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50 Cards in this Set
- Front
- Back
one of the goals of therapy for HF is to improve ejection fraction...what are 2 ways to do that and drugs associated
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1) ↑ contractility- positive inotropic drugs
2) ↓ afterload -arteriolar dilators |
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one of the goals of therapy for HF is to alleviate pulmonary edema...how do you do that? what drugs?
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↓ preload – diuretics and venous dilators
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one of the goals of therapy for HF is to reduce cardiac remodeling... what drugs do this?
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ACE-I, B- blockers, aldosterone antagonists
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what are the goals of therapy for HF? (yes again)
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improve ejection fraction
alleviate pulmonary edema reduce cardiac remodeling reduce mortality |
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1) Explain the clinical syndrome of heart failure.
**OBJECTIVE what causes the clinical syndrome of HF? 2 |
1) Pump failure
2) Inadequate tissue / organ perfusion |
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when the body senses clinical syndrome of HF, what does it do?
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and initiates multiple neurohormonal responses to adjust.
To keep us in balance To keep our ph 7.35-7.45 To maintain homeostasis |
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What are the 3 cardinal symptoms of HF?
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1) Fatigue
2) Dyspnea 3) Edema |
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what is Cor Pulmonale
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failure of the right side of the heart brought on by
long-term high blood pressure in the pulmonary arteries and right ventricle of the heart |
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decreased contractility shows what kind of HF dysfunction?
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systolic
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what is the most common cause of HF?
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Left Ventricular Systolic Dysfunction (LVSD) which is usually caused by CAD
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impaired relaxation and abnormal ventricular filling are characteristic of what HF dysfunction
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diastolic
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this is caused by pulmonary hypertension or RV infarction, or severe tricuspid regurg
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Right ventricular systolic dysfunction
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chronic HTN, ischemic heart disease or restrictive, infiltrative and hypertrophic cardiomyopathies are common causes of
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LVDD
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pericardial effusion or cardiac tamponade are causes of?
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RVDD
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T/F
HF= cardiomyopathy or LV dysfunction |
FALSE
these can cause HF, but are not equivalent |
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What is the neural response to try and maintain CO? 2
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SNS ↑ HR and contractility =↑ CO
Circulating catecholamines - ↑vasoconstriction in non essential beds to shunt blood to brain / ♥=↑SV=↑CO |
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SNS changes try to maintain CO but over time they will....
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cause more harm than good:
1) Aggravate ischemia 2) Potentiate arrhythmias 3) Promote cardiac remodeling 4) Are directly toxic to myocytes 5) Unfortunately ,stimulate renin release from underperfused kidneys |
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what is used in cardiogenic shock?
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VASOPRESSIN
Baroreceptors in the aortic arch and carotids along with osmotic stimuli stimulate vasopressin ( ADH) release from the hypothalamus causing reabsorption of water in the renal collecting duct. |
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BNP levels can show what?
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HF, because it is a counter-regulatory action
1)Released from secretory granules in the cardiac myocytes 2) Promote sys /pulm vasculature dilatation 3)↑ Na / H2O excretion 4)Suppress other neurohormones. |
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if you see Kerley B lines on a chest X-ray what do you have
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CHF
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Fatigue and weakness is a clinical presentation of HF, what causes this?
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reduced perfusion of skeletal muscles
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Dyspnea is a clinical presentation of HF, what causes this?
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pulmonary congestion
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Nausea and anorexia are part of a clinical presentation of HF, what causes this?
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2° to congested liver and portal venous system.
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Paroxysmal Nocturnal Dyspnea is a sign of HF, what is it
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when a person lies down, the edema from lower extremities comes up to lungs and causes person to wake up coughing and whatnot
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why does nocturia happen in pts with HF
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fluid pooled in legs during day, moves up at night when laying down, makes them have to pee
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pt says they have to sleep in the recliner to be able to successfully sleep through the night...what are you thinking
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HF due to pulmonary congestion
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If you see jugular vein distention what should you be thinking
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right ventricular failure
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what is Pulsus alternans, and what is it seen in?
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arterial pulse that is really strong on one beat, then soft, then strong, repeat
LV systolic dysfunction (sign of failure) |
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S4 is heard in what problem
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diastolic dysfunction
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what is the most useful Diagnostic tool for HF?
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echocardiogram
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what lab value will correlate with severity of heart failure?
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BNP
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What NYHA stage does this describe:
no symptom limitation with ordinary physical activity |
I
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What NYHA stage does this describe:
ordinary physical activity somewhat limited by dyspnea (ie long distance walking, climbing 2 flights of stairs) |
II
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What NYHA stage does this describe:
Exercise limited by dyspnea at mild work loads (ie short walking distance, climbing 1 flight of stairs) |
III
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What NYHA stage does this describe:
dyspnea at rest or with very little exertion |
IV
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in HF what will creatinine levels be like?
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increased due to renal hypoperfusion
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what will the pH be like for someone in HF?
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acidic
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what will PO2 levels reveal in someone with HF
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hypoxic
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what are 2 typical dietary changes recommended for the treatment of HF?
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1) 2 gram Na daily-avoid canned foods, cured meats, salt shakers. Low sodium foods only
2) 2 liters of fluid |
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A 56 year old female patient with a recent MI. Her echocardiogram reveals mild left ventricular dysfunction. She denies worsening fatigue, dyspnea on exertion or edema. She walks 2 miles everyday and does her own housework. What AHA Stage is she?
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Stage B
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What does an ACE-I do?
Increase cardiac contractility Prevent/reverse cardiac remodeling Improve ejection fraction Increase heart rate |
Prevent/reverse cardiac remodeling
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A 40 year old male patient with a history of hypertension. His recent echocardiogram revealed normal architecture of valves and leaflets and an ejection fraction of 60%. He denies fatigue, dyspnea on exertion or edema. What AHA stage is this?
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Stage A
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A 76 year old male patient with a left ventricular ejection fraction of 40% and moderate mitral stenosis complains of worsening fatigue and dyspnea during his daily walks. AHA stage?
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Stage C
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What does digoxin do?
Dilates arteries Increases cardiac contractility Increases Na+ excretion Prevent/reverse cardiac remodeling |
Increases cardiac contractility
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A 69 year old female on the cardiac transplant list with severe shortness of breath at rest. AHA Stage?
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Stage D
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What is characterized by Pulmonary capillary pressure exceeds the forces that maintain fluid within the vascular space
AMI, papillary muscle rupture, fluid overload, cardiogenic shock |
Flash pulmonary edema
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Frothy pink sputum, anxiety, dsypnea, and wheezing are all signs of what?
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Pulmonary Edema (left sided HF)
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what is a key treatment of Pulmonary Edema?
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Diuresis
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NTG-sublingual, IV- recommended by
ACC/AHA for tx of _____ |
pulmonary edema
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What are the 5 signs of CHF found on an xray??
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Kerley B lines, cardiomegaly, pulmonary edema, alveolar effusion, cephalization
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