Week 3: Heart Failure, Cardiomyopathy

Which one of these is the most common consequence of Cardiac muscle dysfunction?

a. Hypertension

b. Heart failure

c. Pulmonary embolism

d. Heart valve abnormalities

b. Heart failure

What age related changes lead to cardiac muscle dysfunction?

HTN (CAD), cardiac arrhythmias, renal insufficiency, heart valve abnormalities, congenital acquired heart disease, pericardial effusion, myocarditis, pulmonary embolism, pulmonary HTN

What role does the RAAS system play in heart failure?

RAAS causes sodium retention > leads to fluid overload on the heart

What is cardiomyopathy?

disease of the heart muscle

What are the causes of cardiomyopathy?

- primary causes - pathological processes in heart muscle

- secondary causes - result of systemic disease processes (HTN, valve disease, amyloidosis, toxicity, inflammation)

How does hypertension lead to heart failure?

HTN > L ventricular hypertrophy > heart failure

A patient with pericarditis presents with elevated intracardial pressures, reduced SV and limited ventricular diastolic filling. What is the most likely diagnosis?

a. cor pulmonale

b. cardiac tamponade

c. pericardial effusion

d. myocarditis

b. cardiac tamponade

What is pericarditis?

inflammation of the pericardium (fluid build up)

What are signs and symptoms of pericarditis?

fever, chest pain, worse with deep breathing

Pericarditis can lead to __________

pulmonary effusion

What is pericardial effusion?

fluid build up in pericardium

What are signs and symptoms of pericardial effusion?

SOB, chest pain, edema in LEs

Pericardial effusion could spread to myocardium and lead to ________

cardiac tamponade

What is cardiac tamponade?

compression of the heart by fluid build up > heart can't relax enough to fill blood into chambers

What is myocarditis?

inflammation of the heart muscle

Myocarditis can cause?

heart failure

How does myocarditis heal?

may heal normally or with fibrosis that affects heart muscle

What is a pulmonary embolism?

life-threatening condition that occurs when a blood clot blocks an artery in the lungs (usually caused by DVT)

Which one of the following is NOT a s/s of heart failure?

a. wet cough

b. shortness of breath/dyspnea

c. orthopnea

d. paroxysmal nocturnal dyspnea

a. wet cough

Why is dyspnea a sign of heart failure?

poor gas transport

Why is paroxysmal nocturnal dyspnea a sign of heart failure?

because lungs are already burdened with fluid, the supine position increases fluid return when sleeping

Why is othopnea a sign of heart failure?

fluid build up causes dypnea in supine position

What are other signs and symptoms of HF?

- tachypnea

- peripheral edema

- S3 heart sounds

- jugular distension

- extremity cyanosis

- dry cough

- weight gain

- fatigue

Which of the following is a sign indicative of left-sided heart failure?

a. jugular distension

b. pulmonary rales

c. hepatomegaly/splenomegaly

d. peripheral edema

b. pulmonary rales

What are signs indicative of right sided HF?

PERIPHERAL EFFECTS:

- dependent edema

- bloating

- jugular distension

- increased central venous pressure

- liver/spleen enlargement

- peripheral cyanosis

- increased right atrial pressure

What are signs indicative of left sided heart failure?

PULMONARY EFFECTS:

- dyspnea

- dry cough

- fatigue

- pulmonary rales

- enlarged, stretched out heart

- pleural effusion

- peripheral cyanosis

- increased respiration

What is a sign indicative of HF on both sides?

SOB

A patient reports difficulty with walking uphill on the driveway. No complaints at rest. Which stage of HF?

a. Class I

b. Class II

c. Class III

d. Class IV

b. Class II

What are the stages of HF?

Class I: cardiac diseases without limitations on physical activity

Class II: cardiac disease resulting in slight limitation of physical activity, comfortable at rest

Class III: cardiac disease with marked limitation on physical activity, comfortable at rest

Class IV: cardiac disease affecting patient's ability to carry out any physical activity without discomfort, evident at rest

In which type of HF is the ejection fraction NOT reduced?

a. diastolic HF

b. systolic HF

c. left sided HF

d. right sided HF

a. diastolic HF

Which one of the following indicates worsening HF?

a. BNP 90pg/ml

b. QRS complex - 4 boxes

c. 6 MWT of 500m

d. Apex beat in the left mid axillary line

d. apex beat in the left mid axillary line

What level of BNP (ANP) indicates HF?

> 100 pg/ml > stimulated by stretch (fluid overload)

How many boxes of QRS complex shows worsening HF?

> 4 boces

What parameters for the 6 MWT indicate worsening heart failure?

< 468 m indicates poor prognosis, < 300 m predicts mortality

What heart sounds would you hear if there is worsening HF?

S1, S2, S3 (added heart sound)

Which device minimizes the load on the heart as the patient awaits a transplant?

a. biventricular pacemaker

b. chest tube

c. intra-aortic balloon pump

d. ventricular assistive device

d. ventricular assistive device

The ventricular assistive device keeps the HR ___ beats below ICD firing

20

Which of the following risk factors are tied to metabolic syndrome?

a. male waist circumference 35-40 inches

b. fasting blood sugar of 110 mg/dl

c. serum triglycerides of 140 mg/dl

d. blood pressure of 128/80 mm/Hg

b. fasting blood sugar of 110 mg/dL

What is metabolic syndrome?

a cluster of biochemical and physiological abnormalities associated with the development of cardiovascular disease and type 2 diabetes

What are the values of elevated waste circumference tied to metabolic syndrome?

M > 40 inches, F > 35 inches

What are the values of elevated serum triglycerides tied to metabolic syndrome?

> 150 mg/dL

What are the values of reduced serum HDL tied to metabolic syndrome?

M < 40 g/dL, F < 50 mg/dL

What is blood pressure tied to metabolic syndrome?

> 130/80

What fasting blood glucose values are tied to metabolic syndrome?

> 100 mg/dL

What is a normal response to exercise in vitals?

a. diastolic pressure rises by 20 mmHg

b. heart rate increases in proportion to the exercise then plateaus

c. SBP rises then after a particular level SBP starts to drop progressively as workload increases

d. O2 stats drop from 99 to 89

b. heart rate increases in proportion to the exercise then plateaus

What are the normal responses to exercise seen in vitals?

- normal HR increases (

- steady HR (plateaus at a given level of intensity

- resting HR lower in trained exerciser

- recovery phase after 1 minute HR should drop more than 12 bpm

- systolic BP rises in proportion to workload

- DBP increase or decrease no more than 10 mmHg

- SBP shouldn't continue to rise after 5 minutes

- should not see sustained elevation of DBP in recovery phase

- SpO2 should not be less than 92% in cardiac patient

What are abnormal responses to exercise for vitals?

- hypertensive response: abnormally high SBP with a given level of exertion

- exertional systolic hypertension: BP is normal, starts exercise and SBP rises then after a particular level SBP drops progressively as workload increases

- blunted/flat: slight increase in SBP with low levels of exertion but as exertion levels go up the DBP doesn't go up

In left sided heart failure, where does blood back up into?

left atrium and lungs

In right sided heart failure, where does blood back up into to?

right atrium and venous vasculature

What are indications of systolic HF?

- reduces SV, CO, EF

- HF with reduced ejection fraction (HFrEF)

What are indications of diastolic HF?

- reduced SV, CO

- EF unaltered

- HF with preserved ejection fraction (HFpEF)

What level of the Borg Scale is considered adequate for training?

11-13 or 3-5 (modified)

In mitral regurgitation, blood leaks into?

L atrium

What type of murmur is heard in mitral regurgitation?

holosystolic murmur

What type of murmur is heard with mitral stenosis?

snap diastolic murmur

During tricuspid regurgitation, blood leaks into the (R/L) atrium, which leads to (R/L) HF

R atrium, R HF

What type of murmur is heard with tricuspid regurgitation?

holosystolic murmur

What type of murmur is heard in tricuspid stenosis?

snap diastolic murmur

What is a sign and symptom that is indicative of aortic valve regurgitation/ in sufficiency?

high systolic pressure with lower diastolic pressure means wider pulse pressure > hyperdynamic circulation (bounding pulse)

What type of murmur is heard with aortic valve regurgitation/insufficiency?

diastolic murmur heard in ERBs area

What type of murmur is heard with aortic valve stenosis?

systolic murmur heard at aortic area

What type of murmur is heard with pulmonary valve regurgitation/insufficiency?

early diastolic decrescendo murmur heard in ERBS area during inspiration

What type or murmur is heard with pulmonary valve stenosis?

mid to late systolic murmur heard at pulmonic area