Heart Failure Flashcards

(59 cards)

1
Q

define as a complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood, which in turn leads to the cardinal clinical symptoms of dyspnea and fatigue and signs of HF, namely edema and rales.

A

Heart failure

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2
Q

The overall prevalence of HF in the adult population in developed countries is

A

2%

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3
Q

HF prevalence
follows an exponential pattern, rising with age, and affects

A

6–10% of people over age 65.

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4
Q

True or false:

Although the relative incidence of HF is lower in women than in men, women constitute at least one-half the cases of HF because of their longer life expectancy.

A

True

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5
Q

In industrialized countries, _____ has become the predominant cause in men and women and is responsible for 60–75% of cases of HF.

A

coronary artery disease (CAD)

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6
Q

Hypertension contributes to the development of HF in how many percent of patients, including most patients with CAD.

A

75%

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7
Q

Etiology of heart failure with depressed ejection fraction <40%

A
CAD
HTN
Obstructive Valvular disease
Regurgitation valvular disease 
Intracardiac shunting
Extracardiac shunting 
Col pulmonale
Pulmonary vascular disorder 
Non-ischemic dilated cardiomyopathy 
Toxic/drug induced damage
Chaga's disease
Chronic bradycardia or tachycardia
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8
Q

Preserved ejection fraction causes of HF

A
Secondary Hypertension 
Hypertrophic cardiomyopathy 
Restrictive cardiomyopathy 
Amyloidoisis
Sarcoidosis 
Hemochromatosis fibrosis
Endomyocardial disorders
Aging
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9
Q

High output states causes of HF

A

Thyrotoxicosis (metabolic d/o)
Nutritional d/o (beriberi)
Excessive blood flow requirement
(Chronic anemia and systemic AV shunting)

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10
Q

____ emerging as the single most common cause of HF.

A

CAD

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11
Q

Community-based studies indicate that _____ of patients die within 1 year of diagnosis and ____ die within 5 years, mainly from worsening HF or as a sudden event (probably because of a ventricular arrhythmia).

A
  1. 30–40%

2. 60–70%

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12
Q

patients with symptoms at rest (New York Heart Association [NYHA] class IV) have a _____ annual mortality rate, whereas patients with symptoms with moderate activity (NYHA class II) have an annual mortality rate of ____

A
  1. 30–70%

2. 5–10%

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13
Q

Major determinant of Preload or VEDV

VENTRICULAR END DIASTOLIC VOLUME

A

Total blood volume
Distribution of blood volume
Atrial contraction

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14
Q

Major determinants

of AFTERLOAD

A

Systemic vascular resistance
Elasticity of arterial tree
Arterial blood volume
Ventricular wall tension

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15
Q

MECHANISM OF HFPEF

A

Diastolic dysfunction
Increased vascular stiffness
Impaired renal function

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16
Q

Cardinal symptoms of HF

A

Fatigue
And
Shortness of breath

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17
Q

Most important mechanism of HF

A

Pulmonary congestion which activates juxtacapillary J receptors that stimulates a rapid shallow breathing (cardiac dyspnea)

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18
Q

Etiologies of heart failure with preserved ejection fraction (>40-50%):

A
Hypertrophic CM
Hypertension 
Restrictive cardiomyopathy 
Infiltrative d/o (amyloidosis, sarcoidosis)
Storage diseases (hemochromatosis)
Fibrosis, endomyocardial disorders
Aging
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19
Q

Etiologies of heart failure with high output states:

A

Metabolic disorders: thyrotoxicosis
Nutritional disorders: BERI BERI
Excessive Blood flow requirements: systemic AV shunting, chronic anemia

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20
Q

Major cause of HF in AFRICA AND ASIA esp in the young

A

RHD

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21
Q

Known causes of DILATED CMP

A
Prior viral infection 
Toxin exposure (ALCOHOL, CHEMO)
Genetic defect in cytoskeleton, muscular dystrophy
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22
Q

Most forms of familial dilated CMP

A

Autosomal dominant inheritance

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23
Q

Mechanisms that explains dyspnea in heart failure :

A
Pulmonary congestion 
Decreased pulmonary compliance 
Increased airway resistance
Respiratory muscle or diaphragm fatigue
Anemia
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24
Q

Mechanism: redistribution of fluid from the splanchnic circulation and lower extremities INTO the central circulation during recumbency => increased PCWP

25
Mechanism: increased pressure in the bronchial arteries leading to airway compression + interstitial pulmonary edema causing increased airway resistance
PND | usually 1-3hrs after retiring
26
Periodic respiration or cyclic respiration sec to increased sensitivity of the respiratory center to arterial PCO2 and increased circulatory time
Cheyne stokes respiration
27
“Routine” lab test for new onset HF or chronic heart failure:
``` CBC ELECTROLYTES BUN CREA HEPATIC ENZYMES UA ```
28
Gold standard for assessing LV mass and volume
MRI accurate evaluation of LV structure and causes of HF (amyloidosis,hemochromatosis, CMP - HRPEF)
29
Most useful index of LV dysfunction
Ejection fraction (Normal >/=50%)
30
Increased levels of PRO BNP
``` Increased AGE Renal impairment Women Right heart failure from any cause Use of ARNI ```
31
Pulmary heart disease, | altered “RV” structure and or function in chronic lung disease and triggered by PULMONARY HYPERTENSION
Col pulmonale
32
Common mechanism of col pulmonale
Pulmonary hypertension Inc right ventricular AFTERLOAD RV DILATION AND HYPERTROPHY ALTERED RV FX
33
Signs of CHRONIC COL PULMONALE
TR MURMUR S3 gallop RV HEAVE
34
ECG in severe pulmonary hypertension
P pulmonale RAD RVH
35
Confirms diagnosis of pulmonary hypertension
Right heart catherization
36
Parameters associated with worse prognosis
Bun > 43mg/dL SBP <115 mmHg CREA > 2.75mg/dL ELEVATED TROPONIN
37
Stabilizing hemodynamics using PULMONARY ARTERY CATHETER is NOT recommended unless
Hypotension Poor response to DIURETICS SSX of LOW CO
38
Management for typical ADHF that is hypertensive
VASODILATORS
39
Management for typical ADHF that is NORMOTENSIVE (volume overload)
DIURETICS
40
Cornerstone therapy for HFREF
Acei and BB
41
Benefit of ACE-I and BB extends to NYHA Class
Class IIIB - IV
42
Treatment for PULMONARY EDEMA ADHF
Opiates VASODILATORS DIURETICS O2 and Noninvasive ventilation
43
Inotropic therapy for ADHF which increased CAMP and cytoplasmic calcium
Dobutamine (b1 agonist) | Milrinone (PDE INHIBITOR)
44
Indication for Inotropic therapy for ADHF
As bridge therapy ( to LV assist device support or transplant) Palliation in end stage HF
45
Beta blockers dose dependent improvement and reduction in mortality and hospitalization is restricted to
CBM Carvedilol Bisoprolol Metoprolol succinate
46
Mineralocorticoid antagonist that is selective for NYHA II and post MI HF
Eplerenone
47
Mineralocorticoid antagonist that is non-selective, NYHA III-IV
SPIRONOLACTONE
48
Neurohormonal escape Strategy is ACEI + BB, ARB + BB or ACEI + ARBS if BB INTOLERANT, HOWEVER IF SYMPTOMATIC NYHA II -IV May add
Aldosterone antagonist
49
Substitute to acei and ARBs if intolerable (hyperkalemia and renal insufficiency) combined arterial dilator and about dilator, with benefits for African Americans
Hydralazine and nitrates
50
Trial for sacubitril - Valsartan (ARNI improves survival compared to ACEI alone)
PARADIGM HF TRIAL
51
Inhibitor of funny channels If in the SA NODE which slows HR WITHOUT a negative inotropic effect (SHIFT TRIAL) Indicated in symptomatic px despite Acei, bb and aldo ant with residual hr>70bpm
IVABRADINE
52
True or false In DIG trial: there is decreased HF HOSPITALIZATION but no reduction in mortality , no improvement in QOL AND INCREASED mortality rate and hospitalization in W>M
TRUE
53
Use as initial treatment of HF to achieve volume control prior to neurohormonal therapy
Oral diuretics
54
Use to DECREASE BP in HF
Second generation CCB AMLODIPINE AND FELODIPINE DO NOT USE 1st gen and NON DHP (diltiazem and verapamil)
55
Treatment of anemia in HF sec to iron deficient, dysregulation of iron metabolism and occult gi bleeding
IV IRON ( iron sucrose and carboxymaltose)
56
Treatment of AF in HF
AMIODARONE | DOFETILIDE
57
Dm therapy that DECREASES CV MORTALITYand hospitalization in HF
EMPAGLIFLOZIN (SGLT2 inhibitor)
58
Surgical therapy for px with ischemic cm with multi vessel CAD in HF
CABG
59
Alterations in Left Ventricular Chamber Geometry
Left ventricular (LV) dilation Increased LV sphericity LV wall thinning Mitral valve incompetence