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53 Cards in this Set
- Front
- Back
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What are two main causes of heart failure?
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HTN
CAD |
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What are some of the infectious causes of heart failure?
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Chagas disease (trypanosoma cruzi)
Viral (coxie) Post-viral (immune mediated) |
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What condition of women can cause heart failure some of the time?
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Pregnancy! - peripartum CM
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What are some metabolic causes of heart failure? What type of heart failure does this cause?
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Thyroid disorders
Beriberi High output heart failure |
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What pressures are altered in pulmonary edema?
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Left heart diastolic pressure; high; 10-->30
Right heart systolic pressure: 25-->50 Right heart diastolic pressure: 5-->15 |
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What are the physical findings for left heart failure?
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Pulmonary rales at the bases
Coarse ronchi, wheeze cardiac asthma (compression of airways) Atral impulse: diffuse, sustained or lifting S3 gallop (+/-S4), mitral regurgitation |
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What changes happen to the lungs in chronic heart failure?
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Adjustment of the lungs to high pressure: hardening of the lung capillaries, etc.
Don't hear rales here! |
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What are the symptoms of LHF?
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Dyspnea
Orthopnea (nocturnal cough) Paroxysmal nocturnal dyspnea Fatigue Hemoptysis Nocturia |
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What is the cause of dyspnea during LHF?
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Pulmonary venous congestion
Decreased CO, reduced forward blood flow to respiratory muscles |
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What is the cause of hemoptysis in LHF?
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Increased pressure in lungs drives RBC into alveolar spaces --> coughing up of blood
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What is the cause of nocturia in LHF?
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Kidneys aren't getting as perfused during the day, so they make up for it at night with increased urination
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What are the physical findings in RHF?
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JVD
Right ventricular heave Right sided S3, S4 Tricuspid regurgitation Hepato,splenomegaly Peripheral edema Ascites Cachexia Dusky appearance Tachypnea Cheyne-stokes respiration Pulsus alternans |
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What is a requirement to hear an S4 wave?
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Atrial contraction
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What are the causes of an S4?
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HTN
Aorticstenosis Cardiomyopathy Ischemic heart disease secondary to MI Noncompliant LV |
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What are the causes of the quadruplerhythm (S4-S1, S2-S3)?
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LV anuerysm
End stage dilated cardiomyopathy End stage ischemic cardiomyopathy |
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What are causes of V waves in the jugular veins.
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Tricuspid valve problems
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What is cheyne-stokes respiration? What condition is this found in?
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Irregular breathing while sleeping
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What sign of pericardial disease is seen on EKG? What does this look like? What is the cause?
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Electrical alternans
Voltages go up and down on EKG Heart is swinging back and forth in the chest cavity |
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What is pulsus alternans? What is it felt in?
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It's where there's a strong beat of the heart then a weak one, alternating.
ASSISTANTS COULD FALSELY REPORT A HEART RATE AS BEING HALF OF WHAT IT ACTUALLY IS! Sign of advanced ventricular dysfunction |
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What is cachexia?
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Wasting of the body - look around the eyes for this
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What are the laboratory findings in heart failure?
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Anemia
Hyponatremia Hyper or hypo kalemia Azotemia Elevated LFTs Elevated B-type natriuretic peptide |
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Why does anemia happen in heart failure?
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Infammatory molecules cause bone marrow dysfunction
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What is a cause of hyponatremia during heart failure?
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Brain is secreting AT, which causes retention of water while we're giving loop diuretics which cause loss of Na.
Lower gradients of Na--> hyponatremia |
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On CXR what are signs of heart failure?
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Enlarged cardiac silhouette
Pulmonary vscular redistribituion Interstitial albeolar edema Pleural effusion |
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On EKG what are some signs of heart failure?
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Atrial, ventricular enlargement
Arrhythmias Conduction defects Localized Q waves |
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What is the definition of dilated cardiomyopathy?
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Ventricular dilatation (both RV, LV)
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What type of dysfunction happens in dilated cardiomyopathy?
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Systolic dysfunction: LV, RV can't contract
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What are some causes of dilated cardiomopathy?
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Familial
Sarcoidosis Peripartum Connective tissue disorders Alcoholic Hypothyroidism Muscular dystrophy |
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What proteins are effected in dilated cardiomyopathy?
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Cytoskeletal proteins
Nuclear envelope proteins |
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What drugs give a survival benefit in dilated cardiomyopathy?
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ACE inhibitors
Beta blockers Spironolactone |
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What is the definition of diastolic heart failure?
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Change in cardiac properties that impair the ability of the ventricular cavity to accommodate normal EDV at normal filling pressures - either at rest or during exercise
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Generally, happens in diastolic dysfunction?
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Ventricles become stiff and noncompliant
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What are causes of ventricle stiffening? What disease does this happen in?
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Ischemia
Fibrosis Infiltration Hypertrophic CM |
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What diseases cause infiltration of the heart?
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Hemachromatosis
Sarcoidosis Amyloidosis |
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If a patient has diastolic dysfunction, what is the status of their ejection fraction? What is driving the heart failure?
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EF is preserved
Failure is due to poor diastolic performance |
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What is the genetic basis for hypertrophic cardiomyopathy?
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Problems with the sarcomeres.
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What is the definition of hypertrophic cardiomyopathy?
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LVH in absence of HTN, aortic stenosis
+/- outflow tract obstruction Vigorous systolic function Impaired ventricular relaxation; high diastolic pressures |
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What are the most common symptoms of hypertrophic cardiomyopathy?
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Dyspnea
Chest pain Syncope |
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What drugs should be used to treat hypertrophic CM?
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Beta blockers
CCB's (non-DHPs) |
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What is the effect of valsalva on an HCM murmur? Squatting? Standing?
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Increase
Decrease Increase |
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What is the effect of valsalva on AS murmurs? Squatting? Standing?
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Decreased
Increased Decreased |
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What are noninfiltrative restrictive mycardial cardiomyopathies?
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Idiopathic
Sclerodermic |
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What are the infiltrative restrictive myodardial cardiomyopathies?
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Amyloidosis
Sarcoidosis |
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What storage diseases cause restrictive myocardial cardiomyopathies?
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hemochromatosis
Glycogen storage diseases |
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What are some types of endomyocardial restrictive cardiomyopathys?
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Endomyocardial fibrosis
Hypereosinophilic syndrome Metastatic tumors Radiation therapy |
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What are the clinical findings in restrictive cardiomyopathys?
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L, R sided failure
Decreased CO More systemic congestion than pulmonary congestion |
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What are some of the types of systemic congestion that happen during restrictive cardiomyopathy?
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Jugular venous distension
Peripheral edema Tender liver Ascites |
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What condition presents similarly to restrictive cardiomyopathy? How do you differentiate?
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Constrictive pericarditis
Do an endomyocardial biopsy CT/MRI |
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What is the prognosis for restrictive cardiomyopathies?
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Poor.
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What is the cause of familial restrictive cardiomyopathy?
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Mutation in the gene for troponin I
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What is the inheritance pattern for arrhythmogenic RV cardiomyopathy?
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Autosomal dominant
Variable penetrance |
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What are the symptoms of arrhythmogenic RV cardiomyopathy?
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Arrhythmias
Syncope Sudden death |
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What histological changes occur in arrhythmogenic RV cardiomyopathy?
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Fibro-fatty infiltration of the RV
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