CHF

Question 1

What test is most helpful to determine CHF?

Answer 1

Echo

Question 2

What is BNP an indicator of?

Answer 2

It tells you if the heart is stretched; heart releases it when its in volume overload

Question 3

What is heart failure?

Answer 3

it is a clinical SYNDROME (from structural or functional cardiac disorder) where ventricular supply is less than demand

Question 4

Signs and symptoms of CHF are manifested by what 4 things

Answer 4

dyspnea, fatigue, fluid retention, and decreased exercise tolerance

Question 5

How much of cardiac output is due to atrial kick?

Answer 5

20%

Question 6

Explain the frank-sterling law in terms of heart failure

Answer 6

As the ventricle stretches, it has more forceful contractions; if the stretch exceeds frank starling limit it would actually negatively impact heart functioning (too much stretch is bad)

Question 7

What is preload?

Answer 7

pressure in ventricles at the end of diastole

Question 8

What is afterload?

Answer 8

the resistance the heart must work against to eject blood during systole (related to arterial systolic pressure and vascular resistance)

Question 9

How do Beta blockers impact your cardiac output?

Answer 9

they decrease your heart rate and initially dec CO but body will compensate by increasing SV & getting CO back to normal

Question 10

What are the two opposing forces responsible for fluid transfer to interstitium(edema)

Answer 10

hydrostatic capillary pressure and plasma oncotic pressure

Question 11

What causes shortness of breath during heart failure? How does this happen

Answer 11

pulmonary edema: capacity of lymphatic drainage is exceeded & liquid gathers in the interstitial spaces around bronchioles and lung

Question 12

Is hypertension a systolic or diastolic dysfunction? Why

Answer 12

diastolic; HTN causes stiffness of the ventricle and reduces filling ability

Question 13

What are the two main types of heart failure? What is the cutoff of ejection fraction for these two?

Answer 13

HF with preserved ejection fraction
HF with reduced ejection fraction
Less than 40%EF = HFrEF
More than 40% EF = HFpEF (SV is still reduced)

Question 14

Dilated Cardiomyopathy is is a type of _____ dysfunction. what type of heart failure can this lead to?

Answer 14

systolic

HF with reduced EF

Question 15

Hypertrophic cardiomyopathy is a type of _____ dysfunction. What type of heart failure can this lead to

Answer 15

diastolic

HF with preserved EF

Question 16

What is responsible for 2/3 of heart failure cases?

Answer 16

coronary artery disease

Question 17

What body mechanism is crucial for understanding the pathophysiology of HF?

Answer 17

activation of RAAS (kidneys stimulate it bc they sense decreased perfusion, since perfusion is being directed towards other body parts)-ACE/ARBs to block effects

Question 18

what does Left ventricle hypertrophy lead to in terms of CHF

Answer 18

leads to MV regurg which increases volume overload = CHF

Question 19

What is the first sign of HF on the physical exam?

Answer 19

JVD (shows up even before edema)

Question 20

CHF is a _______ diagnosis

Answer 20

clinical

Question 21

What is a sign of HF that sometimes shows up on a CXR?

Answer 21

Cardiomegaly (cardiothoracic ratio greater than 50%)

Question 22

What is Stage A of HF and how do you treat it

Answer 22

at risk without symptoms or abnormalities

Tx: control risk factors (HTN, CAD, Smoking, ETOH)

Question 23

What is goal of Tx for stages B, C, and D of HF? What 3 main classes of drugs do you use?

Answer 23

decrease fluid overload and congestive symptoms
loop diuretics
ACEIs to minimize angiotensin II (ARBs for pt who cant take ACEI)
BBs

Question 24

Why are BBs so important for HF treatment?

Answer 24

improve systolic function by increase diastolic filling & improves contractility
**shown to dec morbidity, hospitalizations, sudden death & reverses heart remodeling (3-4 months)

Question 25

What are four contraindications of using BB for HF?

Answer 25

diabetes asthma, bradydysrhythmias, heart block

Question 26

What three BBs have been shown effective for CHF?

Answer 26

Coreg (carvedilol), metoprolol succinate/Toprol XL, and Bisoprolol/Zebeta

Question 27

What type of dose should a BB for CHF be started at?

Answer 27

low dose and gradually increased

Question 28

What drug is now considered a last ditch effort for CHF?

Answer 28

Digoxin (so many toxicities)

Question 29

What is the benefit and risk for using mineralocorticoid receptor antagonist/aldosterone antagonist for CHF tx? What type of HF is it usually used for?

Answer 29

(Potassium sparing diuretics)
it has an additive benefit for reducing mortality
risk for hyperkalemia
HF with preserved EF

Question 30

What type of drug do you give after an MI to prevent HF?

Answer 30

statin

Question 31

What other type of drug do you add to pharmacological tx for African American pts?

Answer 31

Nitroglycerin

Question 32

What type of therapy are you considering for a pt in Class D HF?

Answer 32

Cardiac replacement and devices