CHF Flashcards
(30 cards)
Main abnormality behind systolic HF
decreased EF from impaired contractility
Name some causes of systolic HF
- ischemic heart disease/recent MI -> cardiac muscle cannot pump effectively -> decreased EF
- HTN resulting in cardiomyopathy
- valvular heart disease
- myocarditis
- EtOH abuse, radiation, hemochromatosis, thyroid dx
Main abnormality seen in diastolic HF
impaired ventricular filling during diastole (usu. from impaired relaxation or increased stiffness of ventricle or both)
What does echocardiogram show in diastolic HF?
impaired relaxation of left ventricle
Name some causes of diastolic HF
- HTN leading to myocardial hypertrophy
- valvular disease (ex: AS, MS, AI)
- restrictive cardiomyopathy (amyloidosis, sarcoidosis, hemochromatosis)
Symptoms of left sided heart failure
- dyspnea from pulmonary congestion/edema
- orthopnea with nocturnal cough, worse lying down
- paroxysmal nocturnal dyspnea
- critically ill: confusion/memory problems with less brain perfusion and diaphoresis/cool extremities at rest
Physical exam findings in left sided heart failure
THINK PULM CONGESTION
- displaced PMI
- pathologic S3 gallop (may be normal in children) best heard at apex
- S4 gallop (stiff left ventricle)
- crackles/rales at lung bases (pulm edema)
- dullness to percussion and tactile fremitus on left lower lng fileds from pleural effusion
Symptoms/signs of right sided heart failure
THINK VOLUME OVERLOAD IN REST OF BODY
- peripheral edema (non specific)
- nocturia (increased venous return when legs elevated)
- JVD
- hepatomegaly/hepatougular reflux
- ascites
- right ventricular heave (from enlarged right ventricle)
Given enough time, left sided heart failure will always lead to……….
RIGHT SIDED HEART FAILURE and vice versa
Modalities to diagnose CHF
chest xray
transthroracic echo
ECG (look for signs of ischemia, previous MI, or ventricle enlargement)
stress test
cardiac cath is diagnostic and therapeutic
radionuclide ventriculography with tech99
Findings of heart failure on chest xray
cardiomegaly
kerley B lines (horizontal lines near periphery indicated dilated pulmonary lymphatics
pleural effusion
prominent interstitial markings
What is initial test of choice when you suspect CHF and what useful things can it show you?
TTE (trans thoracic echo)
EF (if less than 40% = systolic HF!)
chamber dilations, muscle hypertrophy
helps determine whether cause of CHF is due to pericardial, myocardial, or valvular process
What lifestyle modifications to treat systolic HF
- Na restriction
- fluid restriction (1-2 L per day)
- weight loss, smoking cessation, exercise, weight monitoring yadadadada
Medical therapy for systolic CHF?
diuretics, spironolactone (aldosterone antagonist), ACEIs, ARBs, B blockers, digitalis, hydralazine
What is the most effective way to treat SYMPTOMS (but not necessarily cure systolic CHF)
diuretics (usually Lasix, most potent
How to classify HF?
NYHA Classifications
class 1 - symptoms only with vigorous activity, nearly asymptomatic class 2 - symptoms with prolonged/moderate exertion like climbing stairs or lifting, slight limitation class 3 - symptoms occur with usual ADLs like getting dressed class 4 - symptoms at rest; incapacitating
When is spironolactone (aldosterone antagonist) effective in treating HF?
only in class 3 or 4; contraindicated in renal failure (may cause hyperkalemia)
Benefit of using ACEIs in heart failure
- cause venous and arterial dilation which decreases preload and afterload, use when LVEF<40%
- REDUCES MORTALITY, prolongs survival, and alleviates symptoms in all classes of heart failure
What is the initial treatment in most symptomatic patients?
diuretic and ACEI combo
What to use of patient cannot tolerate ACEI (i.e. due to cough?)
ARB or hydralazine/isosorbide dinatrates
but really really try to do ACEI if you can
When and how are B blockers beneficial in treating heart failure
- decrease mortality in patients with post MI heart failure
- antiarrhythmic and anti-ischemic efect
- metoprolol, bisoprolol, and carvedilol
Who should get B blockers for HF?
STAAAAAABLE patients with mild-moderate CHF (class 1-3)
Who should get digitalis?
patients with EF<40% who continue to have symptoms despite optimal therapy with ACEI, Bblcoker, aldosterone antag, and diuretic
CHECK SERUM DIGOXIN
Disadvantages to digitalis
only provides symptomatic relief, ha snot been shown to improve mortality
