Clinical Cardiac Part 3 Flashcards
(87 cards)
1
Q
What is heart failure?
A
Complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood
2
Q
What are the cardinal clinical symptoms of heart failure?
A
Dyspnea
Fatigue
Edema
Rales
3
Q
What happens in heart failure with preserved ejection fraction?
A
Wall becomes thicker, unable to relax to get blood in
4
Q
What happen in heart failure with reduced ejection fraction?
A
Weak, heart fills fine but can’t eject blood
5
Q
What is advanced heart failure?
A
Refractory heart failure requiring specialized interventions
6
Q
What is cor pulmonale?
A
Altered right ventricular structure and/or function in the context of chronic lung disease (failure of right ventricle)
7
Q
What is the pathophysiology of HFrEF?
A
Precipitating factor (MI) -> decreased cardiac output -> activation of SNS + RAAS -> vasoconstriction
8
Q
What are the most common CV etiologies of HFrEF?
A
CAD (most common) Cardiomyopathies Myocarditis Valvular disease Cardiac infection
9
Q
What are extra-cardiac causes of HFrEF?
A
Thyroid disorders Sarcoidosis SLE Alcohol Chemotherapy (left ventricular problems)
10
Q
What are risk factors for both types of heart failure?
A
Age DM2 Smoking Hypertension Atherosclerosis Obesity Metabolic syndrome
11
Q
What are risk factors for HFrEF?
A
Male LVH Bundle branch block Previous MI Smoking
12
Q
What are risk factors for HFpEF?
A
Older age
Female
Hypertension
Atrial fibrillation
13
Q
What is paroxysmal nocturnal dyspnea?
A
Waking up with SOB at night
14
Q
What are symptoms of congestion?
A
Dyspnea on exertion Paroxysmal nocturnal dyspnea Orthopnea Nocturnal cough Weight fluctutations Edema
15
Q
What are symptoms of hypoperfusion?
A
Exercise intolerance
Fatigue
Decreased mentation
Cold intolerance
16
Q
Which medications exacerbate heart failure?
A
Statins
CCB
COX2 inhibitors
17
Q
Adequate perfusion is what?
A
Warm
18
Q
Hypoperfusion is what?
A
Cold
19
Q
Congestion is what?
A
Wet
20
Q
No congestion is what?
A
Dry
21
Q
What are PE signs for congestions?
A
S3 gallop Orthopnea Peripheral edema Pulmonary edema Ascites Hepatojugular reflex Elevated jugular venous pressure
22
Q
What are PE signs for hypoperfusion?
A
Cool extremities Hypotension Renal dysfunction Altered mental status Hyponatremia Narrow pulse pressure Pulsus alternans
23
Q
What is a S3 gallop?
A
Ventricular gallop immediately after S2
24
Q
What cardiac findings are found on PE for heart failure?
A
Enlarged/displaced PMI
Right ventricular heave
25
What is your goal for PE on a patient with heart failure?
Identify the etiology of heart failure
Identify prognostic factors
Provide information about patient management
26
What do you order when you suspect heart failure?
EKG
CXR
BNP
27
Conduction abnormalities in heart failure patients important why?
Cause and prognosis
28
What with CXR detect in patients with heart failure?
Cardiac enlargement
| Non-cardiac pulmonary pathology that can influence clinical presentation
29
What las should be ordered?
Renal function
Serum potassium
BNP
30
BNP within normal limits in an untreated patient rules out what?
Heart failure
31
BNP and N-terminal-pro BNP should be ordered for diagnosis of what two conditions?
Acute heart failure
| Prognosis in chronic heart failure
32
What can falsely elevated BNP?
```
Advanced age
Renal insufficiency
Anemia
COPD
Pulmonary HTN
```
33
When is a 2D TTE recommended for heart failure?
Suspected heart failure
| Known heart failure with worsening symptoms
34
What is seen in HFrEF on ECHO?
```
Reduced LVEF
Atrial and ventricular dialation/hypertrophy
Valvular disfunction
Pericardial pathology
Elevated ventricular filling pressure
```
35
Why is TEE ordered in heart failure?
Rule out intracardiac thrombus or infectious source
36
When is stress ECHO ordered in heart failure?
Rule out ischemia as precipitating cause
37
When is cardiac MRI ordered in heart failure?
Determining the etiology of cardiomyopathy by identifying the presence of inflammation, fibrosis, and infiltrative pathology
38
When is cardiopulmonary exercise testing ordered in heart failure?
Important component in the determination of candidacy for mechanical circulatory support and cardiac transplantation
39
Is the ACCF and AHA staging progressive?
Yes
40
Is the NYHA functional classification progressive?
No
41
What is class A for heart failure?
High risk of heart failure
| Without structural heart disease or symptoms
42
What is class B for heart failure?
Structural heart disease
| Without signs or symptoms of heart failure
43
What is class C for heart failure?
Structural heart disease
| Prior or current symptoms of heart failure
44
What is class D for heart failure?
Refractory to heart failure
| Requiring specialized interventions
45
What is class I for heart failure?
No limitation in physical activity
| Ordinary physical activity does not cause symptoms of heart failure
46
What is class II for heart failure?
Slight limitation of physical activity
Comfortable at rest
Ordinary physical activity results in symptoms of heart failure
47
What is class III for heart failure?
Marked limitation of physical activity
Comfortable at rest
Less than ordinary activity causes symptoms of heart failure
48
What is class IV heart failure?
Unable to carry on with any physical activity without symptoms of heart failure
Symptoms of heart failure at rest
49
What are the goals of treatment in heart failure?
Improve symptoms
Improve quality and duration of life
Prevent hospital admission
50
What are the goals of treatment in HFrEF?
Improve symptoms
| Prevent remodeling
51
What is the first line therapy for HFrEF?
ACEi
Beta-blockers
*titrate to max dose before adding more meds
52
What is the second line therapy for HFrEF?
Add mineralcorticoid antagonist (spiralactone)
53
What is the third line therapy for HFrEF in patients who can tolerate ACEi or ARB?
Replace ACEi with ARNI
54
What is the third line treatment for HFrEF in patients who have sinus rhythm and QRS duration greater than 130 ms?
Evaluate for CRT
55
What is the third line treatment for HFrEF in patients who have sinus rhythm and HR greater than 70 bpm?
Ivabradine
56
If a HFrEF patient is resistant to symptoms what do you do?
Add digoxin
HYD-ISDN
LVAD
Heart transplant
57
If a HFrEF patient is not resistant to symptoms what do you do?
Consider reducing diuretic dose
58
What do diuretics do in HFrEF?
Relieve symptoms and signs of congestion
| *specifically furosemide
59
What is the best treatment for HFrEF?
Cardiac transplantation
| *also cardiac rehab, exercise programs
60
What is the only medication that should be used to treat HFpEF?
Diuretics
61
How do you treat class A heart failure?
HTN
| Hyperlipidemia
62
How do you treat class B heart failure (diastolic dysfunction wihout symptoms)?
```
HTN
Thiazide diuretics
ACE inhibitors
ARBs
Non-dihydropyridine CCBs
```
63
How do you treat class C heart failure (with preserved ejection fraction)?
Diuretics
Beta-blockers
ACE inhibitors
ARBs
64
How do you treat class D heart failure (with preserved ejection fraction)?
Diuretics
| ARBs (prevent hospitalization)
65
What what is the first step in treating decompensated heart failure?
Identify precipitating factors
| Identify comorbidities
66
What is the treatment for warm-wet HF?
Vasodilators
Diuretics
Renal replacement therapy
67
What is the treatment for warm-dry HF?
Up-titration of disease-modifying oral therapy (HFrEF)
| Treat comorbitities
68
What is the treatment for cold-dry HF?
Fluid challenge
| Inotropic agent
69
What is the treatment for cold-wet HF?
```
Vasodilator
Inotropic agent
Vasopressor (if refractor hypotension)
Diuretics (when perfusion restored)
MCS (if shock refractory to drugs)
```
70
What are complications of heart failure?
```
Anxiety
Sleep disturbance
Worry
Dyspnea
Fatigue
Orthopnea
Bloating
Chest pain
Cough
```
71
What does cor pulmonale develop from?
Chronic pulmonary HTN resulting from parenchymal lung disorders, primary pulmonary vascular disease, or conditions leading to alveolar hypoxia
72
What are the most common causes of cor pulmonale?
COPD
| Chronic bronchitis
73
What is the most common mechanism of cor pulmonale?
Pulmonary HTN -> increased RV afterload -> altered RV structure and function
74
Chronic cor pulmonale results in what?
Compensatory RVH
75
What are the symptoms of cor pulmonale?
SYSTEMIC SWELLING
Lower extremity swelling
Increased abdominal girth from ascites
76
What are signs in the neck of cor pulmonale?
Elevated JVP
77
What are signs in the heart of cor pulmonale?
Tricuspid murmur
S3 gallop
RV heave along left sternal border
78
What are signs in the lungs of cor pulmonale?
Wheezing
| Rales
79
What are signs in the abdomen of cor pulmonale?
Hepatomegaly
Pulsatile liver
Ascites
Hepatojugular reflux
80
What are sign in the extremities of cor pulmonale?
Lower extremity edema
| Cyanosis
81
How do you diagnose cor pulmonale on EKG?
Right axis deviation
| RV hypertrophy
82
How do you diagnose cor pulmonale on CXR?
Enlargment of main central pulmonary arteries and hilar vessels
83
What is used to diagnose cor pulmonale when 2D TTE can't?
MRI
| Cardiac catheterization
84
What is the treatment for cor pulmonale?
```
Keep SaO2 above 90%
Diuretics
Na restriction
IV inotropes
Manage arrhythmias
Palliative care
```
85
What is the strongest predictors of outcomes in patients with heart failure?
Right ventricular hypertrophy
| Right ventricle dysfunction
86
How do you prevent heart failure in stage A?
Appropriate dietary and exercise modifications
87
How do you prevent heart failure in stage B?
Initiation of heart failure-specific therapies
