Heart Failure Flashcards
what are risk factors to cardiovascular disease?
- Hypertension
- diabetes
- obesity
- lipids
- genetics
What are possible etiologies to consider for dilated cardiomyopathy?
- obesity, diabetes, thyroid disease, growth hormone too little and too much
- alcohol related, chemotherapy and other toxinx
- myocarditis, iron overload, amyloidosis, sarcoidosis, connective tissue disease
what are common symptoms of Heart failure?
- dyspnea on exertion
- paroxysmal nocturnal dyspnea/ orthopnea
- fatigue
- lower extremity edema, ascites
- cough, usually worsening at night
- nausea, vomiting, anorexia, RUQ pain
- nocturia
- sleep disorders
what are common physicial findings of heart failure?
- elevated jugular venous pressure
- hepatojugular reflux
- displaced apical impulse
- S3 gallop
- pulmonary rales
- hepatomegaly
- ascites
- peripheral edema
what causes the decompensation?
- Dietary indiscretion
- non adherence to meds
- iatrogenic volume expansion
- non cardiac: anemia, pneumonia, infection, thyroid
- adverse medication effect
- stress cardiomyopathy
- disease progression
- ACS
- acute heart rhythm dysfunction
what is the single most important test for a new diagnosis of HF?
echocardiogram
- It can tell if it is systolic or diastolic HF, what is the severity, what other associated abnormalities are present
what is the ejection fraction? What is normal, borderline or reduced?
the ejection fraction compares the amount of blood in the heart to the amount of blood pumped out
- Normal ejection fraction: 50-70% during each contraction
- boderline ejection fraction: 41-49% is pumped out (symptoms may be noticeable during activity)
- Reduced ejection fraction: < 40% (symptoms may be noticeable even during rest)
- LVEF >50%
- Diastolic function is abnormal
-slowed, delayed or incomplete relaxation
-increased stiffness and reduced distensibility
-reduced augmentation of relaxation with exercise - increased LV diastolic pressure, LA pressure, pulmonary venous pressure
Heart Failure with preserced LVEF
What are mechanisms of diastolic heart failure?
- cardiac senescence
- hypertension, obesity, insulin resistance, sedentary life
- microvascular coronary artery system dysfunction
- pulmonary hypertension, RV dysfunction
- chronotropic dysfunction and af
- patieints at risk for HF but without current or previous symptoms/signs of HF and without structural/functional heart disease of abnormal biomarker
- patients with hypertension, CVD, diabetes, obesity, exposure to cardiotoxic agents, genetic variant for cardiomyopathy, or family hx of cardiomyopathy
Stage A
Patients without current or previous symptoms/signs of HF but evidence of the following:
- structural heart disease
- evidence of increased filling pressures
- risk factors and increased naturietic peptide levels or persistently elevated cardiac troponin in the absence of competing diagnoses
Stage B
- Patients with current or previous symptoms/ signs of HF
Stage C
Marked HF symptoms that interfere with daily life and with recurrent hospitalizations despite attempts to optimize GDMT
Stage D
For patients in Stage A with hypertension what medication would you put them on?
- an optimal medication of BP (ACE/ARB, CCB, Thiazide)
ACE is preferred to keep patient in Stage A
For patients with Stage A with T2DM and CVD or high risk for CVD, what medication class would you put them on?
SGLT2 Inhibitor
