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Cardiology II
Heart Failure
44
Medical
Graduate
11/04/2009

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Cards

Term
Which disease uses the most medicare dollars?
Definition
Heart failure
Term
What is heart failure?
Definition
Condition in which a problem with the structure or function of the heart impairs the ability of the ventricles to fill or eject blood
Term
3 main sx of left HF?
Definition
Dyspnea, dry cough, fatigue
Term
Pts w/ h/o MI most likely have systolic or diastolic left HF?
Definition
systolic (HTN in diastolic)
Term
Is EF diminished in systolic or diastolic dysfunction in (L) HF?
Definition
systolic - <50% (normal or elevated in diastolic)
Term
What murmur is common in systolic dysfunction in (L) HF?
Definition
mitral valve regurgitation
Term
Pulsus alternans is almost a/w indicative of what? What is it?
Definition
(L)systolic HF, alternating strong and weak beats in pulse
Term
Pulsus alternans is almost a/w indicative of what? What is it?
Definition
(L)systolic HF, alternating strong and weak beats in pulse
Term
Which shows cardiomegaly on CXR, systolic or diastolic dysfunction?
Definition
systolic due to dilated ventricle (normal in diastolic)
Term
What heart sounds are heard in systolic dysfunction? Diastolic?
Definition
sys - S3 gallop, dia - S4 gallop
Term
Which shows LV hypertrophy on EKG, systolic or diastolic dysfunction?
Definition
Diastolic
Term
What is the most common cause of systolic HF?
Definition
CAD
Term
What is the second most commmon cause of systolic HF?
Definition
dilated cardiomyopathy
Term
What is the most likely type of HF in a 75 yo female w/ HTN?
Definition
Diastolic
Term
What is the most common cause of (R) HF?
Definition
(L) HF
Term
6 sx of (R) HF.
Definition
1) Anorexia 2) ABd pain/dist. 3)Peripheral swelling 4) Nasal congestion 5) Dyspnea and chest discomfort on exertion 6) Wt gain
Term
What murmurs occur in (R) HF?
Definition
tricuspid regurg, and pulmonic regurg.
Term
Impaired contractility of the (L) ventricle is in systolic or diastolic dysfunction? Impaired relaxation?
Definition
Contractility - systolic, relaxation - diastolic
Term
5 signs of (R) HF?
Definition
1) JVD 2) Hepatomegaly 3) Ascites 4) Peripheral edema 5) (R) sided S3
Term
Low output failure occurs in what? What does it cause?
Definition
Systolic HF, cold extremities and narrow pulse pressure
Term
4 causes of (R) HF?
Definition
1) Pulmonary arterial HTN 2) (L) heart dz 3) Pulmonary dz 4) THromboembolic dz
Term
3 common causes of decompensation?
Definition
1) Dietary Na intake 2) Medical noncompliance 3) Arrhythmia
Term
3 common causes of HF in the western world?
Definition
1) CAD 2) HTN 3) DCM
Term
4 conditions that cause high output states and are uncommon causes of HF?
Definition
1) anemia 2) thyrotoxicosis 3) Beriberi 4) AV fistula
Term
Which of the following is not involved in the pathophysiology of HF? a) ANS b) Renin angiotensin system c) ACTH-cortisol system d) Aldosterone
Definition
c) ACTH-cortisol system
Term
What is the role of the ANS in HF?
Definition
Increased symp. activity (NE). Increased contractility and tachycardia worsen ischemia (can trigger VT or SCD)
Term
What is the effect of angiotensin in HF?
Definition
vasoconstrictor causing increased SVR, stim. aldosterone
Term
What is the effect of aldosterone on HF?
Definition
increases renal Na retention - hypertrophy and fibrosis of myocardium and vascular smooth mus. - reduced vascular compliance and vent. diastolic dysfxn
Term
All are considered bad guys when it comes to HF except? a) epinephrine b) natriuretic peptide c) NE d) angiotensis e) aldosterone
Definition
natriuretic peptide
Term
What is the set of criteria for HF called?
Definition
Framington criteria
Term
4 signs of HF?
Definition
1) pulsus alterans 2) low grade fever 3) Cheyne stokes respiration 4) cardiac cachexia
Term
What lab is considered diagnostic for HF?
Definition
BNP (elevated in HF)
Term
What is the most useful test to dx HF?
Definition
2D echo
Term
What are the 4 classes of HF?
Definition
1) No limitations in phys. activity 2) Slight limits 3) Marked limits 4) Sx at rest
Term
What 2 drugs are used to tx everyone w/ HF?
Definition
ACEI/ARBs and beta blockers
Term
What meds are given to HF pts in the congestive state?
Definition
Diuretics
Term
All of the following have been shown to prolong survival except? a) ARBs b) Beta blockers c) ACEI d) Digoxin
Definition
Digoxin
Term
Which drugs used to tx HF cause hypokalemia? Hyperkalemia?
Definition
Diuretics, spironolactone (aldosterone antagonist)
Term
The suffix -prils indicates what type of med? - tan? - olol?
Definition
ACEI, ARBs, beta-blockers
Term
What are side effects of ACEI?
Definition
cough and angioedema
Term
What are side effects of ACEI?
Definition
cough and angioedema
Term
Which drugs cause worsening of renal function?
Definition
ACEI and ARBs
Term
What drugs can worsen HF if started in high doses or in acute CHF?
Definition
beta-blockers
Term
Indication for ICD?
Definition
EF < 35%
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