Flashcards in CHF Deck (27):
Physiologic complications ofAcute heart failure? May proceed to?
Pulmonary edema and low cardiac output. Cardiogenic shock.
Diastolic dysfunction? Caused by?
Increased diastolic filling pressure. Caused by impaired diastolic relaxation and decreased ventricular compliance
Systolic dysfunction? Caused by?
Low cardiac output (low EF) caused by impaired systolic function
Cardiac remodeling due to?
Increased cardiac loading (preload and afterload)
Congestive heart failure?
Heart cannot meet metabolic needs of body but maintains normal ventricular filling pressures
Neuroendocrine responses to CHF?
Activation of RAAS and increased sympathetic activity
Symptoms of forward failure?
Forward failure is low cardiac output. Symptoms include fatigue lethargy and hypertension
Backward failure symptoms?
Backward failure is increased filling pressures or diastolic dysfunction. Symptoms include dyspnea, peripheral edema and ascites
Patients with CHF have a high mortality if?
Have symptoms at rest, or have an ejection fraction lower than 20%
Death associated with CHF may occur from?
Cardiogenic shock or sudden death from ventricular arrhythmias
Chronic pressure overloads that result in CHF?
Aortic stenosis, hypertension
Chronic volume overload that result in CHF?
Infiltrative diseases that can result in CHF?
Myocardial injuries that could result in congestive heart failure?
Alcohol, cocaine, ischemic cardiomyopathy, rheumatic fever, viral myocarditis, adriamycin
For patients with heart failure appropriate investigation may include?
Electrocardiography, cardiac stress testing, coronary angiography, biopsy
Heart failure symptoms are usually caused by? Are relieved by?
Caused by low cardiac output and fluid overload. Believed with dietary sodium restriction and loop diuretics
Drugs that have been shown to reduce mortality in patients with impaired systolic function and moderate to severe symptoms?
ACE inhibitors, Angiotension receptor blockers, beta blockers
Beta blockers that have been shown to reduce mortality in patients with impaired systolic function?
Carvedilol, metoprolol, bisoprolol
ACE inhibitors are less effective for CHF in what patients?
In patients who cannot tolerate ACE inhibition use what drugs to lower mortality?
Hydralazine with nitrates
Drug that can be added to CHF regimens for additional symptom relief but provides no survival benefit?
Mechanism for beta blockers in CHF?
Prevent and reverse adrenergically mediated intrinsic myocardial dysfunction and remodeling
Mechanism of ACE inhibitors in CHF?
Reduces preload and afterload and prevents remodeling. Drug of choice in CHF because of survival benefit
Mechanism of nitrates and nitrates in CHF?
Reduce preload and clear pulmonary congestion
Mechanism of action of diuretics in CHF?
Used to decrease preload especially in acute settings
What is the most likely cause of Moderately severe congestive heart failure in a 55-year-old man in the United States?
Ischemic cardiomyopathy due to coronary atherosclerosis