Heart Failure + Ischemic Disease

Question 1

S/S of heart failure (4)

Answer 1

1. Exertional dyspnea
2. Orthopnea - SOB in supine
3. Paroxysmal nocturnal dyspnea (SOB at night)
4. Fatigue

Question 2

Common Clinical S/S of HF

Answer 2

1. Fluid retention
2. Ascites
3. Pleural effusion
4. JVD
5. Hepatomegaly
6. Pitting edema
7. Tachycardia
8. S3 gallop

Question 3

Classifications of HF

Answer 3

1. Right sided HF
2. Left sided HF
3. CHF
4. HFpEF
5. HFrEF

Question 4

what is Left sided heart failure?

Answer 4

reduced contractility of the left ventricle resulting in :

• reduced SV, EF, and CO
• reduced blood flow to body and reduced O2 delivery
• fatigue, exercise tolerance, and SOB

Question 5

what are some causes of Left sided heart failure?

Answer 5

1. HTN
2. CAD
3. Arrythmias
4. decreased CO caused by impaired ventricular filling and decreased ventricular relaxation

Question 6

describe how vascular congestion occurs with Left sided HF?

Answer 6

1. reduced contractlity leads to increased LVEDV
2. results in decreased movement from LA
3. increased blood accumulation in LA
4. decreased blood movement from lungs into LA
5. increased blood volume in pulmonnary circulation = congestion
   
   • pulmonary edema
   • hemoptysis (bloody sputum)

Question 7

mnemonic for Left sided HF S/S

Answer 7

DO CHAP

1. Dyspnea
2. Orthopnea
3. Cough
4. Hemoptysis
5. Adventitious breath sounds
6. Pulmonary congestion

Question 8

what is right sided heart failure?

Answer 8

reduced contractility of R ventricle results in:

• accumulation of blood in RV, RA and systemic circulation

Question 9

S/S of right sided HF

Answer 9

1. abdominal blotting/swelling/ascities
2. kidney failure
3. JVD
4. weight gain
5. dependent edema
6. increased frequency of DVT and PEs

AKJ WID

Question 10

what is CHF?

Answer 10

the heart is unable to pump enough blood to meet the metabolic needs of the body b/c of pathological changes in the myocardium

often synonymously with left HF

Question 11

describe the evoluation of the clinical stages of CHF

Answer 11

1. normal → no symptoms
2. asymptomatic LV dysfunction
   
   • no symptoms
   • normal exercise
   • abnormal LV function
3. compensated CHF
   
   • reduced exercise ability
4. decompensated CHF
   
   • symptoms
   • reduced exercise ability
5. refractory CHF
   
   • symptoms not controlled w/treatment

Question 12

describe the NY heart associations HF classifications

Answer 12

1. Class 1 → Cardiac disease, but no symptoms and no limitation in ordinary physical activity
2. Class 2 → Mild symptoms and slight limitation during ordinary activity
3. Class 3 → significant limitation in activity due to symptoms. comfortable only at rest
4. Class 4 → severe limitations. symptoms even while at rest

Question 13

Staging of HF

Answer 13

1. Stage A → pre-heart failure
2. Stage B → a structural heart disorder but no symptoms at any stage
3. Stage C → symptoms exisit due to an underlying structural issue but it is managed with medical treatment
4. Stage D → advanced disease that requries hospitalization and possibly a heart transplant or palliative care

Question 14

what is acute HF?

Answer 14

HF symptoms appear suddenly or a rapid worsening of exisitng symptoms of HF occurs

• exacerbation
• sudden onset of dyspnea and limb and LE swelling
• 5 lb rule

Question 15

what is systolic HF?

Answer 15

also called HFrEF

• left ventricular contractility is reduced in turn reducing EF (L/R) and O2 delivery to the periphery
• net effect-reduced delivery of blood into systemic circulation and subsequent O2 delivery
• reduced LV function is typical

Question 16

what is diastolic HF?

Answer 16

HFpEF

• nearly half of all pts with HF have a normal EF
• seen more frequently in:
  
  • females
  • older age
  • HTN
  • metabolic syndrome, renal dysfunction
  • obesity

Question 17

describe the pathophysiology of diastolic HF

Answer 17

1. ventricles lose ability to relax normally
2. ventricles becomes stiffer and less compliant
   
   • results in reduced filling during diastole
3. global loss of cardiac, vascular, and peripheral reserve
4. often have pulmonary HTN and exercise intolerance

Question 18

T/F: diastolic HF pts can exercise just fine

Answer 18

TRUE

these pts should be achieving or exceeding the guideline-recommended doses of physical activity

Question 19

compare systolic HF to diastolic HF

Answer 19

1. systolic HF (HFrEF)
   
   • chronic comorbidities
   • more men than women
   • more frequent hospitalization
2. diastolic HF (HFpEF)
   
   • chronic comorbidities
   • more women than men

Question 20

T/F: HF can be recognized as a neuroendocrine disease

Answer 20

TRUE

HF is a response to a long-term hyperautonomic and/or chronic hyperinflammatory state

Question 21

medications that a HF pt may be on (6)

Answer 21

1. Diuretics
2. Beta-blockers
3. ACE inhibitors/ARB
4. Ca channel blockers
5. Vasodilators
6. Positive ionotropes

Question 22

define ischemia

Answer 22

a condition in which blood flow (and thus oxygen) is restricted or reduced in a part of the body

Question 23

define hypoxemia

Answer 23

low oxygen content in the blood (low O2 sats)

Question 24

define hypoxia

Answer 24

a condition in which the body or a region of the body or a region of the body is deprived of adequate oxygen supply at the tissue level

Question 25

what is ACS?

Answer 25

Acute Coronary Syndrome an umbrella term for a range of symptoms associated with sudden, reduced blood flow to the heart ie cardiac ischemia

Question 26

what types of conditions are included with ACS?

Answer 26

1. heart attack (MI) 2. unstable angina 3. ST segment elevation MI (STEMI) 4. Non-ST segement elevation MI (NSTEMI)

Question 27

diagnosis of ACS is dependent on what factors?

Answer 27

1. Pt history * chest or left arm pain * hx of CAD 2. Exam * hypotension, diaphoresis * pulmonary edema, rales * ECG changes → ST-segment deviation * Elevated cardiac biomarkers * Tnl, TnT, CK-MD, Tn-Troponin I and T, CK-creatine kinase

Question 28

what is IHD?

Answer 28

ischemic heart disease (aka coronary heart disease or coronary artery disease) the most common specific diagnosis under the umbrella term of ACS

Question 29

list some causes of IHD (4)

Answer 29

1. Atherosclerosis of the coronary arteries (most common) 2. Coronary thrombus or emboli 3. Coronary spasm 4. Complications of connective tissue disorders

Question 30

common symptoms of IHD

Answer 30

1. chest pain or discomfort, which may involve pressure, tightness or fullness 2. pain or discomfort in one or both arms, the jaw, neck, back or stomach 3. SOB 4. feeling dizzy or lightheaded 5. nausea 6. diaphoresis

Question 31

what is ischemic cardiomyopathy?

Answer 31

heart is chronically ischemic which is a type of cardiomyopathy caused by a chronic narrowing of the coronary arteries which, in turns, diminishes blood supply to the heart most common types of dilated cardiomyopathy

Question 32

T/F: one can live with CAD for a long time

Answer 32

TRUE

Question 33

what does ischemic cardiomyopathy ultimately leads to?

Answer 33

ulimately these pts develop clinical CHF prognosis is largely determined by myocardial viability (the number of functioning myocytes)

Question 34

how can RA impact the heart?

Answer 34

attacks the cardiac skeleton and result in: 1. rheumatoid valvular heart disease 2. rheumatoid myocarditis 3. rheumatoid CAD 4. rheumatoid pulmonary HTN

Question 35

what is IHD: angina pectoris

Answer 35

intermittent chest pain caused by transient, reversible myocardial ischemia can be stable or unstable

Question 36

what is stable angina?

Answer 36

1. caused by mismatch between O2 delivery and O2 need 2. brought on by exertion or other form of stress 3. occurs at predictable HR 4. crushing or squeezing substernal sensation with possible radiation down the L arm 5. reduction in stress reduces symptoms 6. responds to NO

Question 37

what is unstable angina?

Answer 37

1. brought on by exertion or other forms of stress 2. onset is predictable 3. crushing or squeezing substernal sensation with possible radiation to the arm 4. poor prognosis 5. NO may be of benefit

Question 38

list and describe the different classification of angina

Answer 38

Question 40

list major ischemic syndromes

Answer 40

1. angina pectoris * stable * unstable 2. ischemic cardiomyopathy 3. MI 4. sudden cardiac death

Question 41

list the stages of morphologic stages of MI inflammation and repair

Answer 41

* 0-6 hours → no change * 6-24 hrs → early features of coagulation necrosis * 1-4 days → coagulation necrosis with acute inflammatory response * 5-7 days → macrophage activity (phagocytic removal of dead myocytes) * 7-10 days → developing perihperal rim of granulation tissue * 1-6 weeks → progressive organization of infart * 1-3 months → progressive collagen deposition, mature replacement scar * area of injury becomes a scar

Question 42

what is a reperfusion injury?

Answer 42

tissue damage caused when the blood supply returns to tissue after a period of ischemia or lack of O2 associated with microvascular injury, particularly due to increased permeability of capillaries and arterioles that lead to an increased diffusion and fluid filtration into the tissues