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Flashcards in Heart failure Deck (62):
1

heart failure

complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood 

2

systolic dysfunction 

impaired cardiac contractile function 

3

diastolic dysfunction 

abnormal cardiac relaxation, stiffness or filling 

4

SNS effect on HR, contractility, preload, afterload, and CO

  • HR increases
  • contractility increases
  • preload increases
  • afterload decreases
  • CO increases

5

preload

volume coming into ventricles (end diastolic pressure) 

6

afterload

resistance-left ventricle must overcome to circulate blood 

7

give examples of neurohormonal imbalances that can cause progressive heart disease by causes cardiac remodeling and decline in heart function 

  1. overactivation of the renin-angiotensin-aldosterone system
  2. sympathetic nervous system

8

what is HFrEF

  • Heart failure with a reduced ejection fraction, also known as systolic heart failure

9

Signs of HFrEF

  • increased LV volumes
  • reduced LVEF (< or = 40%)
  • usually progressive chamber dilation and eccentric remodeling 

10

causes of HFrEF

  • impaired contractility
    • CAD
    • cardiomyopathy
  • high afterload
    • HTN

11

HFpEF

Heart failure with preserved EF; also called diastolic heart failure

  • Diastolic dysfunction
    • abnormal mechanical properties of the ventricle
  • normal LVEF (> or = 50%)

12

differentiate between concentric and eccentric remodeling 

  • concentric: walls are thicker
  • eccentric: walls are thinner

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13

LV diastolic pressure

determined by volume of blood in ventricle and distensibility or compliance of ventricle

14

an elevated LV diastolic pressure will have what effect on pulmonary venous pressure

pulmonary venous pressure will increase causing

  • dyspnea
  • exercise intolerance
  • pulmonary congestion
  • may lead to RHF

15

what are the two most common causes of HFpEF

  • ischemia
  • left ventricular hypertrophy 

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16

most common caues of right heart failure

left heart failure

  • Rt heart does not tolerate increases in afterload

17

signs of Rt heart failure

  • increased pressurein veins, capillaries
  • increased formation of tissue fluid (peripheral edema and ascites) 

18

risk factors of heart failure

  • coronary heart disease
  • smoking
  • HTN
  • obese
  • DM
  • valvular heart disease

19

what is the most common cause of heart failure 

coronary artery disease 

20

clinical presentation

  • dyspnea that becomes worse over time
    • DOE -> orthopnea -> PND -> dyspnea at rest
  • fatigue, weakness
  • dependent edema
  • weight gain 

heart failure

21

what physical exam findings would you expect to see with heart failure

  • edema
  • elevated JVD
  • rales at bases
  • displaced PMI (laterally) 
  • hepatomegaly
  • S3/S4 gallop

22

modified framingham clinical criteria lists major and minor criteria for the diagnosis of heart failure. what is needed to diagnose HF

at least 2 major symptoms or 1 major and 2 minor

23

left heart failure has what impact of CO? what are the effects?

decreased CO 

  • activity intolerance, fatigue
  • signs of decreased tissue perfusion (confusion) 

24

left heart failure causes pulmonary congestion. what are some signs and symptoms you would expect

  • impaired gas exchange
    • signs of hypoxia
  • pulmonary edema
    • cough with frothy sputum
    • orthopnea 

25

these signs lead to what diagnosis

  • dependent edema
  • ascites
  • increased JVD
  • GI tract congestion
  • hepatic congestion
  • weight gain 

right heart failure

26

signs and symptoms point toward what disease 

  • dyspnea
  • diaphoresis
  • tachypnea
  • tachycardia
  • rales
  • S3 or S4

left side heart failure

27

patients with suspected HF should recieve the following diagnostic studies

  • ECG
  • echocardiography
  • chest radiograph

28

a normal ECG makes which heart failure highly unlikely 

systolic dysfunction 

29

what information can echocardiogram tell us regarding HF

  • ejection fraction > 50% is normal 
    • systolic HF: signs/symptoms of HF + EF < or = 40% 
    • diastolic HF: signs/symptoms of HF + normal EF
  • size of left ventricle
    • systolic HF: dilated LV 
    • diastolic HF: LVH

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30

function of chest radiograph in diagnosis HF

  • evaluate CM
  • rule out pulmonary etiology
  • findings suggestive of HF
    • CM
    • cephalization of pulmonary vessels
    • Kerley B lines (interstitial edema) 
    • pleural effusion

31

when is a exercise ECG stress test contraindicated in HF

acute HF

32

what labs would you get for suspected HF

  • cardiac enzymes
  • CBC
    • anemia/infection can exacerbate pre-existing HF
  • CMP
    • electrolytes
    • glucose: detect underlying DM
    • renal function
    • liver function tests to see if hepatic congestion is present
  • UA
  • lipid panel
  • thyroid panel: hypothyroidism can exacerbate HF
  • iron studies 

33

what lab is the marker for HF

brain type natriuretic peptide (BNP)

  • released in response to stretching of ventricular wall 
  • elevated levels -> HF
    • higher level of BNP -> poorer the prognosis

34

stages of heart failure 

  • stage A: high risk but without structural changes or symptoms
  • stage B: structural heart disease but without signs or symptoms
  • stage C:  structural heart disease with signs or symptoms
  • stage D: refractory heart failure including specialized interventions

35

NYHA functional classification 

class I-IV: used to classify patients in stages C and D of heart failure based on their symptoms 

36

goals of heart failure therapy 

  1. reduce preload -> diminish congestive symptoms
  2. reduce afterload -> improve cardiac function

37

recommended initial therapy for ALL patients with HF

  • ACE inhibitor
  • Diuretics 

38

39

preferred diuretic in treatment of HF. Goal of diuretic 

  • Loop diuretic preferred
    • Lasix
  • goal: reduce fluid overload
    • relieve dyspnea and peripheral edema 

40

what must you monitor when you place a patient on a diuretic 

renal function

  • lasix causes hypokalemia and patient may require KCl supplement 

41

what must you monitor when you place a patient on a ACE inhibitors 

  • BP
  • renal function
    • causes hyperkalemia 
  • electrolytes

42

benefit of ACE inhibitors 

shown to reduce morbidity and mortality in both symptomatic and asymptomatic patients 

43

what medication can you give to patients in HF who can not tolerate ACE inhibitors 

angiotensin II receptor blockers (ARBs) 

44

what must you monitor when you place a patient on a angiotensin II receptor blocker 

  • BP
  • renal function
    • hyperkalemia
  • electrolytes

45

when would you administer beta blockers to a patient with HF?

  • start ACE inhibitors first, wait until stable
  • administer only if patient is clinically stable

46

main side effect of beta blockers 

bradycardia

47

what is mineralocorticoid receptor antagonist 

  • aldosterone antagonist
  • potassium-sparing diuretic 

48

indications of mineralocorticoid receptor antagonist 

  • patients with rest dyspnea withint past 6 months; post MI with systolic dysfunction
  • may result in hyperkalemia

49

When is Digoxin given 

  • use in patients with concomitant atrial fib
  • enhances exercise tolerance 

50

loss of what predicts a higher mortality rate 

ADL: activities of daily living 

51

where do statins fall in treatment of HF 

  • statins are not helpful
  • but if already on one for another indication, continue 

52

prognosis of HF 

  • 30-40% die within 1 year
  • 60-70% die within 5 years

53

what are the most common causes of death in a HF patient 

  • progressive pump failure (decompensation)
  • malignant arrhythmias 

54

list some triggers for decompensation 

  • uncontrolled HTN
  • A-Fib
  • ischemia
  • renal dysfunction
  • PE
  • infection

55

name some drugs that can worsens heart failure 

  • NSAIDs
  • metformin
  • PDE-5 inhibitors (Viagra)
  • Antiarrhythmics

56

acute decompensated heart failure 

elevated left sided filling pressures and dyspnea with or without pulmonary edema 

57

clinical presentation

  • dyspnea
  • productive cough
  • diaphoresis
  • rales, wheezes, rhonchi 

cardiogrenic pulmonary edema

  • most often a result of acute decompensated HF

58

what will CXR reveal in cardiogrenic pulmonary edema

  • Kerley B lines
  • edema
  • CM

59

cardiogrenic pulmonary edema effect on pulmonary capillary wedge pressure 

typically elevated ( > 25 mmHg) 

60

clinical presentation

  • cough
  • dyspnea
  • fatigue
  • peripheral edema
  • HTN
  • JVD
  • crackles
  • S3, S4 gallop
  • new murmur

acute decompensated HF

61

managment of acute decompensated HF

  1. O2: keep sat > 90%
  2. diuretics
  3. nitroglycerin: reduce preload and capillary wedge pressure
  4. morphine: reduce anxiety and work of breathing

62

the most common cause of heart failure 

left ventricular systolic dysfunction