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278 Cards in this Set
- Front
- Back
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Heart failure means the heart cannot provide adequate cardiac output to satisfy the metabolic needs of...
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the body.
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Why is congestive heart failure (CHF) termed "congestive"?
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It is termed "congestive" because there is fluid overload from increased venous pressure.
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True or False. With CHF, there is pulmonary congestion (edema) in right heart failure and peripheral edema in left heart failure.
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False. With CHF, there is pulmonary congestion (edema) in LEFT heart failure and peripheral edema in RIGHT heart failure.
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True or False. CHF is not one of the MOST COMMON problems in clinical medicine.
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False. It is, man.
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What does sequelae mean?
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consequences.
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True or False. You will encounter many patients who suffer the sequelae (consequences) of heart failure.
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Duh.
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What is cardiac output? What is the formula? What are the units?
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The volume of blood ejected by the heart per minute.
CO = SV x HR CO is mL/min SV is mL/beat HR is beat/min |
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What is the normal cardiac output range?
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It is normally 4 to 8 liters. The heart can adjust as needed.
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True or False. The heart can go from 1L/min at rest to 50 L/min during strenuous activity.
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False. It can go from 5L/min at rest to 20 L/min during strenuous activity.
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Stroke volume is...
What is a normal value? |
the volume of blood ejected with each contraction.
SV = EDV - ESV Normal: 70 mL |
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EDV = end diastolic volume. What does that mean?
ESV = end systolic volume. What does that mean? |
EDV refers to the point where the left ventricle is filled, just before the heart contracts (max. volume)
ESV is the residual blood that the left ventricle didn't pump (min volume). |
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What three factors determine stroke volume?
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Preload
Afterload Contractility PAC |
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What is Preload? What two things account for Preload?
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Ventricular wall tension at the end of diastole.
Both pressure and volume account for preload. |
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What is Afterload? What does it depend on (four things)?
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The resistance that the ventricle works against to eject blood during systole.
Depends on: Arterial blood pressure Valves Ventricular radius Ventricular thickness |
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What is another term for contractility? What is contractility?
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Inotropic State
The heart muscle's ability to eject larger amounts of blood. |
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There are two different categories for failure, what are they? Which is more COMMON?
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Low-output failure and high-output failure
Low-output failure is more common |
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True or False. The heart has more time to compensate if the volume demands are increased slowly.
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True.
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What is low-output failure?
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When the heart fails to meet normal metabolic demands.
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Scarred myocardium from an old MI will have poor contractility, thus affecting _______ _______, thus affecting ________ ________.
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stroke volume; cardiac output
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Aortic stenosis creates a higher afterload (resistance), thus affecting ______ _______.
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cardiac output.
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A cardiomyopathy such as hypertrophic cardiomyopathy affects ________ ________.
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diastolic function
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What is High-output failure?
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When the circulatory system cannot meet a higher demand for oxygen.
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Disease states can cause the heart to pump abnormally large volumes of blood. What are some of those?
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Left to right shunts
Anemia (severe) Systemic arteriovenous fistulas Hyperthyroidism LASH |
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Usually if the heart is normal, it can accommodate an increase is load, but when a compromised diseased heart is asked to increase its workload...what occurs?
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High-output failure
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True or False. High output and low output failure have patently different symptoms.
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False. Signs and symptoms are similar to low-output failure.
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List the three compensatory mechanisms.
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Frank-Starling Mechanism
Ventricular Hypertrophy Neurohormonal activation |
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What does heart failure cause to initiate the Frank Starling mechanism?
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A decreased stroke volume. Some of the blood that the left ventricle was too weak to eject and remains in the ventricle.
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As a result of left over blood in the ventricle, what happens to ventricular output under the Frank-Starling Mechanism?
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Ventricular output increases in relation to preload (the stretch on the myocardial fibers prior to contraction).
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Regarding the Franks-Starling Mechanism, what does the increase in preload cause?
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It makes the myocardial fibers stretch more to contract more forcefully, and thus the next stroke volume is bigger.
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True or False. Regarding the Frank-Starling Mechanism, The muscle fibers never become overstreched beyond their maximum.
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False. The muscle fibers can eventually become overstreched beyond their maximum.
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Does the Frank-Starling Mechanism eventually fail? Or does it reverse?
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Eventually fails, despite large increases in end-diastolic volume.
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Regarding the Frank-Starling Mechanism, large volumes can transmit pressure backwards. What does this cause?
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Pulmonary congestion and edema.
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True or False. With the Ventricular Hypertrophy Mechanism, the heart wants to slow down and perform less work.
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False. The heart wants to work harder.
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True or False. Regarding the Ventricular Hypertrophy Mechanism, as the heart works harder, each muscle fiber gets bigger. It is better able to maintain contractile force.
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True.
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True or False. Regarding the Ventricular Hypertrophy Mechanism, the enlarging ventricle is thinner and doesn't fill as well.
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False. Regarding the Ventricular Hypertrophy Mechanism, the enlarging ventricle is THICKER and doesn't fill as well.
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True or False. Regarding the Ventricular Hypertrophy Mechanism, the chamber gets larger and therefore heart failure is reversed.
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False. Regarding the Ventricular Hypertrophy Mechanism, the chamber gets SMALLER and therefore heart failure is ensues.
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Regarding the Neurohormonal activation mechanism, list three associated sub-mechanisms.
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Adrenergic nervous system
Renin-angiotensin-aldosterone system Antidiuretic hormone |
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What system is the Adrenergic nervous system part of?
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The sympathetic nervous system (think adrenalin).
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What activates the Adrenergic nervous system to make changes to cardiac output?
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It senses the fall in cardiac output.
It then makes the heart beat faster and work harder (increase in heart rate and increase in ventricular contractility). |
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What does the Adrenergic nervous system do to the veins and arteries? Why?
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It also constricts the veins and arteries to increase peripheral resistance.
Maintains blood pressure so that the vital organs still get perfused. More BLOOD return to the heart INCREASES preload RAISES stroke volume through the Frank-Starling mechanism. |
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The renin-angiotensin-aldosterone system is another facet of the Neurohormonal activation mechanism. What senses the change in cardiac output in this system?
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The kidneys sense the decreased cardiac output (because they are getting less blood).
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Give a brief explanation of what happens when the kidneys sense a changed in cardiac output.
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1) Aldosterone is produced
2) Aldosterone promotes sodium reabsorption back into the circulation. 3) This promotes water reabsorption which increases intravascular volume, again compensating through the Frank-Starling mechanism. Aldosterone ---> Sodium Reabsorption ---> Water Reabsorption ---> Increases Intravascular Volume |
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Antidiuretic hormone is another facet of the Neurohormonal activation mechanism. What secretes it? What does it promote?
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The posterior pituitary
Promotes water retention....increasing the intravascular volume. |
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True or False. Regarding CHF, many patients are symptomatic for years.
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False. Regarding CHF, many patients are ASYMPTOMATIC for years.
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True or False. A patient with CHF almost always has strong, severe symptoms.
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False. With CHF heart failure can be mild, or because compensatory mechanisms are adequate.
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What are some precipitating factors that make the heart work harder and tip the balance towards CHF?
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Hypertension
Arrhythmias Renal Failure Fever Anemia Thyrotoxicosis and pregnancy Infection Endocarditis HAR FATIE |
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How do compensatory mechanisms initially help preserve cardiac output and blood pressure?
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By increasing preload and increasing peripheral resistance.
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What is a downside to increasing preload?
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Pulmonary congestion
Edema |
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What is a downside to excessive arteriolar vasoconstriction?
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It raises the afterload against which the left ventricle contracts.
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True or False. The left side typically is the first to fail, followed by the right side.
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True.
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What is typically the cause of right-sided failure?
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Left-sided failure.
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What is the greatest danger with compensatory mechanisms? Why is this bad news bears?
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Pulmonary congestion and edema. The patient is essentially suffocating.
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What causes suffocation with pulmonary congestion and edema?
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There is accumulation of fluid in the alveolar spaces and there is decreased oxygenation.
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Why are patients with chronic pulmonary vascular congestion and infection at risk for pulmonary infections?
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There is a metabolic stress on the body, and the heart has to work harder.
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What specifically places stress on the heart with infection? (Three things)
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Fever
Tachycardia Hypoxemia (deficiency of oxygen) |
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If a patient has anemia (decreased amount of oxygen-carrying red blood cells), then the only way to compensate for the decreased oxygen is...
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the increase cardiac output, meaning the heart is asked to work harder.
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Why are thyrotoxicosis and pregnancy precipitating factors for CHF?
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These are hypermetabolic states that require an increased cardiac output.
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Why is Infective endocarditis a precipitating factors for CHF?
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The valvular damage, fever, and myocarditis, may precipitate heart failure.
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Why are arrhthmias a precipitating factors for CHF?
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Various arrhthmias can cause troubles:
tachyarrhythmia does not allow for proper filling time (diastolic failure). bradycardia may reduce cardiac output. |
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What does Left heart failure primarily produce?
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Pulmonary effects
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With left heart failure, what happens to the left ventrical?
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It becomes hypertrophied and enlarged due to increased work load and end-diastolic volume.
It is damaged and doesn't function as well |
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True or False. Light damage to the left ventricle causes blood to leave the heart.
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False. It causes blood to pool in the ventricle and atrium.
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When blood pools in the left ventricle and atrium, explain the process that occurs next.
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It backs up into the pulmonary veins and capillaries leading to elevated pulmonary pressure.
Water and sodium are pushed into alveolar spaces resulting in pulmonary edema. |
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There are numerous signs and symptoms for someone in heart failure. What are some? List 5.
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Paroxysmal nocturnal dyspnea (dyspnea during sleep)
Orthopnea (dyspnea while lying down) Dyspnea Dry cough Weakness Increased urination at night Fatigue PODD WIF |
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What does Right heart failure primarily produce?
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Systemic effects
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With right heart failure, what happens when the right side fails?
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Blood pools in the right ventricle and atrium.
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With right heart failure, what happens when blood pools in the right ventricle and atrium, explain the process that occurs next.
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Congestion in the vena cava --> Congestion of the liver and spleen --> Hepatosplenomegaly --> Peripheral edema
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List three treatments of CHF.
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Diuretics
Inotropic Drugs - Digoxin, makes heart contract harder Vasodilators - Fills the heart Oxygen by nose Reduce fluid with salt restriction Reduce risk factors that cause CHF Heart transplant DIV |
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What are used when there is evidence of pulmonary congestion or peripheral edema.
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Diuretics - Lasix. Pushes fluid out.
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Under normal conditions, there is compensation of increased intravscular volume by salt and fluid retention. What does this help with?
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Helps increase the preload of the heart and increase contractility.
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What are Inotropic drugs used for?
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To increase the force of ventricular contraction (whip the heart to work harder).
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Why is it important to increase the force of ventricular contraction with inotropic drugs?
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Improves cardiac output.
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What is an example of an inotropic drug used to improve cardiac output?
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Digitalis or Digoxin
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What are vasodilators used for?
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Relaxes the blood vessels and decreases the work of the heart.
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True or False. Myocarditis is inflammation of the myocardium.
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True.
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What can myocarditis be caused by? Most common?
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Bacteria
Fungi Viruses (Most Common) Autoimmune disease Chemotherapy BF VAC (Best Friend Vacuum) Other: Parasites Toxins and Drugs Radiation Amyloid Malignant Mets Mechanical Trauma Lupus |
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Symptoms of Myocarditis are?
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Fever
Fatigue Palpitations Pericardial discomfort |
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True or False. Myocarditis is difficult to firmly diagnose but there are specific changes on EKG to guide the clinician.
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False. Myocarditis is difficult to firmly diagnose and often there are NONSPECIFIC changes on EKG to guide the clinician.
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True or False. Studies show that exercise should be continued in viral myocarditis because the EKG usually returns to normal.
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False. Studies show that exercise should be AVOIDED in viral myocarditis until the EKG has returned to normal.
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True or False. Regarding myocarditis, therapy is often supportive and most patients recover completely.
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True.
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What is Acute pericarditis?
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Inflammation of the surfaces of the pericardial sac which also includes the epicardium of the heart, which is considered to be the visceral pericardium.
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True or False. The same causes that exist for myocarditis also cause pericarditis.
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True.
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What are some symptoms of pericarditis? List 2.
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Positional chest pain
EKG abnormalities. |
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Explain the chest pain with pericarditis. What word describes it?
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The chest pain is "pleuritic" meaning it is worsened with deep inspiration, movement, or lying down, and it is usually relieved by sitting up, leaning forward and taking shallow breaths.
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What is the most important physical sign with pericarditis? What is another physical sign?
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A pericardial “friction rub” Sounds like sandpaper.
Pericardial Rayles - Sounds like bubbles in the lungs. |
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After pericardial injury there is a repair process that may be eventually harmful to the heart. Why?
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Scar tissue develops around the layers of the pericardium it becomes fibrous and thickened, and "constrictive".
It is difficult for diastolic filling of the normally distendible chambers. |
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True or False. Constrictive pericarditis is an acute process.
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False. It is a chronic process
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True or False. Constrictive pericarditis can be the end result of and acute pericarditis or irradiation.
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True.
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In a great majority of cases of constrictive pericarditis, a specific etiology is genetic.
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False. In a great majority of cases of constrictive pericarditis, a specific etiology is NOT DETERMINED.
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Symptoms of constrictive pericarditis are...
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CHF
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What is an effective treatment for constrictive pericarditis?
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Pericardial stripping (removal)
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Approximately ____ million people in the United Sates have high enough blood pressure to be considered unhealthy, and at risk for premature death.
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60
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True or False. Hypertension is often symptomatic.
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False. Asymptomatic.
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True or False. The first sign of hypertension may be a sudden myocardial event.
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True.
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True or False. Hypertension treatment can be a modification of dietary habits as well as medical.
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True.
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What are the cutoff levels for high blood pressure?
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Systolic >140 mm Hg
Diastolic > 90 mm Hg |
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True or False. A clinician must have a systolic AND diastolic pressure to predict hypertension complications.
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False. Systolic OR diastolic pressure alone may be used to predict hypertension complications.
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True or False. Multiple blood pressure readings at separate times is required.
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True.
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About ___% of people with hypertension do not have a known cause for their elevation of blood pressure.
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95%
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What is another name for primary hypertension?
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Essential hypertension.
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If there is an identifiable cause to the hypertension it is considered to be named...
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Secondary hypertension
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Secondary hypertension is far less common, accounting for only ___% of patients with high blood pressure.
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5%
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Is primary or secondary hypertension more amenable to treat?
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Secondary
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True or False. In most people, blood pressure decreases with age.
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False. In most people, blood pressure INCREASES with age.
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At what systolic and diastolic levels is malignant hypertension?
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greater than 200 systolic, 140 diastolic
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True or False. Malignant hypertension can cause severe life-threatening organ and brain damage.
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True.
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What is the formula for calculating blood pressure? What is the expanded formula?
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BP = CO x TPR
Expanded: BP = SV x HR x TPR SV = Stroke Volume HR = Heart Rate CO = cardiac output TPR = total peripheral resistance |
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What provides the pumping pressure of blood pressure? The systemic resistance? The regulation of intravascular volume?
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Heart
Blood vessels Kidneys |
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In general, how do the kidneys return high blood pressure to normal?
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They cause excretion of sodium and water thereby reducing the intravascular volume.
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True or False. The majority of people with primary hypertension have extremely elevated blood pressure.
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False. The majority of people with primary hypertension have mildly elevated blood pressure.
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What range is the diastolic pressure of patients with primary hypertension?
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90-104 mm Hg
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True or False. Primary hypertension tends to run in families.
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True.
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True or False. Whites are more likely to have hypertension than blacks.
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False. BLACKS are more likely to have hypertension than WHITES.
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Primary hypertension usually occurs after what stage in life? Does it increase or decrease with age?
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Young adulthood. Increases in prevalence with age.
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How many Americans have a diastolic pressure greater than 90 mm Hg by age 55.
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30%
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What shape does the heart develop due to the high cardiac output associated with primary hypertension?
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Concentric ventricular hypertrophy.
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True or False. After concentric ventricular hypertrophy the enlarged left ventricle becomes floppy and promotes diastolic filling.
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False. After concentric ventricular hypertrophy the enlarged left ventricle becomes STIFF and COMPROMISES diastolic filling.
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After the enlarged left ventricle becomes stiff and compromises diastolic filling what happens to cardiac output?
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CO decreases.
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True or False. Regarding concentric ventricular hypertrophy, the blood vessels eventually develop medial hypertrophy of the vessel wall to combat the high pressure of the cardiac output.
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True.
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How do blood vessels combat the high pressure of the CO? What is the end result with older hypertensive patients?
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They reduce their lumen diameter.
Older hypertensive patients develop a high blood pressure that has normal CO but an elevated TPR. (pumps same amount of blood, but through narrower vessels). |
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What is secondary hypertension caused by?
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Renal artery stenosis is a common cause.
It is also caused by a renal, mechanical or endocrine abnormality. REM |
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Is secondary hypertension curable?
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It may be curable, thus avoiding the long-term damaging effects of hypertension.
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What should one suspect if a patient suddenly develops hypertension below age 20 or above age 50.
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Secondary hypertension.
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True or False. The blood pressure in secondary hypertension is more often mild. In contrast the elevation of primary hypertension is severe.
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False. The blood pressure in secondary hypertension is more often SEVERE. In contrast the elevation of primary hypertension is MILD.
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If primary hypertension runs in families, does secondary?
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NEIN!
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Regarding hypertension, if the coronary arteries are compromised by significant atherosclerosis, this may place the left ventricle at risk for what?
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Ischemia.
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How does the left ventricle adapt from increased load?
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Concentric hypertrophy
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True or False. After concentric hypertrophy occurs there is an accompanying enlargement of the chamber and the filling of the left ventricle becomes increased.
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False. After concentric hypertrophy occurs there is NO accompanying enlargement of the chamber, thus the filling of the left ventricle becomes REDUCED.
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If the etiology of hypertension is from increased circulating volume, like from an endocrine abnormality that causes increasing intravascular volume, patients may instead develop what?
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Eccentric hypertrophy with chamber dilatation.
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Left ventricular hypertrophy is a strong predictor of what?
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Morbidity
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The degree of hypertrophy correlates well with the development of what three pathologies?
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Congestive heart failure
Myocardial infarction Sudden cardiac death |
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Regarding hypertrophy, eventual myocardial infarction is due to? (List 2)
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Increased coronary atherosclerosis
Increased size and workload of the LV (LV size requires more oxygen due to more muscle mass) |
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60% of people who die of transmural myocardial infarctions have a history of...
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hypertension
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Regarding treatment for hypertension, what offers an immediate route for effective control of blood pressure?
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Drugs
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Instead of drug treatment for hypertension, what should be addressed and modified?
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Lifestyle and dietary habits
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True or False. Obesity has been strongly associated with HTN, especially when the distribution is in the lower peripheral extremities.
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False. Obesity has been strongly associated with HTN, especially when the distribution is in the ABDOMINAL AREA.
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True or False. Blood pressure often reduces following weight loss.
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True.
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True or False. Sleeping is even more effective in reducing blood pressure, more so than weight loss.
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False. EXERCISE is even more effective in reducing blood pressure, more so than weight loss.
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What is the best type of exercise for lowering blood pressure?
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Regular and aerobic.
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True or False. Excessive sodium intake is handled by the kidneys in normotensive people.
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True.
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True or False. In about half of the people with primary hypertension, blood pressure is affected by salt intake.
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True.
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True or False. Smoking is a significant contributor to hypertension
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False. Smoking increases cardiovascular risk by increasing atherogenic potential, but overall, does not significantly contribute to hypertension.
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So salt restriction and exercise are correlated with lower blood pressure. What else is?
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Restriction of saturated fats
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To recap, list 4 non-pharmacologic treatments of high blood pressure.
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Salt restriction
Aerobic Exercise Saturated fat restriction Lose Weight |
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What are 5 pharmacologic treatments of hypertension?
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Beta blockers - End in 'lol
Sympatholytics Angiotensin Converting Enzyme (ACE) inhibitors Vasodilators Diuretics - Lasix B - SAVD |
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What does the term Sympatholytic mean?
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"cutting off" of the sympathetic nervous system
lytic = cleave |
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What do Diuretics (water pills) do for hypertension?
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Reduce intravascular volume, thereby reducing cardiac output and arterial pressure.
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Which patients do diuretics work well in?
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Patients with mild to moderate hypertension
and normal renal function. |
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What is an example diuretic? What do they promote?
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Thiazide diuretics or Lasix. They promote excretion of sodium and chloride.
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What exactly are Sympatholytic agents?
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Sympathetic nervous system antagonists
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What is a sympathetic nervous system antagonist?
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It act against the sympathetic nervous system, promoting the opposite effects.
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So if sympatholytic agents act against the sympathetic nervous system, what does this cause?
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A reduction of: Heart rate, Contractility, Vasoconstriction
(they act against the fight-or-flight type response) |
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What do Vasodilators do for hypertension?
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Directly relax vascular smooth muscle in vessels.
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What are some vasodilators?
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Hydralazine
Minoxidil (Rogaine) |
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How do angiotensin converting enzyme inhibitors (ACE inhibitors) help with hypertension?
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They block the conversion of angiotensin I to angiotensin II.
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What is the conversion of angiotensin I to II for?
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It is part of the kidney’s hormonal regulation of intravascular volume.
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How does the renin-angiotensin-aldosterone pathway increase intravascular volume?
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By reabsorbing sodium.
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What happens when the renin-angiotensin-aldosterone pathway is blocked with ACE inhibitors?
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Sodium is excreted and so is water.
"Water follows salt" |
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True or False. Patients are typically on ACE inhibitors for a long time.
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True.
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True or False. One can tailor an ACE inhibitor regimen for each individual patient.
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True.
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Aside from drugs and exercise, what is another major treatment of hypertension?
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Surgery and transplantation.
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What is the MOST COMMON cardiac operation performed for hypertension? What percentage of all cardiac surgeries does this account for?
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Coronary artery bypass graft surgery (CABG)
80% of all cardiac surgery |
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What exactly is CABG surgery? What is used to create the bypass?
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Vein (or artery) used as a conduit to by-pass an obstruction in a coronary artery.
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What are some reasons for CABG?
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Congestive Heart Failure
Myocardial infarction Angina Unstable angina Ischemia C MAUI |
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Recent changes to the CABG patient profile include which high risk type of patients?
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Older and sicker patients
"Re-do" patients |
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What are higher risk patients subject to associated with the CABG operation?
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Higher morbidity and mortality
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True or False. The majority of CABG patients experience a significant reduction in quality of life after surgery.
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False. Quality of life is improved in the great majority of patients.
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Complete angina relief is achieved in almost ____% of the patients, while ____% improve, and ____% are unchanged.
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80; 10; 10
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True or False. Even with relief of angina, patients are not able to perform more physical activities.
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False. With relief of angina, patients ARE able to perform more physical activities.
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What is a common reason for reoperation with CABG surgery patients?
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Vein graft closure.
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What is the cause of early stage graft closure? The cause of late closure?
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A surgical problem at the DISTAL anastomosis
Vein graft atherosclerosis is the most common cause of late graft closure. |
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Which artery is better for long-term patency and survival compared to the saphenous vein?
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Internal mammary artery
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How many mammary arteries are standard to use for the most important bypasses?
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One or both
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What types of patients is valvular heart surgery reserved for?
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Symptomatic patients.
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True or False. Some valvular diseases are tolerated for many years without significant progression.
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True.
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Are there are certain valvular diseases that would be markedly improved with surgery? What are they?
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Aortic stenosis
Acute insufficiency of the aortic or mitral valve. |
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What are some indications for valvular heart surgery? List 5.
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Threatened survival
Valvular infection Fatigue Angina (from congestive heart failure) Dyspnea TV FAD |
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Three types of valvular procedures can be performed depending on the abnormality of the valve and patient's history? What are they?
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Reconstruction
Valve replacement Balloon valvuloplasty (enlarge the hole). |
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There are two major types of artificial valves, what are they?
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Mechanical valves and tissue valves
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Some examples of mechanical valves are...
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Starr-Edwards (ball-cage) and St. Jude (tilting disc)
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The newer valves tend to be of what design?
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Tilting disc design.
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Many types of tissue valves are available, What are they?
|
Heterografts - Nonhuman
Homografts - Human tissue Autografts - Same patient’s tissue |
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The most widely used tissue valve is...
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The porcine heterograft valve
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What are the major criteria for deciding which valves to use?
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Durability and anticoagulation
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How long does a porcine heterograft last? When is it used?
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10 - 15 years. When this time exceeds the expected life expectancy of the patient, it is usually used.
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So why is a porcine a good choice in general?
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Non-antigenic and longterm anticoagulation is not needed. No evidence of rejection is seen.
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What choice should be considered if a patient's life expectancy exceeds that of a porcine valve?
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Mechanical or tissue valves may be the option.
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What is a downside to mechanical and tissue valves?
|
Mechanical valves require long-term anticoagulation (imparts a high risk of stroke).
Tissue valves degenerate after 10-15 years. |
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Complications arising from prosthetic valves include...
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Thromboembolism
Infective endocarditis Partial dehiscence (comes loose at the seam) Hemolysis can also occur due to high blood shear Obstruction to forward flow (design related). Structural deterioration |
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True or False. Regarding congenital heart surgery. There is a high operative mortality, so surgical intervention is not favored.
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False. Regarding congenital heart surgery. There is a LOW operative mortality, so surgical intervention IS favored. Even if the patient is only mildly symptomatic.
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True or False. Small ventricular septal defects and patent ductus arteriosus usually follow a benign course, and often times, these patients are not operated on, even though the operation may hold little risk.
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True.
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Regarding coarctation of the aorta, how can it be managed without surgery?
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It can be managed with anti hypertensive therapy alone.
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True or False. Due to the increased rate of mortality cardiac transplant is decreasing in frequency.
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False. Cardiac transplantation is increasing in frequency.
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Why has the rate of rejection gone down with cardiac transplant? What is another present risk?
|
Better immunosuppressive drugs have allowed better tolerance of the donor heart but increased risk of infectious complications.
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What is one of the more significant complications of rejection?
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Coronary vasculopathy
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What is coronary vasculopathy? What causes it?
|
The small blood vessels in the transplanted heart close up from fibrosis and inflammation
Caused by host immune response |
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Why not perform a CABG with coronary vasculopathy?
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The small vessels, rather than the large coronaries, are affected, CABG is of no use, thus re-transplantation is the only life-prolonging option.
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True or False. Both IHD and myopathies affect the myocardium.
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True.
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The MOST COMMON cause of infectious myocarditis is...
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Virus.
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What is a virus that tends to affect the heart more than others?
|
Coxackie virus (Mouth Hand and Foot disease)
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What is the diagnostic test for viral infection of the myocarium?
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Lymphocyte test.
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The MOST COMMON bacterial infection of the heart is...
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Pneumonia.
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Another common bacterial infection of the heart is...
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bacterial TB.
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What is a parasite associated with myocardial infection? What does it cause?
|
Mexico Kissing Bug; Shagas disease
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What the MOST COMMON type of pericarditis?
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Fibrinous or bread and butter pericarditis.
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What is the MOST COMMON type of effusion?
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Serous fluid effusion. Usually chronic.
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True or False. Pericarditis and effusion often go together.
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True.
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True or False. Common associations with pericarditis are viral infections like flu, cold, mono.
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True.
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What other things cause pericarditis?
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Trauma
Pain from Ischemia Renal Failure |
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Why does renal failure cause pericarditis?
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Uremia is toxic
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True or False. Acute effusion is more dangerous than chronic effusion.
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True.
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True or False. Effusion can have malignant cells.
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True.
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What are the six main heart diseases we discussed so far? When is the end result?
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IHD
Valvular Cardiomyopathy CHD Myocardium/Pericardium Hypertension End result is CHF. |
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True or False. Regarding CHF, failure is always congestive because if you fail forward, you back up behind.
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True.
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What is the formula or ejection fraction? What is the normal range? What is failure?
|
EF % = SV/EDV
Normal: 50-70% World Class Athletes: 80% Failure: < 50% |
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What ejection fraction is life threatening? When is death imminent?
|
Below 25%; Below 10%
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How do you increase cardiac output?
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By increasing HR or SV.
CO = SV * HR |
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How do you increase stroke volume?
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Increase EDV or Decrease ESV.
SV = EDV - ESV |
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So four things affect cardiac output? What are they?
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HR
SV EDV ESV |
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What is another name for EDV? ESV?
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EDV = Preload
ESV = Afterload |
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What part of the body suffers from underperfusion in left CHF?
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Peripheral organs and extemities.
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What happens when your extremities don't have the proper blood flow?
|
You can't walk
You get cold You lost hair |
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What is the MOST SIGNIFICANT symptom of left CHF?
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Back up of blood to lungs: congestion and pulmonary edema.
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How does Rayles appear on an X-Ray?
|
All white...wiped out.
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One measure of how severe a breathing problem is has to do with pillows. Explain. What is this called?
|
The number of pillows you need to sleep sitting up, the worse is your heart failure.
Paroxismal Dyspnea - Dyspnea at rest |
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True or False. Right heart failure isn't necessarily heart disease but failure of the lungs.
|
True.
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|
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What is a major complication of right heart CHF?
|
Backup of blood through SVC and IVC. Systemic edema.
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What is edema in the legs called?
|
Pedal edema
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True or False. The higher the fluid moves up the body, the more severe the right heart CHF.
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True.
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What is it called when the skin can be pushed in and it stays there?
|
Pitting
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What is swelling up to the neck called? What does this look like in the neck?
|
Anasarca; Distended jugular veins.
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There are rare cases when a patient only has right CHF. What is this called?
|
Cor Pulmonale
|
|
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What are some causes of Cor Pulmonale?
|
Pulmonary embolism
Emphysema (smoking) Chronic asthma PEC |
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Can ejection fraction exceed 100%?
|
NEIN!
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True or False. Afterload is good, Preload is bad.
|
False. Preload is good, Afterload is bad.
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What are the major end results of any type of heart failure. List three things in order of occurrence.
|
1) Cardiomegaly
2) Dilatation 3) Hypertrophy |
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What level of the body do you need to measure blood pressure? What is normal BP?
|
At the level of the heart. The brachial artery.
120/80 |
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What is abnormally low blood pressure called? What about a deathly condition with low blood pressure?
|
Hypotension; shock.
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|
|
Why is hypotension lethal?
|
Your brain needs oxygen. Without pressure to get it there, you die.
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True or False. Hypotension is always symptomatic.
|
True. It's an emergency room issue.
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|
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What is abnormally high blood pressure called?
|
Hypertension.
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For funzies...how does the body respond with hypovolemic shock? What happens to the peripherals?
|
By increasing HR and constricting blood vessels. Peripherals become blue and pale.
|
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|
What bacterial infection affects the peripheral system?
|
Sepsis
|
|
|
What happens to the vessels with sepsis?
|
They become broken and leak out.
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|
How does the body respond to sepsis in terms of cardiac output.
|
Increase HR and Increase SV
|
|
|
Is there a high rate of CHF heart failure with sepsis? If so, why?
|
Yes, the heart can't keep up with demand from weakened vessels.
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True or False. Hypertension is more dangerous than shock.
|
False. Other way around sporto.
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What is one risk factor for obtaining hypertension? Why is this a risk factor?
|
Age > 50; Causes more rigid vessels
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|
What are the symptoms of primary hypertension?
|
Mostly asymptomatic
Headaches Renal failure |
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|
The best way to measure blood pressure is...
|
Three separate measurements on three separate occasions.
|
|
|
What major organs are affected by hypertension. List 4.
|
Kidneys
Brain (including eyes) Heart Vessels Note: These are the same systems that control blood pressure. |
|
|
What happens to vessels with hypertension over time?
|
They become thicker and less pliable and can't regulate pressure.
|
|
|
What are the classic associations of secondary hypertension. List 2.
|
Young age
Unstable/Mobile blood pressure readings. |
|
|
What is the treatment of secondary hypertension.
|
Treat the cause. Whatever it is.
|
|
|
What sound will you hear under auscultation regarding renal artery stenosis?
|
Bruit
|
|
|
What is a paradoxical finding associated with renal artery stenosis?
|
The disease keeps the affected kidney normal sized and the unaffected kidney atrophies.
|
|
|
What is the treatment for renal artery stenosis?
|
Angioplasty/Remove the stenosis
|
|
|
What is a rare benign tumor that can causes elevated blood pressure.
|
Pheochromocytoma
|
|
|
What are the risk factors for pheochromocytoma?
|
Young age
Genetics |
|
|
How is Pheochromocytoma diagnosed?
|
Ultrasound
Blood test |
|
|
What is Pheochromocytoma aggrevated by?
|
Anesthesia and pregnancy
|
|
|
How is Pheochromocytoma usually found?
|
By surprise...which is usually death.
|
|
|
Can Pheochromocytoma by ectopic or bilateral?
|
Yes.
|
|
|
Can Pheochromocytoma be malignant?
|
Yes, a minority.
|
|
|
Can Pheochromocytoma have involvement with a hormonal organ?
|
Yes, the thyroid is one example.
|
|
|
What is the end consequence of hypertension on the heart?
|
LVH --> CHF
|
|
|
What are 2 complications of LVH?
|
Arrhythmia
Sudden Death |
|
|
So the major force behind atherosclerosis is...
|
hypertension
|
|
|
So walk through the chain of pathologies starting with hypertension and ending with CHF.
|
HTN ---> Atherosclerosis and LVH ---> CAD ---> IHD ---> CHF
|
|
|
The MOST COMMON cause of CHF in the U.S. is...
|
hypertension
|
|
|
The non-modifiable risk factors for CHF are...
|
Age
Genetics Gender |
|
|
What are the modifiable risk factors for CHF?
|
Smoking
Hypertension |
|
|
What are four types of cardiac surgery? What is the most common?
|
Bypass (Most common)
Valves Congenital Heart Surgery Trauma |
|
|
Risks of cardiac surgery. List 4.
|
Graft Failure
Infection - Use sterile technique to fight off Dihesence - Rupture of anastomosis Thrombosis GIDT |
|
|
The MOST COMMON reason for heart transplant is...
|
IHD
|
|
|
What must patients do to survive following a cardiac transplant?
|
Chronic immunosuppressive drugs to prevent rejection.
|
|
|
If veins are weak vessels, how are heart transplants executed?
|
Tissue is sewn across the atria instead of the veins.
|
|
|
What is a complications from heart transplants? Why is this bad.
|
Long term rejection - Damages vessels which leads to IHD
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