Heart Failure Flashcards by Andrew Kreutzer

Risk Factors for developing HF

HTN
DM
Metabolic Syndrome
Atherosclerotic dz

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Metabolic Syndrome is when the patient has any 3 of the following

Abdominal adiposity
Hypertriglyceridemia
Low HDL
HTN
Fasting Hyperglycemia

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Etiology of HF can be from?

Valvular dz
Cardiomyopathy
HTN
Ischemic Heart Dz - major cause of HFrEF

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Pathophysiology of HF
Increased LVEDP d/t structural or functional impairment of ventricular filling or ejection of blood leads to?

Activation of SNS, RAAS, increased ADH

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Pathophysiology of HF
Activation of SNS, RAAS, increased ADH leads to?

Vasoconstriction/increased blood volume

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Pathophysiology of HF
Vasoconstriction/increased blood volume leads to?

Increased preload & afterload

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Pathophysiology of HF
Increased preload & afterload leads to?

Decreased SV & congestion

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Pathophysiology of HF
Decreased SV & congestion leads to?

Increased LVEDP d/t structural or functional impairment of ventricular filling or ejection of blood

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RAAS activation
Renin secreted to low renal perfusion pressure leads to?

Cleaving of angiotensinogen to angiotensin I to II via ACE

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RAAS activation
Cleaving of angiotensinogen to angiotensin I to II via ACE leads to?

Vasoconstriction, increased ADH & aldosterone secretion

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RAAS activation
Vasoconstriction, increased ADH & aldosterone secretion leads to

Increased Na, H20 retention

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RAAS activation
Increased Na, H20 retention leads to?

Increased preload, afterload, pressures in heart

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RAAS activation
Increased preload, afterload, pressures in heart leads to?

cardiac remodeling, hypertrophy, sympathetic activity

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RAAS activation
cardiac remodeling, hypertrophy, sympathetic activity leads to?

Renin secreted in response to low renal perfusion pressure

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Diagnosis of HF
Assessment includes?

Clinical Hx
Physical examination
ECG, labs

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Diagnosis of HF
Labs

NT-proBNP > 125 pg/mL
BNP >/= 35 pg/mL

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Diagnosis of HF
Imaging?

TEE

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Diagnosis of HF
HF Diagnosis Confirmed
Determine cause and classify
HFrEF is?
HFmrEF is?
HFpEF is?

LVEF </= 40%
LVEF 41-49%
LVEF >/= 50%

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In pts w/ HF what should be assessed at each encounter to guide overall management including adjustment of what?

vital signs and evidence of clinical congestion
diuretics and other medications

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In pts w/ symptomatic HF, clinical factors indicating the presence of what? should be sought via the what?

advanced HF
Hx and Physical Exam

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In pt w/ cardiomyopathy, what should be obtained or updated when assessing the cause of the cardiomyopathy to identify what?

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a 3-generation family hx
inherited dz

In pts presenting w/ HF what should direct diagnostic strategies to uncover specific causes that may warrant disease-specific management?

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thorough hx and physical exam

In pts presenting w/ HF what should be obtained to identify what that might cause or accelerate the development or progression of HF?

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thorough hx and physical exam
carddiac and noncardiac d/os, lifestyle and behavioral factors, and SDOH

Symptoms of HF
Typical include?

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Breathlessness
Orthopnea
Paroxysmal nocturnal dyspnea
Reduced exercise intolerance
fatigue, tiredness
ankle swelling
inability to exercise
swelling of parts of the body other than ankles
bendopnea

Symptoms of HF Less typical

Nocturnal cough Wheezing Bloated feeling Postprandial satiety loss of appetite decline in cognitive function confusion (especially in elderly_ Depression Dizziness, syncope

Signs of HF More Specific

Elevated JVP S3 Summation gallop w/ S3 and S4 heart sounds Cardiomegaly, laterally displaced apical impulse Hepatojugular reflux Cheyne-stokes respiration in advanced HF

Signs of HF Less specific

Peripheral edema Pulmonary rales unintentional weight gain (> 2 kg/wk) Weight loss (in advanced HF) w/ muscl wasting and cachexia Cardiac murmur Reduced air entry and dullness to percussion at lung abases suggestive of pleural effusion Tachycardia, irregular pulse Tachypnea Hepatomegaly/ascites Cold extremities Oliguria Narrow pulse pressure

Diagnostic Lab Testing For patients presenting w/ HF, the specific cause of HF should be explored using what? for appropriate managment.

additional lab testing

Diagnostic Lab Testing For pts who are diagnosed w/ HF, lab evaluation should include what?

CBC UA BMP Lipid profile LFT Iron studies TSH

Diagnostic Lab Testing For all pts presenting w/ HF what should be performed at the initial encounter to optimize management?

a 12-lead EKG

Diagnostic Lab Testing Genetic screening and counseling are recommended in what patients, to detect cardiac dz and prompt consideration of treatments to decrease HF progression and sudden death?

in first-degree relatives of selected patients w/ genetic or inherited cardiomyopathies

Diagnostic Lab Testing In pts presenting w/ dyspnea measurement of what is useful to support or exclude a diagnosis of HF?

B-type natriuretic peptide (BNP) N-terminal prohormone of B-type natriuretic peptide

Diagnostic Lab Testing In pts w/ chronic HF, measurements of BNP or NT-proBNP levels are recommended for what?

risk stratification

Diagnostic Lab Testing In pts hospitalized for HF, measurements of BNP or NT-proBNP levels at admission is recommended to establish what?

prognosis

Diagnostic Imaging What is typical Imaging to obtain for HF diagnosis?

CXR TEE

Diagnostic Imaging What is alternative imaging to obtain for HF diagnosis?

cardiac MRI CT Radinuclide imaging

Management Stage A In pts w/ HTN, BP should be controlled in accordance w/ what?

Guideline Directed Medical Therapy for hypertension to prevent symptomatic HF

Management Stage A In pts w/ DM T2 and either established CVD or at high CV risk, what should be used to prevent hospitalizations for HF?

SGLT2 inhibitors

Management Stage A In the general population, what strategies are helpful to reduce future risk of HF?

healthy lifestyle habits such as regular physical activity, maintaining normal weight, healthy dietary patterns and avoiding smoking

Management Stage B Pts w/ LEVEF

ACE inhibitors

Management Stage B Pts w/ a recent MI and LVEF

ARB if ACE inhibitor intolerant

Management Stage B Pts w/ LVEF 1yr survival; > 40d post MI should receive?

ICD

Management Stage B Pts w/ a recent or remote hx of MI or ACS, what should be used to prevent symptomatic HF and adverse cardiovascular events?

statins

In pts w/ a recent or remote hx of MI or ACS and LVEF

Beta blockers

In pts w/ HF who have fluid retention, what should be used to relieve congestion, improve symptoms and prevent worsening HF?

diuretics

For patients w/ HF and congestive symptoms, addition of what? to treatment w/ loop diuretics should be reserved for pts who do not respond to moderate- or high-dose loop diuretics to minimize electrolyte abnormalities?

thiazide diuretic like metaloazone

In pts w/ HFrEF and NYHA class II to III symptoms, the use of what is recommended to reduce morbidity and mortality?

Angiotensin Receptor Neprilysin inhibitors (ARNi)

In pts w/ previous or current symptoms of chronic HFrEF, the use of what is beneficial to reduce morbidity and mortality when the use of ARNi is not feasible.

ACEi

In pts w/ previous or current symptoms of chronic HFrEF, who are intolerant to ACEi d/t cough or angioedema and when the use of ARNi is not feasible, the use of what is recommended to reduce morbidity and mortality?

ARB

Heart Failure Flashcards

(50 cards)