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34 Cards in this Set

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CHF causes (4)
1. cardiac valve abnormalities

2.impaired myocardial contraction (ischemic heart disease, cardiomyopathy)

3.systemic HTN

4.pulm HTN (cor pulmonale)
are CHF symptoms closely r/t severity of LV dysfunction?
no. only mildly
is LV dysfunction closely r/t mortality?
yes
decreased ventricular systolic wall motion represents diastolic or systolic dysfunction?
systolic dysfunction
increased end diastolic pressure in a normal sized chamber represents diastolic or systolic dysfunction? why?
diastolic dysfunction

cannot fill at normal diastolic pressures
how is diastolic CHF diagnosed?
absence of cardiomegaly w/ pulmonary/systemic congestion
diastolic CHF s/s
pulmonary/systemic venous congestion w/ normal Left ventricular chamber
some diastolic CHF tx (4)*
1.avoid Na intake
2.cautious diuretics
3.restoration & maintenance of NSR
4.correction of precipitating factors
what is CO?
cardiac output = stroke volume X heart rate
CO for severe CHF?
decreased CO < 2.5 L/min/m2
what is the relationship of SV and LVEDP in CHF?
lower SV for any given LVEDP
what is Vmax?
maximum velocity of myocardial contraction representing inotrope state of heart
what happens to Vmax in CHF?
decreased
what happens to catechols in CHF?
depleted
what is afterload?
tension ventricle has to develop to open aortic & pulmonic valves
what is the rate-treppe phenomenon?
increases in myocardial contractility w/ increase HR
what is increased CO in CHF dependent on?
increases in HR b/c the SV is fixed
what effect does CHF have on the heart?
-myocardial hypertrophy & dilation
how is BP maintained in CHF eventhough CO is decreases?
1.increased HR - increases CO
2.arteriolar & venous constriction - shift blood from periphery to central circulation, increases venous return, and maintains CO
what is the CHF vicious cycle?
a.the vasoconstictive compensatory responses to maintain central circulation volume constricts blood from kidneys, splanchnic organs, etc.

b.this decrease BF to kidneys causes increased tubular Na & H2O absorption to increase blood volume & CO

c.increased fluid retension, increases venous return & afterload increasing work on the heart and further decreases in CO
what medication can break the CHF vicious cycle?
peripheral vasodilators
what are 3 ways EF can be decreased?
1.decreased contractility
2.increased afterload
3.asynchrony of LV contraction
normal LV ejections
56-78%
What happens to EDP and EDV in CHF?
both increased b/c parallel each other
normal LVEDP
< 12 mmHg
normal RVEDP
< 5 mmHg
hallmark sign of CHF
fatigue at rest or with minimal exertion
hallmark findings of CHF (5)
1.decreased CO
2.increased VEDP
3.peripheral vasoconstriction
4.metabolic acidiosis
5.tachycardia
signs of LV failure (5)*
1.pulmonary edema
2.paroxysmal nocturnal
3.hilar peripheral haze (cxr)
4.butterfly pattern (cxr)
5.pleural effusion (cxr)
signs of RV failure (3)*
1.peripheral edema
2.systemic HTN
3.organomegaly (liver)
name 4 traditional pharm tx for CHF and what they do
1.ACE inhibitors = conserve K & excretes Na

2.diuretics = excretes fluid volume from body

3.vasodilators = decrease resistance to LV ejection & increased venous capacitance

4.digitalis = enhances inotropy & decreases activation of SNS
treatment of dig toxicity (5)
1.correct low K
2.lidocaine
3.phenytoin
4.atropine
5.temporary pacer for complete block
name 2 non-pharm tx of CHF
1.ventricular assist devices
2.mechanical pump
name 2 newer pharm tx for CHF
1.beta-adrenergic antagonists (metoprolol)
2.Ca2+ channel blocking durgs (felodipine, amiodipine)