Term
| Differentiate between Stage A and Stage B of Heart Failure |
|
Definition
A: Risk factors but no structural disease or symptoms
B: Structural disease, no symptoms/signs |
|
|
Term
| Describe Stage C of Heart failure |
|
Definition
| Current or past symptoms of heart failure, like shortness of breath |
|
|
Term
| Describe Stage D of heart failure |
|
Definition
| Pt's have refractory heart failure-are usually maximally medicated and measures must be taken to keep their heart going. |
|
|
Term
| Name the 3 Big causes of Heart failure |
|
Definition
Ischemic Heart Disease
Cardiomyopathy (dilated)
HTN |
|
|
Term
| Name 4 common causes of Left-sided heart failure |
|
Definition
Ischemic heart disease (most common)
HTN (chronic or malignant)
Aortic/mitral valve disease
Cardiomyopathies |
|
|
Term
| Name 4 common causes of Right-sided heart failure |
|
Definition
Left heart failure
COPD
Pulmonary emboli
Tricuspid/pulmonic valve disease |
|
|
Term
| Which type of heart failure is associated with decreased contractility or increased afterload? |
|
Definition
|
|
Term
| Explain what is occuring in the heart chambers during Diastolic heart failure |
|
Definition
There is impaired active relaxation of the chambers during diastole, due to impaired Ca+ reuptake into sarcoplasmic reticulum.
This leads to abnormalities in passive filling
|
|
|
Term
| What do catecholamines do when they are considered to have an inotropic effect? |
|
Definition
| They increase the force of contraction |
|
|
Term
| What do catecholamines do when they are considered to have a chronotropic effect? |
|
Definition
| They increase the rate of contraction |
|
|
Term
| Differentiate between compensatory and decompensatory heart failure |
|
Definition
The heart adopts certain methods to deal with problems.
If these methods are successful and the heart does not fail it is termed compensatory heart failure.
If the heart adopts methods but they are not enough to prevent heart failure then it is termed decompensatory. |
|
|
Term
| Name 3 Compensatory mechanisms the heart may adopt |
|
Definition
Catecholamine release (force and rate of contraction)
Hypertrophy
Dilation of ventricle (increased stretching and thus force of contraction) |
|
|
Term
|
Definition
| Difficulty breathing when lying on your back |
|
|
Term
| Name 2 major signs of heart failure |
|
Definition
1. Progressive breathlessness
2. Pulmonary problems (like edema,congestion, rales etc. ) |
|
|
Term
| What part of the heart causes heart sound S1? |
|
Definition
| Closure of mitral and tricuspid valves |
|
|
Term
| What causes heart sound S2? |
|
Definition
| Closure of pulmonic and aortic valves |
|
|
Term
| What causes heart sound S3? |
|
Definition
ABNORMAL HEART SOUND in older pts
Early diastolic, rapid filling of dilated ventricles creates sound |
|
|
Term
| What causes Heart sound S4? |
|
Definition
ABNORMAL HEART SOUND
late diastolic sound caused by loss of compliance of hypertrophied and subsequently stiff ventricle. Atrium needs an extra little push to get all the blood into the ventricles. |
|
|
Term
| Which heart sound is called the ventricular gallop? |
|
Definition
|
|
Term
| Which heart sound is called Atrial Gallop? |
|
Definition
|
|
Term
| Name 4 methods of diagnosing heart failure |
|
Definition
EKG
Chest radiograph
Echocardiogram
Cardiac catheterization |
|
|
Term
| Which portion of the heart is specifically assessed with cardiac catheterization? |
|
Definition
|
|
Term
| What might the dr specifically look for in Echocardiograms? |
|
Definition
| Look for enlargement and valvule disease |
|
|
Term
| Which drug class are Captopril, lisinopril and enalapril? |
|
Definition
| Angiotensin Converting Enzyme Inhibitors |
|
|
Term
| Which drug class are Losartan, Valsartan, Candesartan and Ibersartan? |
|
Definition
ARBs
Angiotensin II Receptor Blockers |
|
|
Term
| Name 2 drug classes that are first choice for treating patients with Stage B heart failure |
|
Definition
ACEI
ARBs
(might also be on a beta blocker) |
|
|
Term
| What is one advantage of ARBs over ACEI? |
|
Definition
| ARBs do not produce a cough like ACEIs do |
|
|
Term
| What effect of ARBs and ACEIs is helpful in treating heart failure? |
|
Definition
lowers venous pressure
lowers systemic vascular resistance
decreases circulating catecholamines |
|
|
Term
| In addition to the same therapy as Stage B, what might be given to patients with Stage C heart failure? |
|
Definition
Diuretics (reduce blood volume and thus demand on the heart)
Cardiac glycosides (increase contractility) |
|
|
Term
| Give an example of a cardiac glycoside that might be given to a pt in STage C |
|
Definition
|
|
Term
| Name 5 treatment methods for Stage D heart failure |
|
Definition
Inotropes
Biventricular pacemaker
Implantable cardioverter-defibrillator (ICD)
Left ventricular assist device (LVAD)
Transplantation |
|
|
Term
| What drug class may be used as an inotrope in Stage D? |
|
Definition
Beta-adrenergic agonists
(possibly dopamine) |
|
|
Term
| Describe what occurs in the vessel in atherosclerosis |
|
Definition
| Inflammation of intima of large and medium sized arteries narrows the vessels |
|
|
Term
| Describe the difference in transport of lipids between LDLs and HDLs |
|
Definition
LDLs-lipids from liver to body
HDLs-lipids from cells to liver for excretion |
|
|
Term
| How is the disease process of Atherosclerosis initiated? |
|
Definition
Injury to the vessel wall increases permeability
LDLs accumulate |
|
|
Term
| What triggers the inflammatory process of atherosclerosis? |
|
Definition
When LDLs accumulate they are oxidized by endothelial cells.
Macrophages then enter the vessel wall to take care of the oxidized LDL particles |
|
|
Term
| Describe the changes in macrophages after they have entered the vessel wall (in atherosclerosis) |
|
Definition
They take up oxidized LDL particles, grow in size and become foam cells.
These foam cells accumulate, forming a convex surface that increases shear stress. |
|
|
Term
| How do macrophages compound the problem of atherosclerosis? |
|
Definition
1. When they become foam cells they continue to release substances that further damage the site.
2. Along with platelets they secrete growth factors that cause migration and proliferation of smooth muscle cells.
This creates a fibrotic cap over a lipid-rich core. |
|
|
Term
| Name 3 lab tests that might be done in diagnosis of atherosclerosis |
|
Definition
Fasting total serum cholesterol
HDLs
Serum highly sensitive C-Reactive Protein (hs-CRP) |
|
|
Term
| What is the desirable level of Total cholesterol? |
|
Definition
|
|
Term
| Approx what should HDL levels be at? |
|
Definition
|
|
Term
| Approx. what level should LDLs be at? |
|
Definition
|
|
Term
| Approx. what level should Triglycerides be at? |
|
Definition
|
|
Term
| What approx ratio of HDL/TC is desired? |
|
Definition
|
|
Term
| What does hs-CRP indicate? |
|
Definition
| highly-sensitive C-reactive protein indicates inflammation in the body |
|
|
Term
| Which drug category acts by inhibiting HMG CoA reductase and subsequently inhibits cholesterol production? |
|
Definition
|
|
Term
| Which drug class works by binding cholesterol and bile and excreting it and preventing it's absorption into circulation? |
|
Definition
|
|
Term
| Which drug class is used to lower triglycerides and slightly increase HDLs? |
|
Definition
Fibrates
(PPAR-alpha agonists) |
|
|
Term
| Which drug is good for lowering total cholesterol, LDL and triglyceride levels? |
|
Definition
|
|
Term
| Name 4 types of drugs used to decrease risk of atherosclerosis |
|
Definition
Statins
Bile acid Binders
Fibrates
Nicotinic acid |
|
|
Term
| Which drugs are contraindicated for patients on Statins? |
|
Definition
| Erythromycin and clarithromycin because they increase Statin levels in the blood. |
|
|
Term
| What complication may arise with use of bile-acid binders? |
|
Definition
| They may interfere with absorption of other drugs (like b-blockers, APAP, tetracyclines, cephalosporins and oral contraceptives) |
|
|
Term
| Which 2 cholesterol lowering drugs may also decrease incidence of Diabetic nephropathy? |
|
Definition
|
|
Term
| Name 2 optometric considerations associated with nicotinic acid |
|
Definition
Macular edema
Toxic amblyopia |
|
|
Term
| Of all the Statin drugs listed, which may actually be able to decrease atherosclerotic plaques (whereas all the others just try to stop it from progressing) |
|
Definition
|
|
Term
| Name 2 contraindications of Statins |
|
Definition
Liver dysfunction
Pregnancy |
|
|
Term
What drug class do
Cholestyramine
Cholestipol
Colesevelam
fall in? |
|
Definition
|
|
Term
| Which cholesterol-lowering drug may increase risk of gallstones, anemia and bleeding? |
|
Definition
|
|
Term
| What pathophysiology of ischemic heart disease is different in women than in men? |
|
Definition
Women have smaller coronary arteries, and thus they produce less NO --> decreased dilation
Endothelial dysfunction |
|
|
Term
| Why is it so important to understand the differences in ischemic heart disease between women and men? |
|
Definition
The stereotypical signs of this are those that happen in men, thus it is less likely to be diagnosed in a woman.
Women are much more likely to die from an MI than men. |
|
|
Term
| What is the clinical term for chest pain that results from transient myocardial ischemia? |
|
Definition
|
|
Term
| Differentiate between Stable and variant angina |
|
Definition
Variant=fixed atherosclerotic lesion combined with a vasospastic episode
Stable-just the fixed atherosclerotic lesion |
|
|
Term
| Name 4 types of medical therapy for management of Angina Pectoris |
|
Definition
1. ASA q.d
2. Nitrates (dilation)
3. B-blockers
4. Ca channel blockers (dilation and prevention of spasm) |
|
|
Term
| Name 2 methods of surgical intervention in treatment of AP |
|
Definition
1. Percutaneous coronary intervention (PCI-balloon and stent)
2. Coronary Artery Bypass Grafting (CABG) |
|
|
Term
| What 3 conditions are included under the name Acute Coronary Syndromes? |
|
Definition
Unstable angina
Non-ST-elevation myocardial infarction (NTSEMI)
ST-elevation myocardial infarction (STEMI)
|
|
|
Term
| Name 4 mechanisms common to all Acute coronary syndromes (ACS) |
|
Definition
Rupture/erosion of fibrous cap of coronary artery cap
Platelet aggregation/adhesion
Thrombus formation/vasoconstriction
Embolization |
|
|
Term
| What is a differentiating factor between stable and non-stable angina? |
|
Definition
| The presence of 'rest' pain is present in unstable angina (pre infarction angina) |
|
|
Term
| How is NSTEMI differentiated from unstable angina? |
|
Definition
| Presence of cardiac enzymes indicates the blockage has progressed to NSTEMI |
|
|
Term
| Describe the degrees of blockage in the 3 Acute Coronary Syndromes |
|
Definition
1. Unstable angina- no blockage, but thrombus can break off at any time-progressive luminal narrowing
2. NSTEMI-Partial occlusion of coronary artery
3. Total occlusion of coronary artery (myocardial infarction) |
|
|
Term
| What happens to the heart chambers with aortic stenosis? |
|
Definition
There is pressure overload on the left ventricle since it can't get all the blood past the aortic valve.
Leads to hypertrophy of the left ventricle. |
|
|
Term
| What heart sounds are indicative of aortic stenosis? |
|
Definition
Soft S2 sound due to lack of aortic component (just pulmonary valve can be heard)
Development of S4 sound (due to hypertrophy) |
|
|
Term
| Name 3 symptoms/progressions of aortic stenosis |
|
Definition
Angina
Syncope with exercise
Heart Failure |
|
|
Term
| What is a major cause of mitral valve stenosis? |
|
Definition
|
|
Term
Why does mitral stenosis result in pulmonary congestion?
How does it affect the atria? |
|
Definition
The problem with the mitral valve impedes blood flow into the left ventricle, causing a back up into pulmonary circulation.
This increases the demand on the atria to propel the blood. It is not that strong in the first place and can thus result in failure.
|
|
|
Term
| Name 2 major symptoms of pulmonary problems? |
|
Definition
Shortness of breath
cough |
|
|
Term
|
Definition
| Accumulation of fluid in the abdomen-->anorexia |
|
|
Term
| Why might Mitral stenosis cause embolization |
|
Definition
| Blood stagnates when it is unable to leave the chamber, it begins to clump together. Can cause an embolus when it finally gets out of the heart |
|
|
Term
| What heart sound might be associated with mitral stenosis? |
|
Definition
|
|
Term
| Name 3 causes of aortic regurgitation |
|
Definition
Idiopathic aortic root dilation
Rheumatic heart disease
Collagen vascular disease |
|
|
Term
| How does the heart try to compensate for aortic regurgitation? |
|
Definition
| Increases strength of contraction to try to get rid of blood. |
|
|
Term
| Describe what you moght observe when checking the pulse and BP of an individual with aortic regurgitation. |
|
Definition
Increased pulse pressure (pounding pulse)
Pt will have high systolic pressure and low diastolic pressure |
|
|
Term
| Which problem with the heart is assocaited with dyspnea, orthopnea and paroxysmal nocturnal dyspnea? |
|
Definition
|
|
Term
|
Definition
| capillary pulsation in nail beds |
|
|
Term
| What is De Musset's sign? |
|
Definition
| head bobbing with each heartbeat |
|
|
Term
| Name 3 signs of aortic regurgitation |
|
Definition
Increased left ventricular size
Quincke's sign
De Musset's sign |
|
|
Term
| Name 4 causes of mitral valve regurgitation |
|
Definition
Mitral valve prolapse
coronary artery disease
rheumatic heart disease
ruptured chordae tendinae |
|
|
Term
| What chamber of the heart is first affected by mitral regurgitation? |
|
Definition
| The left atria-blood backs up in it since some gets pushed back in whenever the left ventricle contracts. |
|
|
Term
| Name 4 types of medical therapy used to treat valvular dysfunction |
|
Definition
Diuretics
Digitalis
Anticoagulants
Vasodilators (reduce resistance) |
|
|
Term
| Briefly describe what occurs in a valve autograft (replacement) |
|
Definition
| The pulmonic valve is moved to replace the aortic valve, and a homograft is used to replace the pulmonic valve. |
|
|
Term
| What is the most common bacterial cause of infective endocarditis? |
|
Definition
|
|
Term
| What is the most common fungal cause of infective endocarditis? |
|
Definition
|
|
Term
| Name 2 ocular manifestations of infective endocarditis |
|
Definition
1. Splinter hemorrhages of conj
2. Roth spots |
|
|
Term
| What is done prior to invasive procedures to prevent the development of infective endocarditis? |
|
Definition
|
|
Term
Which antibiotic is used for prophylactic prevention of endocarditis?
What if the pt is allergic to penicillins? |
|
Definition
2-3 mg Amoxicillin 1 hour before
Clindamicin 600mg if allergic |
|
|
Term
| What term is used to describe conditions that are primary diseases of the heart and are not secondary to increased pressure? |
|
Definition
|
|
Term
| Name 2 types of medical therapy used to treat hypertrophic cardiomyopathy |
|
Definition
Beta blockers
Digitalis (end stage) |
|
|
Term
| Name 3 types of surgery for treating hypertrophic cardiomyopathy |
|
Definition
Myomectomy (reduce thickness of septum)
Pacemaker and defibrillator implantation
Intentional septal infarction |
|
|
Term
| What is the proper term for 'Broken Heart Syndrome'? |
|
Definition
|
|
Term
| What triggers Takotsubo cardiomyopathy and who tends to experience it? |
|
Definition
| Mostly experienced by women, triggered by emotional stress. |
|
|
Term
| Differentiate between Mi and Takotsubo's |
|
Definition
Same symptoms, different signs
Takotsubos will not have cardiac enzyme elevation (or only slightly), EKG will be normal.
Takosubos will have an odd type of left ventricular ballooning |
|
|
Term
| Name 7 possible causes of Acute pericarditis |
|
Definition
MI
viral
SLE
Infectious endocarditis
Malignancy
Radiation
Drugs |
|
|
Term
| Name 2 clinical features of Acute pericarditis |
|
Definition
1. Inspiratory chest pain on left side
2. Friction rub during systole and diastole |
|
|
Term
| How is Acute pericarditis treated? |
|
Definition
1. Treat underlying/causative problem
2. NSAIDs, colchicine, steroids |
|
|
Term
| What is pericardial effusion? |
|
Definition
| Fluid accumulation secondary to pericarditis |
|
|
Term
| What clinical features are associated with pericardial effusion? |
|
Definition
no symptoms
just soft heart sounds due to extra fluid dampening the sound |
|
|
Term
| What is cardiac tamponade? |
|
Definition
As a result of pericarditis there is rapid accumulation of fluid.
This fluid compresses the heart, inhibiting filling |
|
|
Term
| How is Cardiac tamponade detected and treated? |
|
Definition
There will be decreased systolic pressure during inspiration and the patient may be in shock.
Treated by pericardiocentesis |
|
|
Term
| What causes constrictive pericarditis |
|
Definition
| Previous inflammation produces a thickened pericardium |
|
|
Term
| Name 8 symptoms/signs of carotid TIA |
|
Definition
1. Hollenhorst plaques
2. Amaurosis fugax
3. Some sort of paresis or numbness
4. Ataxia
5. Aphasia
6. Dysarthria
7.Diplopia
8. Vertigo |
|
|
Term
| What do endarectomies treat? |
|
Definition
They are an option after a carotid TIA
-Plaque is removed from the carotid artery |
|
|
Term
| What is the best management for patients with <75% carotid artery occlusion? |
|
Definition
|
|
Term
| What are the 5 P's associated with Peripheral arterial disease? |
|
Definition
Pain
Pallor
Paralysis
Pulselessness
Paresias |
|
|
