Term
| what is ejection fraction? what is a normal value? |
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Definition
| the amount of volume being pumped out of the heart, normally 50-70% |
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Term
| what is systolic vs diastolic dysfunction? |
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Definition
| systolic: impaired contractility/ejection, diastolic: impaired filling/relaxation |
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Term
| how much of heart failure is due to systolic dysfunction (EF < 40%)? |
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Definition
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Term
| how much of heart failure is due to diastolic dysfunction (EF > 40%)? |
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Definition
| 40%. the EF is > 40%, b/c the heart is hypertrophic and is ejecting almost all of it's small(er) volume (relative to a normal heart) |
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Term
| what is the main presenting symptom of heart failure? |
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Definition
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Term
| what is the definition of heart failure? |
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Definition
| the heart is incapable of maintaining a cardiac output adequate to accomodate *metabolic requirements and the *venous return |
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Term
| when you have decreased CO or oncotic pressure, as you do w/heart failure, where does the fluid volume go? |
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Definition
| into the 3rd space, following gravity - when standing, into the lower extremities (knees, feet, ankles), when lying in bed, into the sacrum |
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Term
| what is the american college of cardiology method of classifying heart failure? |
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Definition
| A: risk factors, but no symptoms, B: in heart failure, but not symptomatic, C: in heart failure & half heart symptoms, D: cardiomyopathy, severe heart failure |
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Term
| what are the 2 formulas we need to know when diagnosing/treating heart failure? |
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Definition
| BP = CO x SVR and CO = HR x SV. if know these 2 formulas, you can figure out heart failure every time; know which direction to go in, what type of drug to give to patient and will see whether the choice works and whether the patient feels better; if you know these formulas, you will no know no fear because know what changes you make and how physiologically the patient will respond; *the biggest problem you always face is the patient’s BP is below normal and have to give drug that treats heart failure that also lowers BP |
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Term
| what is the #1 cause of heart failure in the US? what comes after it? what is the symptom of all these? how do you determine between them? |
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Definition
| #1: HTN, then ischemic heart disease, MI, valvular heart disease, CMP, congenital heart disease, and arrhythmia. -> SOB is the common symptom here, *H+P is what you use to suss them out |
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Term
| what is the NY heart association heart failure classification? |
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Definition
| SOB w/severe exertion, SOB w/moderate exertion, SOB w/mild exertion, and SOB at rest or w/minimal activity |
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Term
| what are the major neurohumoral responses in heart failure to standing up in order to perfuse the brain, liver, and kidneys? |
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Definition
| increase HR and increase SVR |
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Term
| what are the 2 major hormones of heart failure? |
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Definition
| adrenaline (increases HR and increases SVR) and the RAA axis (vasoconstriction, water retention - increase SV) |
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Term
| how can the body's system for maintaining SV become problematic? |
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Definition
| SVR is up (due to adrenaline), SV is up (too much due to RAA), and its harder for your heart to pump, pts end up SOB and the extra volume deposits in the tissues (edema) |
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Term
| what are the controlling mechanisms of SV (and thus systolic dysfunction)? what are the factors that combine with SV to give CO? |
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Definition
| controlling mechanisms of SV: *preload, *afterload and *inotropism factors that combine with SV to give CO: *HR, synergistic LV contraction, wall integrity and valvular competence. (the ones he emphasized are *starred) |
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Term
| what is the therapy of choice for systolic dysfunction? |
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Definition
| ACE inhibitors and beta blockers. diuretics relieve symptoms and reduce preload, but don't directly address the physiology and pathophysiology |
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Term
| what factors lead to LV dysfunction (EF <40%) and ultimately heart failure? |
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Definition
| volume overload (can be due to valvular heart disease mitral/aortic regurg), pressure overload (HTN), loss of myocardium (MI, viral), and impaire contractility |
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Term
| what are indications for dig/diuretics? |
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Definition
| if the pt doesn't respond to max beta blocker and ACE inhibitor w/diuretics OR if the pt presents initially w/EF below 40%. digitoxin is the only oral agent that increases EF (however, it will not prolong life) |
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Term
| what are symptoms of LV dysfunction? |
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Definition
| dyspnea on exertion, paroxysmal nocturnal dyspnea, tachycardia, couch and hemoptsis |
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Term
| what are signs of LV dysfunction? |
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Definition
| basilar rates, pulmonary edema, S3 gallop, pleural effusion, and cheyne-stokes respiration |
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Term
| what is the result of long term HTN in the heart? |
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Definition
| hypertrophy - which drops its capacity, displacing it's volume to the lungs and R side |
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Term
| how does diastolic dysfunction (hypertrophy) affect the kidney, and thus worsen the effect on the entire body? |
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Definition
| diastolic dysfunction causes less volume to be ejected, which the kidneys sense, causing them to reabsorb more Na/H2O (via the RAA axis) - increasing the volume, leading to overload, extending the heart failure cycle. (if have decreased CO or decrease volume status, SVR increases to maintain BP; in the cycle again and this time, underperfused instead of overperfused) |
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Term
| what is the warning sign for heart failure? |
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Definition
| increased sinus tachycardia - the heart is trying to compensate for SV decrease with a HR increase |
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Term
| what defines systolic dysfunction? |
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Definition
| big heart, s3, and a volume overloaded state |
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Term
| what defines diastolic dysfunction? |
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Definition
| small heart, s4, pressure overloaded state |
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Term
| what can cause diastolic dysfunction? |
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Definition
| infiltrative heart disease, hemachromatosis, amyloidosis, constriction of the pericardium, chronic ischemic heart disease, and aging |
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Term
| how do inspiration/expiration affect heart sounds? |
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Definition
| inspiration increases the venous blood return to the R side of the heart (this is why R-sided murmurs are generally increased with inspiration). expiration decreases venous return to the R side of the heart (this is why L-sided murmurs are generally increased with expiration) |
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Term
| why do people die of heart failure? |
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Definition
| heart failure and arrhythmia |
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Term
| how does heart failure cause arrhythmia? |
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Definition
| eventually, progressively high levels of NE will irritated muscle |
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Term
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Definition
| converts angiontensinogen to angiotensin I |
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Term
| what does angiotensin converting enzyme (ACE) do? |
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Definition
| converts angiotensin I to angiotensin II |
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Term
| what does *angiotensin II do? |
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Definition
| hits the AT-1 receptor, causing vasoconstriction, oxidative stress, cell growth, protienuria, LV remodeling, and vascular remodeling |
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Term
| what do angiotensin receptor blockers do? |
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Definition
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Term
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Definition
| a hormone released by the pituitary gland that causes vasocontriction in response to decreased systemic BP. (which central baroreceptors sense, which stimulate the hypothalamus, which stimulates vasopressin's release from the pituitary gland) |
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Term
| what are the *etiologies of diastolic dysfunction? |
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Definition
| HTN, IHSS (hypertrophic cardiomyopathy), mild to moderate aortic stenosis, restrictive heart diseases (amyloidosis, hemachromatosis, loeffler's eosinophila, and constructive heart disease, (infiltrative sarcoidosis, valvular heart disease, mitral stenosis, ischemic heart disease, and aging) |
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