cardiac failure

A

Heart loses ability to pump properly

Myocardium cannot generate enough force to expel blood from ventricle

  • ejection fraction is low
  • low stroke vol
  • normal end diastolic vol
  • high end systolic vol
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4
Q

Define diastolic failure

A

Myocardium loses ability to relax and accept blood
Myocardium has decreased compliance so during diastole it is
unable to expand and fill with blood
• Ejection fraction is normal
• Low stroke volume
• Low end diastolic volume
• Normal/Low end systolic volume

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5
Q

What happens with right sided heart failure

A

Failure of the right ventricle to pump enough blood

  • Pitting oedema something to look for
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6
Q

What are the symptoms of right sided heart failure

A
  • fatigue
  • increased venous pressure
  • distended jugular veins
  • Ascites
  • Enlarged liver & spleen
  • Weight gain
  • Anorexia & GI distress
  • dependent oedema
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7
Q

What are the symptoms of left sided heart failure

A
  • Paroxysmal nocturnal dyspnea
  • Elevated pulmonary pressure
  • Pulmonary congestion
    • Couch, crackles, wheezes, blood-tinged sputum, tachypnea
  • Restlessness
  • Confusion
  • Tachycardia
  • External Dyspnea
  • Fatigue
  • Cyonosis (peripheral)
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8
Q

What happens with left sided heart failure

A

Failure of the left ventricle to adequately pump enough blood

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9
Q

What is Biventricular failure?

A

When failure occurs in both ventricles, left and right.

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10
Q

What is the difference between acute and chronics heart failure?

A

Acute is sudden onset, chronic is progressive worsening

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11
Q

What is Starlings Law?

A

Define this…

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12
Q

What are the causes of heart failure?

A 
Ischaemic heart disease
• STEMI
• NSTEMI
Hypertension
Valvular disease
Cardiomyopathy
Diabetes Mellitus
Causes
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13
Q

What is ischemic heart disease?

A
  • most common cause of heart failure

Caused by myocardial scarring and loss of contracting heart tissue post infarct
event.

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14
Q

What is arterial hypertension?

A

Elevated BP common cause of LV hypertrophy

May lead to LV diastolic and systolic dysfunction and heart failure

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15
Q

What happens during mitral valve stenosis?

A

Hardening and thickening of the valve vessel

Going to get reduce blood filling in ventricle. Leading to diastolic heart failure which leads to thickening of the myocardium.

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16
Q

What happens during mitral valve regurgitation

A

Loose valve which leads to backflow into atrium and into either pulmonary of venous system.

17
Q

What is cardiomyopathy

A
  • Series of multiple of issues

Characterised by enlargement of chambers

18
Q

What type of failure does cardiomyopathy lead to?

A

Systolic heart failure

19
Q

What are the pathological features of cardiomyopathy?

A
  • Dilated cardiomyopathy
    Characterised by enlargement of chambers

Stretching of myocytes and loss of contractility
->systolic HF

  • Hypertrophic cardiomypathy

Characterised by thickening of heart muscle
Wall of myocardium become thick and non-compliant

  • > First causes diastolic then systolic heart failure
  • Restrictive cardiomyopathy

Characterised by increasing stiffness of ventricular
wall

Wall of myocardium become non-complaint
->Diastolic HF

20
Q

What is the difference between hydrostatic pressure and osmotic pressure?

A

Hydrostatic - Pushes fluids across membranes due to blood pressure

Osmotic pressure - Pulls fluid across membranes to balance concentration

21
Q

What happens during acute pulmonary oedema?

A
  • Heart failure causes a decrease in LV function
  • Activation of compensatory mechanisms
  • Increase in left ventricular end diastolic pressure
  • Transmission of pressures back through LA into pulmonary arteries
  • Increased capillary hydrostatic pressure
  • Leakage of serous fluid into alveoli
  • Build up of fluid in alveoli
  • Loss of surface area for gas exchange causes decrease in –SpO2 and increase in PCO2
  • Loss of surfactant causes collapse of alveoli and increase in work of breathing
22
Q

What are the symptoms of Acute Pulmonary Oedema

A 
Short of breath – remember postioning
Anxious
High work of breathing
Decreased speech
Hypertensive often 150+/90+
Decreased SpO2
Tachycardia
\+/- Cough
Pink frothy sputum - fulminating APO
23
Q

What is a differential between APO and asthma/CPOD?

A

High Blood pressure

24
Q

When auscultating for APO what are you listening for?

A

-> Listen to front and back. 8 places in each

-Fine inspiratory crackles
Bilateral

-Starts at bases and move up
chest with progression

-Be systematic - compare left to right

25
Q

How do you treat APO?

A
  • O2 - 10+L via non re-breather
  • GTN - decreased preload and afterload (reduce arterial pressure and systemic venous return)
  • R+R
  • CPAP
  • Diuretics (ICP level) - decreases blood volume
26
Q

What are the contraindications for CPAP?

A 
GCS < 13
Facial trauma
Pneumothorax
Active vomiting
Life threatening arrhythmias
The need for a secure airway
Hypoventilation
27
Q

What are the indications for the removal of CPAP?

A 
Cardiac/respiratory arrest
• Mask intolerance/patient agitation
• Nil improvement after 1 hour of treatment
• HR < 50 or SBP < 90mmHg
• Loss of consciousness or GCS < 13
• Decreasing SpO2
• Loss of airway control
• Copious secretions
• Active vomiting
28
Q

What are some common issues associated with CPAP?

A

Claustrophobic
Noisy
Uncomfortable
Patient feel like they are suffocating

29
Q

What is cardiogenic shock?

A

Persistant hypotension and tissue hypoperfusion caused by cardiac dysfunction in the
presence of adequate intravascular volume and left ventricular filling pressure.

30
Q

What are the causes of cardiogenic shock?

A 
AMI
Cardiomyopathy
Sepsis
Myocarditis
Dysrhythmias – decreased diastolic filling
Metabolic abnormalities
Papillary muscle rupture
Aortic or mitral valve insufficiency
31
Q

What is the ejection fraction?

A

The percentage of blood in a ventricle ejected with each contraction

32
Q

What is the normal percentage of ejection fraction?

A

55-75%

<40% - Low
<25% - constantly symptomatic

PAR2021 Cardiology (12 decks)

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