1. Resting Tach 2. Low Systolic with narrow PP 3. High JVP 4. Hepatojjugular reflex 5. Pulmonary rales 6. S3 and S4 gallop 7. \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \

1. Atheroscclerosis 2. HTNDM 3. Valve disease 4. Alcohol 5. Viral 6. Familial

Heart Failure Flashcards by Chris Rodarte

A larger heart is a ____

weaker heart

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Heart failure includes problems with __ and__

contraction and relaxation

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Systolic dysfunction causes

decreased ej. fraction

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Heart Failure symptoms (6)

Fatigue and poor stamina
Dyspnea
PND (parox. nocturnal dyspnea)
Orthopnea (nocturnal cough)
Abdominal fullness
Edema

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Signs for HF

Resting Tach
Low Systolic with narrow PP
High JVP
Hepatojjugular reflex
Pulmonary rales
S3 and S4 gallop
**********************************

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Pathologic features..____ in left heart fail

Flooded lungs

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High ____ Pressure in LHF

pulmonary venous pressure

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____ is a development in LHF

Pulmonary edema (fluid in alveolar sp.)

Causes dyspnea and hemoptysis

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___ and ____ on CXR for LHF

Enlarged cardiac shadow (Hypertrophy)

Pulmonary infiltrate

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Auscultation of lungs in HF

Rales (pulm)

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______ from high hepatic venous pressure

nutmeg liver

backpressure going into the liver from the IVC from the Rt heart, causing sinusoids to fill with blood, liver veins become dilated)

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FIrst sign of volume overload

Jugular venous distension (Lay 30 degrees and look at IJV)Should be EMPTY normally

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Always observe JVD on…

right side (more direct)

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Symptoms of right CHF

Fatigue, edema *******

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Reduced CO causes…

Increased RAAS = salt and water retention = increased volume

Increased SNS = vasoconstriction and increased afterload/contractility

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Pathophysiology of HF

Myocardial cell death from Necrosis, apoptosis, fibrosis, _____

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LV remodeling means heart has had ____

an insult area will either thicken or get thinned and stretched out)

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Heart fail etiology

Atheroscclerosis
HTNDM
Valve disease
Alcohol
Viral
Familial

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Stage A-D HF

A = at risk (with DM or HTN)

B = Asymptomatic, Uncontrolled HTN, Structural disease

C = Previous/current Sx

D = Refractory Sx

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Functional stages of heart failure (NYHA) classification

1 = no symp or limitations to regular activity

2 = mild symptoms in ordinary physical activity

3 = marked symp with less than usual activity, comfort at rest

4 = Severe limmit and Sx at rest. Bedbound patients

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People in Stage A can be in

Class 1

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People in Stage C can be

class 2 or 3

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Dx of HF

Clinical exam
ECG
Chest film
BNP
ECHO

Heart fail ECG is usually…

usually abnormal but nonspecific

CXR - 6 signs

1. Cardiomegaly 2. Vascular enlargement 3. Cephalization 4. Kerley B lines 5. Pleural eff 6. Enlarged main PA

Many CXR signs may be

absent in chronic compensated HF

BNP is secreted as

pro BNP

BNP is released when there is...

increased pressure/stretch in the atrium

BNP is most increased during

CHF Other conditions may cause small release, but CHF is highest by far

Echo for HF assesses... (5)

1. Chamber size 2. Severity of LV systolic dysfunction 3. Regional LV function (CAD) 4. Assess LV diastolic function and estimation of pressures 5. Valve/pericardial/RV abnormalities

EF equation Normal/severe?

LV EDV - LV ESV \_\_\_\_\_\_\_\_\_\_\_\_ LVEDV Normal 55-65%, Severe = less than 30%

Natural Hx of Heart failure

usually the time course varies, some may progress further/more rapidly than others

3 General Tx measures

Dietary sodium restriction Daily weight Vaccinations

Vax recommended in HF

influenza and pneumococcus

Meds that Improve Sx only

DIuretics and Digoxin

Meds that Improve Sx and prognosis

ACEI (-pril's) / ARBs Hydralazine and isosorbide B-blockers spironolactone Devices (ICD, resynch)

\_\_\_ is not first line Tx

DIgoxin

Next stage after Rx

ICD"call krause"

Indications for ICD (primary prevention)

CAD, prior MI with EF less than 30 EF less than 35, chronic class 2-3 CHF despite meds

People with chronic HF are prone to

sudden cardiac death

Resynchronization effects

improves LVEFImproves Symptoms and NHYA classReduces functional MR (improves survival)

Indication for resynch.

EF less than or equal to 35% \*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

Chronic inotropic support

DobutamineMilrinone

LVAD (left vent assist devices)

Bridge therapyDestination therapy

Last advanced therapy measure

cardiac transplantation

Chronic HF: Advanced therapies

Chronic inotropic supportLVADCardiac transplant

LVAD function

One end on LV, the other in aorta sucks blood from left ventricle and pumps it back into the aorta

5 most frequent acute decompensated HF causes

Diet noncompliance Med noncompliance failure to seek care Other (ischemia, HTN, Arrhythm.) Inappropriate Tx

Acute dcompensated CHF graph

Warm and Dry is normal (PCW ad CI nrmal)Warm and Wet (PCW elevated)Cold and dry (CI decreased)Cold and wet = PCW high, CI low)

Low perfusion at rest is indication for

Inotropic agents

\_\_\_\_\_\_\_\_\_\_\_ Y axis is indication for

Naturetic agents

Tx for acute CHF

Address precipitating causeseducate patient

HF with preserved LVEF

Increased LV filling pressure d/t abnormalities in LV relaxation and complience40% \_\_\_\_\_\_\_\_\_\_\_\_\*\*\*\*\*\*\*\*\*\*\*\*

Diastolic fail Tx

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

\_\_\_\_\_\_ is measured in HF

Anti-pro-BNP