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Flashcards in Heart failure Deck (45):
1

another name for heart failure

congestive heart failure

2

what is heart failure

complex clinical syndrome resulting from structural or functional cardiac disorders

3

pumping difficulties

systolic heart failure
-depressed EF

4

difficulty filling

diastolic heart failure
-preserved EF

5

normal venrticular pumping

SVC/IVC->RA-RV-Pulmonary artery-> lungs-> pulmonary veins-> LA-> LV-> systemic circulation

6

symptoms of heart failure

-fatigue
-poor stamina
-dyspnea: on exertion
-paroxysmal nocturnal dyspnea: in bed at night
-nocturnal cough (orthopnea)
-abdominal fullness, bloating, nausea
-edema

7

signs of heart failure

-resting tachycardia
-low systolic BP and narrow pulse pressure
-volume overload
-elevated BP
-hepatojugular reflex: press on abdomen
-pulmonary rales
-S3, S4 or summation gallop
-displaced PMI
-murmurs: mitral or tricuspid regurgitation
-hepatomegaly

8

why have shortness of breath: left side

difficulty of pumping/filling-> back pressure goes into pulmonary circulation-> liquid seeps into alveoli-> alveolar edema (pulmonary edema)
-high pulmonary venous pressure
-see narrow pulse pressure

9

why have shortness of breath: what happens on right side

back pressure goes-> pulmonary artery
-high pulmonary artery pressure
-get jugular-venous distention
-can go to liver-> ascites
-edema

10

what is seen on X-ray

pulmonary infiltrates
-enlarged heart (maybe)

11

what is heard on auscultation of lungs?

crackles or rales on lung bases

12

symptoms of right CHF

ankles swelling
weight gain
fatigue
muscle atrophy

13

heart failure pathophysiology

-decreased CO
-poor circulation to organs
-low circulation to musculoskeletal system
-low circulation to kidneys

14

low circulation to kidneys results in

increase RAA-> salt and water retention, plasma volume expansion, and increased preload

15

what happens to heart in CHF: systolic heart failure

in systolic heart failure: heart muscle walls thin, cavity sites get bigger

16

Etiology of heart falire

coronary artery disease=atherosclerosis
hypertension
diabetes
alcohol
valvular heart disease
viral
familial

17

what happens to heart in CHF: diastolic heart failure

in diastolic heart failure: heart muscle thickens, and cavity site gets smaller

18

how to we stage heart failure

-Stage A: at risk of CHF (have diabetes, alcoholics)
-Stage B: asymptomatic structural disease (thinning wall or thickening wall)
-StageC: previous/current symptoms
-Stage D: refractory symptoms

19

class I classifications

no symptoms and no limitations to ordinary physical activity

20

class II

mild symptoms to ordinary physical activities

21

class III

marked symptoms with less than usual activity, comfortable at rest

22

class IV

severe limitations and symptoms at rest. Bed bound patient

23

steps in diagnosis of CHF

1.clinical exam
2.ECG
3.chest film
4.BNP
5.echocardiography

24

what to look for on CXR

-enlargement of heart base
-congested lungs

25

big heart is

inefficient heart

26

BNP

comes from heart
-released from wall tension
-enlarged heart-> if increased pressure or volume overload----> release BNP
-normal BNP <100

27

what can you see on echo

chamber sizes
presence and severity of LV systolic dysfunction
valve lesions
regional LV function
assessment LV diastolic function
Valvular abnormalities
Pericardial diseases
RV abnormalities

28

normal EF

55-65%
(LV EDV- LV ESV)/ (LV EDV)

29

hyperdynamic circulation

70-90% EF

30

what happens when someone is diagnosed with CHF

-natural progression

31

treatment of CHF

-diet: low sodium restriction, 2gm or less
-daily weight: check everyday (morning)
-vaccinations (drugs): influenza and pneumococcus)
-limit how much fluid they drink in a day: 1-1.5 liters

32

drugs that improve symptoms for CHF

improve symptoms:
diuretics
digoxin: to strengthen heart contractility

33

most common drugs to treat CHF

diuretics, beta-blockers and ACE inhibitors
Spironolactone
Devices

34

drugs that improve symptoms/prognosis

improve symptoms and prognosis
-ACE inhibitors/ARB's
-beta-blockers
-hydralazine/isosorbide
-spironolactone
-devices

35

cardiac resynchronization

improves LV EF
improves symptoms
Reduces function MR

Indications: EF 120ms

36

advanced therapies

1. chronic inotropic support (first option, if fails, go to 2)
-dobutamine
-milrinone

2. LV assist devices (LVAD): helps heart to squeeze
-Bridge therapy
-destination therapy

3. Heart transplantation (last option)

37

acute decompensated CHF

1. don't follow diet
-drink too much fluid
-get volume overload
2. don't take medicine
3. progression of disease itself: chronic hypertension

38

treatment of acute CHF

1. Diuretics: reduced volume overload
2.Vasodilators: decrease preload and afterload, ACE inhibitors, beta-blockers
3. Inotropes: augment contractility (stage D patients)

39

reasons for acute CHF and treatment

1. address precipitating causes
-correct myocardial ischemia
-remove offending medications
-treat arrhythmias
-control elevated BP

2. Patient education

40

heart failure with preserved LV EF (diastolic heart failure)

increased LV filling pressure due to abnormalities in LV relaxation and compliance
-elderly, history of HTN, CAD common

41

treatment heart failure with preserved LV EF

control BP
diet
drugs
maintain sinus rhythm
Diuretics
Relieve MI

42

larger heart is

NOT stronger heart
-weak

43

chest pain is symptoms of

MI or heart attack

44

first line drugs to improve symptoms in CHF

diuretics

45

What is seen on Chest radiograph

Cardiomegaly
Vascular engorgement
Cephalization
Kerley B lines
Pleural effusion
Enlarged main PA

Many may be absent in chronic compensated CHF