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77 Cards in this Set
- Front
- Back
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This is the inability of the heart to fill or eject blood at a rate adequate to meet tissue requirements.
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heart failure
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____ is the most common medicare discharge diagnosis.
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heart failure
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Symptoms of heart failure
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SOB, swelling BLE, chronic lack of energy, difficulty sleeping due to breathing problems, swollen/tender abdomen, loss of appetite, cough w frothy sputum, inc nocturnal urination, confusion/memory impairment
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What are the etiologic causes of HF?
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impaired myocardial contractility
valve abnormalities systemic HTN pericardial disease pulm HTN (cor pulmonale) |
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What is the most common cause of RV failure?
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LV failure
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Pts w systolic heart failure exhibit _____ Disease, dilated ______, and ____ and ____ chronic overload.
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CAD, dilated cardiomyopathy, chronic pressure and volume overload
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What cause chronic pressure overload in systolic heart failure?
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aortic stenosis, HTN
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What causes chronic volume overload in systolic heart failure?
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aortic and mitral insufficiency (leaking/regurg), high output failure
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Patients w diastolic HF may have normal _____ function.
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systolic
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What are the causes of diastolic heart failure?
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ischemia, aortic stenosis, HTN, anything that makes heart muscle hypertrophy
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Describe stage 1 of diastolic HF.
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abnormal relaxation (LVEDP incr) with normal left atrial pressure
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Describe stages 2-4 of diastolic heart failure.
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abnormal relaxation with high left atrial pressure and LVEDP
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Diastolic heart failure is more common in
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women
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Chronic heart failure is seen in pts with _______ cardiac disease. They exhibit ____ congestion, _____ BP, and the process is well tolerated because ______.
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long-standing,
venous congestion, well-maintained BP, bc it occurs gradually |
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Acute heart failure is seen in pts with the following conditions:
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MI, valve rupture, HTN crisis
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Pts w acute heart failure have _____ edema, ____ BP, and a more ______ presentation.
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no edema, hypotension, catastrophic presentation
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CAD, cardiomyopathy, HTN, valvular disease, and pericardial disease are all causes of _______ output heart failure.
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low output
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Anemia, pregnancy, AV fistula, hyperthyroidism, Beri Beri, and Paget's disease are all causes of _____ output heart failure.
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high output
av fistula- some blood that normally goes through lungs will take shortcut through fistula and too much may take shortcut |
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Starlings Law of the heart describes the relationship between ____ and _____.
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EDV and cardiac output
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In a normal person, the relationship between LVED volume and stroke volume is very _____.
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linear
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In a normal heart, increased preload leads to ____ CO.
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increased
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In pts w heart failure, the starling curve has a more _____ pattern. Increased preload does not improve ______. In fact, it may make things worse and decrease CO.
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flat curve, stroke volume
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Will pts in cardiogenic shock or severe heart failure respond to volume challenge?
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NOPE
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According to the NYHA, there are 4 classes of heart failure...
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1. no symptoms w ordinary activity
2. symptoms w ordinary exertion 3. symptoms w less than ordinary exertion 4. symptoms at rest |
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Describe the cocktail of drugs available for medical mgmt of heart failure.
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ace inhibitors, ARBs, aldosterone antagonists, B blockers, diuretics, digitalis (positive inotrope), vasodilators (Decr afterload), statins
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When medical management of heart failure is unsuccessful, the next step is...
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surgery
OHTX (orthotopic heart transplant) Ventricular assist device Cardiac resynchronization (to improve electrical conduction) ICD (implanted cardiac defibrillator) |
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When an LVAD is functioning normaly, the aortic valve does not need to ______.
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close
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How is acute heart failure managed?
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- diuretics and vasodilators
- inotropic support - Ca sensitizers (levosemindan) - B-type natriuretic peptide (Natrecor) - Nitric oxide synthase inhibitors - intra-aortic balloon pump |
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Milrinone works by preventing the breakdown of ___.
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cAMP
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When chronically giving pts meds to improve contractility, they usually die from...
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side effects
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An IABP rapidly shuttles helium gas in and out of the balloon, which is located in the ______. The balloon is inflated at the onset of cardiac _____ and deflated at the onset of _____ to improve coronary perfusion
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descending aorta, inflated during diastole, deflated during systole
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During systole, an IABP deflates rapidly to cause a sudden decr in ______ to augment LV ejection.
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afterload
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IABPs are synced to _____ to set them up, and BP increases when the balloon is _____.
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EKG, inflated
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You cannot use _____ in a bradycardic pt with a denervated transplanted heart. Instead you must use ____.
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no atropine,
use epi instead (beta adrenergic agonists) |
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What are the effects of general anesthesia on heart failure pts?
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- narcotics decr sympathetic stim/tone
- positive pressure ventilation and PEEP aid LV ejection and decr afterload - on a vent, lungs squeeze heart to aid LV ejection |
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What are the effects of regional anesthesia in heart failure pts?
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decr systemic vascular resistance (afterload) may incr CO
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The transplanted heart is ______, and is _____ dependent.
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denervated, preload dependent
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The heart is a ____ chamber within a _____ Chamber.
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pressurized within pressurized!
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LV pressure - intrathoracic pressure =
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LV transmural pressure
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Positive swings in intrathoracic pressure result in
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a decrease in LV transmural pressure -- easier for heart to eject
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Negative swings in intrathoracic pressure result in
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an increase in LV transmural pressure -- harder for heart to eject
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Cardiomyopathies are a heterogeneous group of diseases of the myocardium associated with ____ and/or _____ dysfunction that usually (but not invariably) exhibit inappropriate ______ hypertrophy or dilation du to a variety of causes that are frequently genetic.
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mechanical and/or electrical dysfunction, ventricular
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_______ either are confined to the heart or are part of generalized systemic disorder, often leading to cardiovascular death or progressive heart failure- related disability.
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Cardiomyopathies
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What is the difference between primary and secondary cardiomyopathy?
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primary- confined to heart muscle
secondary- part of multiorgan disease |
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What are the types of primary cardiomyopathy?
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- genetic
- mixed - acquired |
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What are the types of secondary cardiomyopathy?
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- infiltrative (amyloidosis)
- storage - toxic - inflammatory processes - endomyocardial - endocrine - neuromuscular - autoimmune |
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Hypertrophic cardiomyopathy is a ________ trait, involving hypertrophy of ____ and _____.
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autosomal dominant trait,
hypertrophy of septum and anterolateral LV free wall |
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Describe the dynamic LV outflow obstruction of hypertrophic cardiomyopathy.
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the harder the heart works, the worse the flow, because the valve gets sucked into the ventricle and valve leaks - common in athletes
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Hypertrophic cardiomyopathy results in ____ movement of the mitral valve during systole.
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anterior
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Mitral regurg, diastolic dysfunction, myocardial ischemia, and dysrhythmias are all symptomatic of what type of cardiomyopathy?
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hypertrophic
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Describe systolic anterior motion (SAM).
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blood leaks back through mitral valve (mitral regurg), mitral valve presses against septum causing obstruction to blood flow ---> leads to SAM
The LV outflow tract becomes very narrow, close to the anterior leaflet of the mitral valve. Due to the bernoulli principle, with high velocity through narrow area --> causes leaflet to be sucked into LV outflow tract, leads to mitral regurg and sudden decr in CO because blood isn't leaving the heart |
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What factors may increase left ventricular outflow tract obstruction?
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-incr contractility (B agonist, digitalis)
-decr preload -decr afterload |
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What factors may decrease left ventricular outflow tract obstruction?
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-decreased contractility (B blockers, anesthetics, ca channel blockers)
-incr preload -incr afterload best to keep heart optimally filled w afterload normal or high |
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Hypertrophic cardiomyopathy is usually ______, but patients may have angina relieved by _____.
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asymptomatic, lying down
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In some circumstances, hypertrophic cardiomyopathy may present as sudden ____.
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death
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In patients with hypertrophic cardiomyopathy, the murmur of MR may be increased by ______ because it causes a drop in preload and venous return.
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valsalva
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What are the medical and surgical treatment options of hypertrophic cardiomyopathy?
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- medical: beta blockers, Ca channel blockers
- surgical: septalplasty to make larger LV outflow tract |
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What are the anesthesia management goals of hypertrophic cardiomyopathy?
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- minimize LV outflow tract obstruction
- avoid sympathetic stimulation, hypotension and hypovolemia - maintain sinus rhythm |
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What effects do anesthetics have on contractility?
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- depr contractility by decr Ca entry into cells
- halothane (like inhaled beta blocker, potent negative inotrope) and enflurane have most negative inotropic effects - N20 and ketamine - minimal effects - local anesthetics, esp bupivicaine/ropivicaine/tetracaine cause myocardial depr |
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Primary dilated cardiomyopathy is also referred to as
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idiopathic cardiomyopathy
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The etiology of dilated cardiomyopathy may be ____ or ____.
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genetic, infectious
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Secondary types of dilated cardiomyopathy have similar _____ to primary types.
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clinical appearance
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Symptoms of dilated cardiomyopathy
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heart failure, dysrhythmia, embolization, low CO, stasis, mural thrombi, high CVA risk
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Peripartum cardiomyopathy carries a risk of ____ % mortality within 3 mo of delivery, and occurs in 1 out of every ____ Births.
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25-50%, 3000-4000
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Risk factors for peripartum cardiomyopathy
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obesity
multiparity advanced maternal age preeclampsia afroamerican |
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What are the possible etiologies of peripartum cardiomyopathy?
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viral, autoimmune, maladaptive response to hemodynamic effects of pregnancy
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Peripartum cardiomyopathy is an enlargement of the ___ Due to _______.
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left ventricle due to dilated cardiomyopathy
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What are the 3 types of secondary cardiomyopathies with restrictive physiology?
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1. myocardial infiltration: causes severe diastolic dysfunction, very stiff, can't relax
2. amyloidosis: classic example 3. infiltrative diseases: hemochromatosis, sarcoidosis, carcinoid |
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The symptoms of secondary cardiomyopathies with restrictive physiology include ____ and ____.
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heart failure, afib
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An echocardiogram of a pt w secondary restrictive cardiomyopathy reveals
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normal systolic function, severe diastolic function
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With pts in secondary restrictive cardiomyopathy, it is important to maintain ____ and _____.
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sinus rhythm, preload
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The diastolic function of less compliant hearts exhibits ______ end diastolic pressure and volume.
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higher than normal
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The diastolic function of more compliant hearts exhibits ____ end diastolic pressure and volume.
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lower than normal
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_____ dilatation is seen in diseases that induce pulmonary HTN, which include...
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RV dilatation,
COPD, OSA, restrictive lung disease |
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The other name for cor pulmonale is
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pulmonary HTN
incr BP and resistance in lungs leading to R sided Heart failure |
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OSA is characterized by ____ Retention, _____ vasoconstriction, and the heart having to pump against elevated pulm artery pressures, leading to ____ failure.
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CO2 retention, Pulm vasoconstriction, R heart failure
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_____ is essential to improving prognosis of cor pulmonale.
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O2 therapy
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