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SU18: Internal med final > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

incidence

A

5.7 million Americans and increasing

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2
Q

how many people die from heart failure every year?

A
  • 56,000 deaths/year

- contributing cause in 262,000 deaths

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3
Q

pathophysiology

A

chronic, progressive inability of the heart to function as a pump

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4
Q

what happens if ventricles don’t empty during systole?

A

inadequate blood volume supplied to tissues

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5
Q

what happens if ventricles don’t fill during diastole?

A

backup of blood causing systemic congestion

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6
Q

common causes of heart failure

A
  • coronary heart disease
  • hypertension
  • cardiomyopathy
  • valvular heart disease
  • myocarditis
  • infective endocarditis
  • congenital heart disease
  • pulmonary hypertension
  • pulmonary embolism
  • endocrine disease
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7
Q

what percent of heart failure cases is caused by coronary heart disease?

A

60-75%

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8
Q

ejection fraction

A

reflection of heart’s efficiency as a pump

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9
Q

what guides the medical treatment of a pt with heart failure?

A

ejection fraction

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10
Q

what percent is considered a normal ejection fraction?

A

55-70%

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11
Q

what percent is considered a severe ejection fraction?

A

<35%

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12
Q

how is ejection fraction calculated?

A

amt of blood pumped out of ventricle/total amt of blood in ventricle

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13
Q

which ventricle normally will give out first?

A

left

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14
Q

symptoms of pts with heart failure with depend on what?

A

which side of the heart has failed

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15
Q

what are the cardinal symptoms of heart failure?

A
  • dyspnea

- fatigue

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16
Q

dyspnea is more of a failure on which side of the heart?

A

left

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17
Q

fatigue is more of a failure on which side of the heart?

A

right

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18
Q

pathophysiology of right ventricular failure

A
  • increased pressure and fluid retention
  • venous congestion
  • peripheral edema
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19
Q

pathophysiology of left ventricular failure

A
  • increased pressure and fluid retention
  • pulmonary hypertension
  • edema
  • increased perioheral resistance or myocardial disease
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20
Q

symptoms of heart failure

A
  • dyspnea
  • fatigue/weakness
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • pulmonary edema
  • dependent edema
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21
Q

orthopnea

A

dyspnea in recumbent position

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22
Q

paroxysmal nocturnal dyspnea

A

dyspnea awakening patient from sleep

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23
Q

pulmonary edema

24
Q

dependent edema

A

swelling in legs/ankles

25
pts with dependent edema is seen more in patients with which side of heart failure?
right
26
prognosis of heart failure
poor (5-yr survival 35% men, 50% women) | - sudden death 6-9x that of general population
27
1 year after diagnosis, what percent of ppl will die from heart failure?
20%
28
stage A heart failure
at high risk for HF but without structural heart disease or symptoms of HF
29
stage A heart failure pts
pts with - HTN - atherosclerotic disease - diabetes mellitus - obesity - metabolic syndrome OR - using carcinotoxins - w/ family history of cardiomyopathy
30
stage B heart failure
structural heart disease but without signs or symptoms of HF
31
stage B heart failure pts
pts with - previous MI - left ventricular remodeling including left ventricular hypertrophy and low ejection fraction - asymptomatic valvular disease
32
stage C heart failure
structural heart disease with prior or current symptoms of HF
33
stage C heart failure pts
pts with - known structural heart disease - HF signs and symptoms
34
stage D heart failure
refractory HF | *nothing is working for these pts so either need heart transplant or admit to hospice
35
stage D heart failure pts
pts with - marked HF symptoms at rest - recurrent hospitalizations despite guideline-directed medical therapy
36
how many classes are there in the classification of stage C heart failure?
4
37
does class 1 have symptoms with activity?
no
38
does class 1 have symptoms at rest?
no
39
does class 2 have symptoms with activity?
yes but ordinary activity
40
does class 2 have symptoms at rest?
no
41
does class 3 have symptoms with activity?
yes but less than ordinary activity
42
does class 3 have symptoms at rest?
no
43
does class 4 have symptoms with activity?
yes
44
does class 4 have symptoms at rest?
yes, pts are symptomatic no matter what they do
45
which classes are pts considered decompensated?
2, 3, 4
46
why is compliance difficult for pts with heart failure?
compliance difficult with life sentence to lifestyle mods and drug therapy
47
can pts with HF receive elective dental care?
``` depends on the status of HF *can txt pts w/ class 2 & 3 even though by the book, they're considered decompensated - just make sure there are no symptoms during activity or at rest ```
48
a history of compensated heart failure is considered what type of risk factor?
intermediate
49
perioperative risk is increased in pts unable to meet a MET demand of what?
≥4
50
decompensated heart failure is considered what type of risk factor?
major
51
what is the most common reason for pts to have episodes of decompensation?
noncompliance with meds
52
what is the goal in your office for decompensated heart failure pts?
keep CV system status quo... no major shifts in heart rate or BP
53
mods to dental txtment
- antibiotics - manage anxiety/stress - bleeding (pts may be taking anticoagulants or antiplatelet agents) - chair position (pt may not tolerate supine position) - consultation to estabilish level of disease control (ejection fraction) - check drug interactions - profound local anesthesia, modest epi
54
do pts with heart failure need antibiotic prophylaxis?
- check with treating cardiologist | - left ventricular assist device may require
55
can pts w heart failure take NSAIDS?
NO, will exacerbate syms
56
can asymptomatic HF pts have dental txtment?
yes
57
can symptomatic HF pts have dental txtment?
no, require further medical evaluation and optimizing prior to elective care

SU18: Internal med final (25 decks)

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