Exam 4 - Heart Failure Flashcards
Heart Failure is defined as a complex syndrome that results from:
any structural or functional impairment of ventricular filling or blood ejection
s2
Five signs of tissue-hypoperfusion that result from HF:
fatigue, dyspnea, weakness, edema, and weight gain
s2
HF may be caused by structural abnormalities of what 5 cardiac structures?
pericardium, myocardium, endocardium, heart valves, or great vessels
s2
what EF % classifies HF with reduced EF (aka systolic HF)?
EF ≤ 40%
s2
what EF % classifies HF with preserved EF (aka diastolic HF)?
EF ≥50%
s2
A pt with clinical symptoms with an EF between ___ - ___% is labeled as having borderline HF w/ preserved EF
40-50%
s2
True or false: Diastolic dysfunction is present in both HFrEF and HFpEF.
True!
s2
Patters of what 2 things are the major distinguishing features between HFrEF and HFpEF?
LV dilation and remodeling
s2
What serves as the main marker for establishment of HF risk factors, treatment, and outcome?
Ejection Fraction!
s2
Which of the 2 HFs are women more likely to be affected by?
HF w preserved EF
s3
Which of the 2 HFs are men more likely to be affected by?
HF with reduced EF
s3
Which HF is more likely to have modifiable risk factors and a higher prevalence of MI, previous coronary intervention, CABG, and PVD?
HF w reduced EF
s3
what is the primary determinant of HFpEF?
left ventricular diastolic dysfunction
s4
what 5 things determine LV’s ability to fill?
pulmonary venous blood flow
LA function
mitral valve dynamics
pericardial restraint
active and passive elastic properties of LV
s4
What 3 things are majority of measurements of LV Diastolic dysfxn dependent on?
HR, loading conditions, and myocardial contractility
s4
Higher ________ are required to achieve normal end-diastole volume in pts with HFpEF.
LV filling pressures
s4
What is the steeper rise of the end-diastolic pressure-volume curve indicative of?
what does it result in regarding LV compliance?
delayed LV relaxation and an increase in myocardial stiffness
resulting in reduced LV compliance that restricts filling
s5
The reduced LV compliance that eventually restricts filling can precipitate what (regarding the left atrium and pulm system)?
LA hypertension, LA systolic & diastolic dysfunction,
pulmonary venous congestion, and exercise intolerance
s5
What does the left picture indicate about contractility?
what does the right picture indicate regarding LV compliance?
Left: a decrease in myocardial contractility as indicated by a decrease in the slope of the end-systolic pressure-volume relation
Right: a decrease in LV compliance as indicated by an increase in the position of the end-diastolic pressure-volume relation
These diagrams emphasize that heart failure may result from LV systolic or diastolic dysfunction independently
s5
List some common causes of Left Ventricular Diastolic Dysfxn
LV End- diastolic dysfunction or delay in relaxation which is considered a form of “active stiffening” is complicated by
Failure of the actin-myosin disassociation, which occurs due to inadequate perfusion or dysfunctional intracellular Ca++ homeostasis
S9
The NYHA system focuses primarily on ____ to classify HF?
the degree of physical limitation
S18
The ACC/AHA focus on ____ to classify HF?
on the presence & severity of HF
S18
What should be noted with classification of HF?
- note that these stages are progressive
- oftenclassified using a combination of both scoring systems
S18
Which NYHA Classification has no limitation and no symptoms from ordinary activity?
NYHA Class I
S18
What NYHA Classification has mild limitation with activity and comfortable at rest or with mild exertion?
NYHA Class II
S18
Which NYHA Classification has significant limitation with any activity and comfortable only at rest?
NYHA Class III
S18
Which NYHA Classification has discomfort with any physical activity and symptoms occuring at rest?
NYHA Class IV
S18
Which ACC/AHA classification has high risk of developing heart failure but no functional or structural heart deficits?
ACC/AHA Class A
S18
Which ACC/AHA classification has structural heart deficit but no symptoms?
ACC/AHA Class B
S18
Which ACC/AHA classification has heart failure symptoms due to underlying structural heart deficit with medical management?
ACC/AHA Class C
S18
Which ACC/AHA classification has advanced disease requiring hospitalization, transplant, or palliative care?
ACC/AHA Class D
S18
Which condition has improved survival rate in the past three decades: HFrEF or HFpEF?
HFrEF
S19
Which condition benefits with using medications: HFrEF or HFpEF?
HFrEF
S19
What are the treatments for HFpEF?
- Mitigation of sx’s
- treat associated conditions
- exercise
- weight loss
S19
What are the treatments for HFrEF?
- Beta Blockers
- ACE-Inhibitors
S19
What class of medication stimulate β-receptors on the myocardium to activate adenylyl cyclase to increase cAMP?
Catecholamines
Slide 31
How does a implantable hemodynamic monitoring improve chronic HF?
it allows remote observation of intracardiac pressures to guide tx and prevent decompensation
Slide 24
What are the medical treatments for Chronic HF?
- Diuretics
- B-blockers
- ACE-inhibitors & ARBs
- Lifestyle change
S21-22
What are 2 important biomarkers in the diagnosis of HF?
BNP and N-terminal pro-BNP
17
How does Loop Diuretics help CHF?
- reduce LV filling pressures
- decrease pulmonary venous congestion
- improve HF sx
S21
Which type of pts. are Thiazide diuretics useful and why?
pts with poorly controlled HTN
to prevent the onset of HFpEF
S21
How does a Implantable cardioverting-defibrillators (ICDs) helps patients with chronic Heat failure?
Its used to prevent sudden death in pts with advanced heart failure?
Slide 24
Which type of CHF are Beta-Blockers strongly recommended for?
HFrEF
(HF with reduced EF)
prescribed for other indications (HTN, MI, HR control w/Afib)
S21
̴ ____% HF deaths are d/t sudden cardiac dysrhythmias
50%
Slide 24
What is the mainstay treatment for HFrEF?
ACE-inhibitors and ARBs
(studies do not show benefit in HFpEF unless used for treatment of HTN)
S22
What is the name of the device used by patients in the terminal stages of HF that may benefit from mechanical circulatory support (MCS) by a ventricular assist device (VAD)?
LV assist device
silde 25
What are the lifestyle changes that pt. can do to treat CHF?
- Aerobic fitness
- Weight loss
- Salt-restricted, Dietary Approaches to Stop Hypertension (DASH) diet
- Control of HTN and blood glucose
S22
HF preserved EF is associated w/ lower BNP and NT-proBNP levels [than HF reduced EF] due to what characteristics?
concentric hypertrophy, normal LV chamber size and lower LV end diastolic wall stress
17
Causes of LV relaxation
Due to afterload, which is elevated in hypertensive pts. Tachycardia exacerbates the failure of LV relaxation.
S9
What is the goal of surgical treatment for CHF?
to prevent ventricular remodeling and retain the natural geometry of the heart
S23
What are the benefits of coronary revascularization via CABG or PCI?
- can reverse LV dysfunction following MI
- may prevent permanent EF reductions
- reduce 10-year mortality by 7% (CABG)
S23
What is commonly seen w/ HFpEF despite having only a modestly depressed LV systolic fx?
Profound exercise intolerance
S9
What is another name for Cardiac resynchronization therapy (CRT) and what is the treatment for?
“biventricular pacing”
tx for HF w/ ventricular conduction delay (prolonged QRS)
S23
Cardiac resynchronization therapy (CRT)
Placement of a ____ cardiac pacemaker (w/RA & RV leads), an additional lead is introduced through the coronary sinus and advanced until it reaches the lateral wall of the ____.
This stimulates the heart to contract more ____ and efficiently and improve COP
dual chamber
LV
synchronously
S23
Prolonged compression of coronary arteries restricts diastolic coronary blood flow, which contributes to ____ ____ and a further reduction in exercise tolerance.
subendocardial ischemia
S9
What NYHA class is CRT recommended?
NYHA class III or IV w/ EF < 5% and a QRS duration 120-150 ms
S23
What are the outcomes of CRT?
- fewer HF sx
- better exercise tolerance
- improved ventricular function
- less hospitalizations
- decreased mortality
S23
What are the most common symptoms of HF?
Fatigue, tachypnea, dyspnea, paroxysmal nocturnal dyspnea, orthopnea, S3 gallop, JVD, peripheral edema, exercise intolerance, and reduced tissue perfusion.
S10
What are the risks of CRT?
- infection
- misplacement
- device failure
S23