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31 Cards in this Set

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What is the number one etiology for CHF?
CAD
Name and describe the 4 classifications of heart failure
• Class 1 - no symptoms with ordinary physical activity
• Class 2 - symptoms with ordinary activity; slight limitation of activity
• Class 3 - symptoms with less than ordinary activity; marked limitation of activity
• Class 4 - symptoms with any physical activity or even at rest
What four factors determine systolic function of the heart?
• contractile state of the myocardium
• preload of the ventricle
• afterload applied to the ventricles
• heart rate
What is the difference between "heart failure" and "congestive heart failure"?
• heart failure is when the heart is unable to pump sufficient blood to meet metabolic demands of the body at normal filling pressures
• CHF describes a syndrome with complex symptoms and signs that accompany heart failure (ie dyspnea, fatigue, rales, tachycardia, cardiomegaly, S3 gllop, edema)
What is most common hospital discharge diagnosis?
CHF
Which drugs are responsible for a 50% decrease in mortality of CHF?
ACE inhibitors and Beta-blockers
CHF usually occurs secondary to what two conditions?
• heart failure
• subsequent neurohormonal activation (sympathetic and renin-angiotensin-aldosterone system)
Describe how the heart compensates to heart failure
• heart compensates with dilatation and hypertrophy to maintain cardiac output
• then the body thinks that it's hemorrhaging because the heart is not receiving enough fluid
• the body tries to conserve volume by Na+ and water retention and vasoconstriction
Describe what happens to fluid levels in the body as a result of CHF
• there is increased intravascular circulatory congestion due to elevated LVEDP and pulmonary venous pressures
• movement of fluid out of intravascular space into interstitial (trasudation)
• can lead to pulmonary edema, peripheral edema, and hepatomegaly
True/False: In acute heart failure, there is no congestion
• There is no congestion in acute heart failure because there has been no Na+ and water retention
• The correct answer is: True
Describe the left ventricle dynamics in heart failure
• decreased stroke volume
• increased end diastolic volume
• decreased ejection fraction
• generally, the ventricle is more full, ejects less, and retains more volume
What are the effects of epinephrine and heart failure on inotropy?
• epi increases inotropy (shifts curve to the left)
• heart failure decreases inotropy (shifts curve to the right)
What are 3 etiologies for heart failure?
• work overload or mechanical abnormalities
• primary myocardial abnormailities
• abnormal rhythm or conduction
What are 5 factors that can cause work overload of mechanical abnormailities?
• valvular stenosis/regurgitation
• pericardial constriction/tamponade
• endocardial/myocardial restriction
• ventricular aneurysm
• ventricular dysynergy (right and left ventricle do not pump at the same time)
What are myocardial abnormalities of primary etiology?
• cardiomyopathy
• neuromuscular disorders
• myocarditis
• metabolic (diabetes, berberi, thyroid)
• toxicity (etoh, cobalt
• presbycardia - aging with myocardial cell loss
What are some abnormal cardiac rhythms that can cause heart failure?
• fibrillation
• extreme increased or decreased heart rate
• chronic tachycardia
• electrical asynchrony, conduction disturbance
Describe systolic dysfunction in heart failure
• normal LVEDP (early sign)
• poor ejection fraction
• S3 heart sound
• heart is able to relax but is unable to squeeze effectively
Describe diastolic dysfunction in heart failure
• normal ejection fraction
• elevated LVEDP
• S4 heart sound
• prolonged contraction and delayed relaxation
Older adults and elderly with heart failure usually have which extra heart sound
S3
How does the autonomic nervous system compensate in heart failure?
• increased sympathetic stimulation of the heart (increased heart rate and inotropy)
• arterial vasoconstriction and increased venous tone (allows blood to sit on the venous side of circulation)
• increased aldosterone levels
• adrenal medulla and arteries increases norepinephrine synthesis
What does excess norepinephrine do to the heart? How is this condition treated?
• excess NE causes the beta-receptors to become overstimulated » heart becomes less responsive to NE (essentially denervated)
• beta blockers in heart failure create a renewed responsiveness to NE, allowing NE's positive inotropic effects to be effective
True/False: Beta blockers are a good drug to use with patients in acute CHF exacerbation
• Beta blockers should be used in patients with compensated (or stable) CHF.
• Beta blockers in patients with acute CHF can make the worsen the patient's condition
• The correct answer is: False
Describe how the compensatory mechanism of the heart in failure initiates a perpetual cycle
less stroke volume evokes more vasoconstriction and fluid retention mechanisms » congestion and an even greater burden to ventricular emptying
Hypertrophy of what type of myocardial cells promote stiffness?
hypertrophy of the interstitial cells promote stiffness
What factors can cause increased peripheral vascular resistance?
• arteries become stiff secondary to Na+ and water retention
• vasoconstriction is a direct result of neurohormonal influences (NE, angiotensin II, AVP, endothelin
When taking the history, what complaints could a person with CHF have?
• exertional dyspnea
• easily fatigued
• orthopnea
• ankle edema
• increasing abdominal girth
• weight gain
What are some finding upon physical examination of a patient with CHF?
• low blood pressure
• tachycardia
• tachypnea
• JVD
• rales
• pedal edema
• hepatomegaly
When examining the heart, what are some abnormal findings in a patient with CHF?
• diffuse, displaced PMI
• palpable "filling wave" over PMI
• S3 gallop (maybe an S4)
• murmur of mitral and/or tricuspid regurgitation
• pulses alternans
What lab tests would you order for a CHF patient?
• CBC, sedimentation rate
• PT, PTT, Platelets
• electrolytes
• BUN/Creatinine
• Cardiac enzymes/lipid profile
• arterial blood gas
• urinalysis
• BNP (B-type natriuretic peptide)
What percentage of deaths from heart failure are sudden deaths?
50%
Why are chest xray and echo used to evaluate CHF?
• Chest xrays are used to evaluate for cardiomegaly, pleural effusion, and congestion
• Echocardiogram are used to evaluate wall motion and ejection fraction