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23 Cards in this Set
- Front
- Back
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if pt's wheeled into clinic, what's that say? |
not good
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Class I through IV heart failure |
I Patients with cardiac disease but resulting in no limitation of physical activity. II slight limitation of physical activity. fine at rest, activity = fatigue, palpitation, dyspnea or anginal pain. III marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes problems IV inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort increases. |
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what is difference dyspnea and SOA? |
SOA: cyanosis, low Po2, air hunger
dyspnea: difficult, labored breathing. Reduced compliance of lungs. |
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why orthopnea |
when legs down, edema and fluid store
legs up, fluid comes out into pool- all volumes go up so pulm vascular pressure goes up and then paroxysmal nocturnal dyspnea |
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skin turgor |
tells about dehydration |
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what's a good way to tell quick and dirty if pt has water retention |
if weight has been gained quickly- water accumulation |
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irregularly irregular rhythm points to |
a fib |
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diaphoresis really tells you that what else?
what kinds of things causes this? |
sympathetic nerve activity being pale
anemia and CHF are going to be low O2 delivery. |
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sympathetics. what do they do in exercise
how does it compare in CHF |
constrict skin and splanchnics central- heart rate and contractility up exercise vasodilates muscle beds with NO so TPR is down slightly and CO is way higher
no NO muscle lowering of SVR so with higher SVR means CO is lower. So splanchnics esp poorly perfused = ischemic bowel. Renal low so renin put out for vasconstriction and aldosterone. |
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why is dilation so bad? |
need more tension to contract for the same pressure, so way more work (Laplace's Law)
RV is a spiral and as it expands, the vector becomes smaller going inward because the curve is facing more obliquely |
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S3 S4 |
volume overload in messed up hear twall
atrial kick into non-compliant wall |
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spleen and liver enlargement is secondary to waht heart condition |
right side failure |
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what are # 1 and 2 causes of RV dysfunction |
LV dysfunction
long term pulm dz |
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retaining both Na and water but are at low end of Na osmolarity |
ADH in excess to aldosterone
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kidney being sad during CHF |
underperfusion so prerenal. Can't excrete so see the azotemia. |
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B-type natriuretic peptide |
is from the heart stretching that is supposed to slow down aldosterone but it's no match |
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biventricular and biatrial dilation
what does that tell you |
long standing CHF
dilated cardiomyopathy |
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what are you seeing in the xray with prominent vascular and lymphatic markings |
the congestion of all the pulm vessels |
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peripheral edema differential |
oncotic like hypoalbuminemia (depressed) hydrostatic like htn (elevated)
kidney heart- hydrostatic liver kwashiorkor |
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categories of heart failure |
valvular: murmurs congenital: age, cyanosis ischemic: atherosclerosis, spasm, vasculitis cardiomyopathy: restrictive, (infiltrative [amyloid, sarcoid, fibrosis {previous radiation}, met cancer], noninfiltrative) hypertrophic (myosin problems in exercise since subaortic stenosis do echo), dilated (toxic [anthrocyclins, alcohol, cobalt, cocaine], infectious [coxsackie, echo, Chagas], congenital [Duchenne's]) infectious: sbe abe myocarditis |
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18 yo looks like acute MI |
probs coke |
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normal LVEF? |
60% |
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diffuse coronary artery narrowing in transplant heart |
chronic graft rejection |
