Exam 4 - Heart Failure -organized Flashcards
Stages of Heart Failure
Stage A:
Stage B:
Stage C
Stage D:
Stage A: At risk (risk factors but no structural changes or symptoms)
Stage B: Pre- heart failure (structural changes but no symptoms)
Stage C: Heart failure (symptoms like shortenss of breath and fatigue)
Stage D: Advanced heart failure (symptoms don’t respond to treatment)
S1
Heart Failure is defined as a complex syndrome that results from:
any structural or functional impairment of ventricular filling or blood ejection
2
Five signs of tissue-hypoperfusion that result from HF:
fatigue, dyspnea, weakness, edema, and weight gain
2
HF may be caused by structural abnormalities of what 5 cardiac structures?
pericardium, myocardium, endocardium, heart valves, or great vessels
2
what EF % classifies HF with reduced EF (aka systolic HF)?
EF ≤ 40%
2
what EF % classifies HF with preserved EF (aka diastolic HF)?
EF ≥50%
2
A pt with clinical symptoms with an EF between ___ - ___% is labeled as having borderline HF w/ preserved EF
40-50%
2
True or false: Diastolic dysfunction is present in both HFrEF and HFpEF.
True!
2
Patters of what 2 things are the major distinguishing features between HFrEF and HFpEF?
LV dilation and remodeling
2
What serves as the main marker for establishment of HF risk factors, treatment, and outcome?
Ejection Fraction!
2
Which of the 2 HFs are women more likely to be affected by?
HF w preserved EF
Diastolic HF
3
Which of the 2 HFs are men more likely to be affected by?
HF with reduced EF
Systolic HF
3
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
3
what is the primary determinant of HFpEF?
left ventricular diastolic dysfunction
4
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
4
What 3 things are majority of measurements of LV Diastolic dysfxn dependent on?
HR, loading conditions, and myocardial contractility
4
Higher ________ are required to achieve normal end-diastole volume in pts with HFpEF.
LV filling pressures
4
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
5
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
5
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
5
List some common causes of Left Ventricular Diastolic Dysfxn
8
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
9
Causes of LV relaxation
Due to afterload, which is elevated in hypertensive pts. Tachycardia exacerbates the failure of LV relaxation.
9
What is commonly seen w/ HFpEF despite having only a modestly depressed LV systolic fx?
Profound exercise intolerance
9
Prolonged compression of coronary arteries restricts diastolic coronary blood flow, which contributes to ____ ____ and a further reduction in exercise tolerance.
subendocardial ischemia
9
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.
10
What are the most common symptoms of HFpEF?
paroxysmal nocturnal dyspnea, pulmonary edema, dependent edema
10
What is the most common sign of HFrEF?
S3 gallop
10
When EF is reduced, the presence of HF symptoms establishes the diagnosis of?
HFrEF (following standard guidelines)
10
What does cardiac catheterization define?
Elevated LV systolic and diastolic stiffness using pressure-volume analysis or provocative testing (s/a exercise & rapid IV volume expansion)
11
What other diagnostic measure can offer further information about severity of HFpEF?
Direct measurement of RV filling.
11
Which type of HF is harder to diagnose?
HFpEFis often more difficult to diagnose,especially when the pt has little/no symptoms at rest
11
What diagnostic finding provides strong evidence of HFpEF and is a predictor of mortality?
Mean pulmonary capillary wedge pressure >15mmHg at rest or 25mmHg duringexercise
11
What would you expect to see on CXR of someone w/ HF?
pulmonary dz, cardiomegaly, pulmonary venous congestion, and interstitial or alveolar pulmonary edema.
13
What is an early radiographic sign of LV failure and pulmonary venous HTN?
distention of the pulmonary veins in the upper lobes of the lungs
You read in the chart that the pt has perivascular edema, so you look at pt’s CXR and you see…
hilar or perihilar haze with ill-defined margins
13
Pt presents with edematous interlobular septae. What would you expect to see on CXR?
Kerley lines, which produce a honeycomb pattern
13
Pt presents with alveolar edema, what would you expect to see on CXR?
homogeneous densities in the lung fields, typically in a butterfly pattern
13
Radiographic evidence of pulmonary edema may lag behind the clinical evidence of pulmonary edema by up to ____hours
12 hours
13
Which criteria is more specific in diagnosis of HFpEF and incorporates several echocardiographic indexes based on 2-dimensional measurements?
European Society of Cardiology (ESC)
15
ESC guidelines rely entirely on ____ echocardiogram; and are limited because they do not incorporate ____testing.
resting
provocative
15
European Society of Cardiology criterias
15
Which diagnostic testing has low predictive value for diagnosis or risk- prediction of heart failure?
EKG alone
16
What underlying pathologies are common in HF pts with EKG abnormalities?
LVH, previous MI, arrhythmias and conduction abnormalities
16
What are 2 important biomarkers in the diagnosis of HF?
BNP and N-terminal pro-BNP
17
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
CRP and GDF15 (growth differentation factor 15 represent what component of HF?
inflammatory component of HF
17
The NYHA system focuses primarily on ____ to classify HF?
the degree of physical limitation
18
The ACC/AHA focus on ____ to classify HF?
on the presence & severity of HF
18
What should be noted with classification of HF?
- note that these stages are progressive
- oftenclassified using a combination of both scoring systems
18
Which NYHA Classification has no limitation and no symptoms from ordinary activity?
NYHA Class I
18
What NYHA Classification has mild limitation with activity and comfortable at rest or with mild exertion?
NYHA Class II
18
Which NYHA Classification has significant limitation with any activity and comfortable only at rest?
NYHA Class III
18
Which NYHA Classification has discomfort with any physical activity and symptoms occuring at rest?
NYHA Class IV
18
Which ACC/AHA classification has high risk of developing heart failure but no functional or structural heart deficits?
ACC/AHA Class A
18
Which ACC/AHA classification has structural heart deficit but no symptoms?
ACC/AHA Class B
18
Which ACC/AHA classification has heart failure symptoms due to underlying structural heart deficit with medical management?
ACC/AHA Class C
18
Which ACC/AHA classification has advanced disease requiring hospitalization, transplant, or palliative care?
ACC/AHA Class D
Which condition has improved survival rate in the past three decades: HFrEF or HFpEF?
HFrEF
19
Which condition benefits with using medications: HFrEF or HFpEF?
HFrEF
19
What are the treatments for HFpEF?
- Mitigation of sx’s
- treat associated conditions
- exercise
- weight loss
19
What are the treatments for HFrEF?
- Beta Blockers
- ACE-Inhibitors
19
What are the medical treatments for Chronic HF?
- Diuretics
- B-blockers
- ACE-inhibitors & ARBs
- Lifestyle change
21-22
How does Loop Diuretics help CHF?
- reduce LV filling pressures
- decrease pulmonary venous congestion
- improve HF sx
21
Which type of pts. are Thiazide diuretics useful and why?
pts with poorly controlled HTN
to prevent the onset of HFpEF
21
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)
21
LVAD is used for
- temporary ventricular assistance while heart is recovering its function
- Pts awaiting cardiac transplant
- Pts are on inotropes or balloon pump (IABP) with potentially reversible medical conditions
- Pts with advanced HF who aren’t transplant candidates
25
What class of medication stimulate β-receptors on the myocardium to activate adenylyl cyclase to increase cAMP?
Catecholamines
What are the 6 most common inotropic drugs used in AHF? (chart)
32
The Society of Thoracic Surgeons (STS) developed a MCS decision-making tool based on pt clinical profiles. What is that tool or Profile System called?
Inter-agency Registry of Mechanically Assisted Circulatory Support
INTERMACS Profile System
34-AHF
The Impella consists of a miniature ____________ blood pump inserted through the ____________ artery, advanced through the aortic valve and is situated in the ______
The Impella consists of a miniature rotary blood pump inserted through the **femoral **artery, advanced through the aortic valve and is situated in the LV
36
