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50 Cards in this Set

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one of the goals of therapy for HF is to improve ejection fraction...what are 2 ways to do that and drugs associated
1) ↑ contractility- positive inotropic drugs

2) ↓ afterload -arteriolar dilators
one of the goals of therapy for HF is to alleviate pulmonary edema...how do you do that? what drugs?
↓ preload – diuretics and venous dilators
one of the goals of therapy for HF is to reduce cardiac remodeling... what drugs do this?
ACE-I, B- blockers, aldosterone antagonists
what are the goals of therapy for HF? (yes again)
improve ejection fraction

alleviate pulmonary edema

reduce cardiac remodeling

reduce mortality
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
when the body senses clinical syndrome of HF, what does it do?
and initiates multiple neurohormonal responses to adjust.
To keep us in balance
To keep our ph 7.35-7.45
To maintain homeostasis
What are the 3 cardinal symptoms of HF?

******
1) Fatigue

2) Dyspnea

3) Edema
what is Cor Pulmonale
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
decreased contractility shows what kind of HF dysfunction?
systolic
what is the most common cause of HF?
Left Ventricular Systolic Dysfunction (LVSD) which is usually caused by CAD
impaired relaxation and abnormal ventricular filling are characteristic of what HF dysfunction
diastolic
this is caused by pulmonary hypertension or RV infarction, or severe tricuspid regurg
Right ventricular systolic dysfunction
chronic HTN, ischemic heart disease or restrictive, infiltrative and hypertrophic cardiomyopathies are common causes of
LVDD
pericardial effusion or cardiac tamponade are causes of?
RVDD
T/F

HF= cardiomyopathy or LV dysfunction
FALSE

these can cause HF, but are not equivalent
What is the neural response to try and maintain CO? 2
SNS ↑ HR and contractility =↑ CO

Circulating catecholamines - ↑vasoconstriction in non essential beds
to shunt blood to brain / ♥=↑SV=↑CO
SNS changes try to maintain CO but over time they will....
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
what is used in cardiogenic shock?
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.
BNP levels can show what?
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.
if you see Kerley B lines on a chest X-ray what do you have
CHF
Fatigue and weakness is a clinical presentation of HF, what causes this?
reduced perfusion of skeletal muscles
Dyspnea is a clinical presentation of HF, what causes this?
pulmonary congestion
Nausea and anorexia are part of a clinical presentation of HF, what causes this?
2° to congested liver and portal venous system.
Paroxysmal Nocturnal Dyspnea is a sign of HF, what is it
when a person lies down, the edema from lower extremities comes up to lungs and causes person to wake up coughing and whatnot
why does nocturia happen in pts with HF
fluid pooled in legs during day, moves up at night when laying down, makes them have to pee
pt says they have to sleep in the recliner to be able to successfully sleep through the night...what are you thinking
HF due to pulmonary congestion
If you see jugular vein distention what should you be thinking
right ventricular failure
what is Pulsus alternans, and what is it seen in?
arterial pulse that is really strong on one beat, then soft, then strong, repeat

LV systolic dysfunction (sign of failure)
S4 is heard in what problem
diastolic dysfunction
what is the most useful Diagnostic tool for HF?
echocardiogram
what lab value will correlate with severity of heart failure?
BNP
What NYHA stage does this describe:

no symptom limitation with ordinary physical activity
I
What NYHA stage does this describe:

ordinary physical activity somewhat limited by dyspnea (ie long distance walking, climbing 2 flights of stairs)
II
What NYHA stage does this describe:

Exercise limited by dyspnea at mild work loads (ie short walking distance, climbing 1 flight of stairs)
III
What NYHA stage does this describe:

dyspnea at rest or with very little exertion
IV
in HF what will creatinine levels be like?
increased due to renal hypoperfusion
what will the pH be like for someone in HF?
acidic
what will PO2 levels reveal in someone with HF
hypoxic
what are 2 typical dietary changes recommended for the treatment of HF?
1) 2 gram Na daily-avoid canned foods, cured meats, salt shakers. Low sodium foods only

2) 2 liters of fluid
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?
Stage B
What does an ACE-I do?

Increase cardiac contractility
Prevent/reverse cardiac remodeling
Improve ejection fraction
Increase heart rate
Prevent/reverse cardiac remodeling
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?
Stage A
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?
Stage C
What does digoxin do?

Dilates arteries
Increases cardiac contractility
Increases Na+ excretion
Prevent/reverse cardiac remodeling
Increases cardiac contractility
A 69 year old female on the cardiac transplant list with severe shortness of breath at rest. AHA Stage?
Stage D
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
Frothy pink sputum, anxiety, dsypnea, and wheezing are all signs of what?
Pulmonary Edema (left sided HF)
what is a key treatment of Pulmonary Edema?
Diuresis
NTG-sublingual, IV- recommended by
ACC/AHA for tx of _____
pulmonary edema
What are the 5 signs of CHF found on an xray??
Kerley B lines, cardiomegaly, pulmonary edema, alveolar effusion, cephalization