Clinical Medicine (CHF)47 cards

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1

Define CHF

“A heterogeneous syndrome in which an abnormality of cardiac function is responsible for the inability of the heart to pump blood at an output sufficient to meet the requirements of metabolizing tissues and/or to do so only at abnormally elevated dia

2

How is CHF characterized?

Intravascular and interstitial volume overload, and manifestations of inadequate tissue perfusion


4

Examples of inadequate tissue perfusion?

Impaired exercise tolerance, fatigue, renal dysfunction





9

What are the different types?

Impaired systolic function, diastolic dysfunction, mechanical abnormalities, Disorder of Rate and Rhythm, Pulmonary Heart Disease, High Output states

10

There are many ways impaired systolic function can occur, name the 4 main, general, ways

-Ischemic damage or dysfunction (MI, shock) -Chronic pressure overload (HTN, Obstructive VHD-aortic stenosis -Chronic volume overload (Regurgitant VHD, Intracardiac right to left shunting) -Non-ischemic dilated cardiomyopathy (Infectious agents, Inf

11

What are the 4 major determinants of impaired systolic func?

– Contractile state of the myocardium – Preload of the ventricle – Afterload of the ventricle – Heart Rate

12

How is Ventricular Preload defined?

end-diastolic volume or pressure

13

What is ventricular afterload?

The amount of pressure the LV is pumping against

14

What can be given to reduce the ventricular afterload?

Vasodilators (improves CO and CHF)


16

What is the relationship being presented with a Frank-Starling Curve?

Since the SV is less with HF than with a normal heart, but if you give inotropic drug to pt. then the SV increases

17

What is the formula for CO (Cardiac Output)?

Heart Rate (HR) x Stroke Volume(SV) = CO

18

Why is CO a poor indicator of LV systolic function?

CO can be affected by HR, SVR, and the degree of LV dilation

19

How does Rate and Rhythm of the heart affect a person with CHF?

? Heart Rate – Increasing rate increases the inotropic state – Increased rate increases cardiac output, especially in CHF with fixed stroke volume – However, chronic tachycardia inhibits cardiac function ? Rhythm – Coordinated atrial and ventricular


21

What are the causes for diastolic dysfunction?

-Pathologic hypertrophy of cardiac myocardium LVH- LV hypertrophy (“stiff”) -Aging -Ischemic fibrosis -Restrictive cardiomyopathy (Amyloidosis, Sarcoidosis, hemochromatosis)-decr. LV complaince

22

Why would you see a large “Atrial Kick”?

Stiff ventricle does not allow normal filling to occur. Atrial kick provides most of the filling, which is caused by diastolic dysfunction.


24

Give 3 more examples of Intracadiac mechanical abnormalities

– Regurgitant VHD (MR, AI) – Intracardiac shunts (VSD, ASD) – Congenital abnormalities

25

What are 2 examples of Extracardiac mechanical abnormalities?

– Obstructive (Coarctation) – Left-to-right shunting (patent ductus)



28

Define Cor pulmonale.

– Right sided heart failure due to increased pulmonary artery pressures







35

What is the difference between Acute and Chronic CHF?

Acute CHF – Acute pulmonary edema – Sudden onset of symptoms – Hypotension – Significant hypoxia – Peripheral edema often not found – Tachycardia, diaphoresis, cyanosis more common Chronic CHF – Pt may have some element of chronic pleural effusions –

36

What does BNP stand for, and what does it indicate?

B-type natriuretic peptide; indicates myocardial stretch

37

A CBC can be used to test a patient for what? Why would this be significant?

Anemia. Anemia may be a cause of high output failure.


39

Name 2 things that can be done in the management of CHF that is non-pharmacologic

– Case management, diet, & exercise training – Coronary revascularization – Biventricular pacing (resynchronization) – Implantable Cardiac Defibrillators (ICD) – Cardiac transplantation, valve repair or replacement

40

What are the 4 goals of Pharmacologic Treatment of CHF?

– Correct reversible causes- CAD, VHD – Decrease preload – Decrease afterload – Increase systolic function



43

Digoxin is an example of what?

Positive Inotropic Agents

44

Anti-coagulation therapy may be used for what reason?

Severe LV dysfunction, especially after an anterior MI


46

Who may benefit from Biventricular pacemaker?

May be beneficial in pts with cardiomyopathy and left bundle branch block