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Clin Med Exam 1(Lauren) > Heart Failure > Flashcards

Heart Failure Flashcards

(75 cards)

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1
Q

What is the definition of heart failure?

A

Heart is not meeting the needs of the body

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2
Q

What are the two types of dysfunction that can cause Left sided heart failure?

A

Systolic dysfunction

Diastolic dysfunction

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3
Q

What is systolic dysfunction?

A

Impaired contraction

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4
Q

What is diastolic dysfucntion?

A

Abnormal relaxation, stiffness or filling

(LV not ballooning out to receive the blood. Low compliance in LV. Cardiac output goes down becasue its not filling well enough

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5
Q

What is the main cause of Right-sided heart failure?

A

Left sided HF

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6
Q

What causes heart failure?

A

There is some initial insult (MI, chronic HTN causing pressure and volume overload, etc)

Then the body responds to the initial insult to maintain CO using neurohormonal stimulation (RAS or SNS).

This ends up making it worse over time (ventricular dilation, increased impedance)

Now ventricular performance is even more impaired, and the body will try to maintain CO with neurohormonal stim again.

Vicious cycle.

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7
Q

Is an asymptomatic patient usually in heart failure or heart dysfunction ?

A

Dysfucntion

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8
Q

What kind of dysfunction causes HFrEF?

A

Systolic dysfunction

HFrEF is also known as Systolic Heart Failure

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9
Q

What will the EF be in HFrEF?

A

40% or less

Normal is 50-55%

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10
Q

What happens to the volume of the LV in HFrEF?

A

Increases

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11
Q

What kind of remodeling occurs in HFrEF?

A

Eccentric remodeling with chamber dilation (volume overload)

The myocytes elongate and get all thin and floppy

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12
Q

What kind of dysfunction causes HFpEF?

A

Diastolic dysfunction

HFpEF is also known as Diastolic Heart Failure

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13
Q

What is the EF with HFpEF?

A

Normal. (50% or higher)

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14
Q

What kind of remodeling occurs in HFpEF?

A

Concentric remodeling or hypertrophy

Walls get very thick=low LV compliance= reduced filling

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15
Q

What is it called when the LV mass is normal and there is concentric geometry?

A

Concentric remodeling

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16
Q

What is the difference between concentric remodeling and concentric hypertrophy?

A

In concentric hypertrophy, the LV mass is increased

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17
Q

What is the difference between eccentric remodeling and eccentric hypertrophy?

A

In eccentric hypertrophy, the LV mass is increased.

Dilated and hypertrophic=floppy, doesn’t contract well

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18
Q

What are the long term effects of HFpEF?

A

Increased diastolic pressure in the LV causes an increase in pulmonary venous pressure, which then causes SOB and pulmonary congestion/edema.
This can then increase pulmonary arterial pressure, increasing afterload on the RV causing Right sided heart failure

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19
Q

What are the causes of HFrEF?

A

Impaired contractility (CAD or cardiomyopathy)

High afterload (HTN)

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20
Q

What are the causes of HFpEF?

A

HTN

LV hypertrophy

Aging

CAD

DM

Sleep apnea

Obesity

Kidney disease

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21
Q

What things cause HFpEF and HFrEF?

A

Old age

HTN

CAD

DM

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22
Q

Patients with HFpEF (vs HFrEF) tend to be:

A

Older

Have HTN

Overweight

Women

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23
Q

What causes the peripheral edema and ascites in Right HF?

A

Elevated pressures in the right atrium (as a resusult of high pressure in the RV)

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24
Q

What are the risk factors for heart failure?

A

CAD

Smoking

HTN

Overweight

Diabetes

Valvular heart disease

(Obvious shit)

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25
What is the most commmon cause of heart failure?
Coronary artery disease (CAD)
26
What are the symptoms of heart failure? (There’s a lot)
Dyspnea** Cough Fatigue/weakness*** worse on exertion Dependent edema** Weight gain** Ascites RUQ discomfort/early satiety (hepatic congestion) Nocturia (secondary to increased renal perfusion when lying down)
27
What is the progression of dyspnea as the heart filaure gets worse?
DOE —> orthopnea -> PND —> dyspnea at rest
28
What is the cough in HF like?
Nocturnal, nonproductive | OR pink frothy sputum
29
What kinds of things will you find on your physical exam on a pt with HF?
Edema Elevated JVD Crackles at base of lungs Displaced PMI (heart is enlarged) S3/S4 gallop (early decompensation) Hepatomegaly Hepatojugular reflux
30
Right or Left HF: Dyspnea Diaphoresis Tachypnea Tachycardia Rales S3 or S4
Left
31
Left or Right HF: Peripheral edema RUQ pain JVD Ascites
Right
32
What 3 diagnostic studies should every patient with suspected HF receive?
ECG Echo CXR
33
A normal ECG makes _________dysfunction HIGHLY unlikely
Systolic | Most pts with systolic dysfunction have abnormal EKG
34
What will you see on an echo of systolic dysfunction?
Dilated** left ventricle
35
What will you see on an echo of someone with diastolic dysfuncion?
Left ventricle hypertrophy*
36
What CXR findings are highly suggestive of HF? (KNOW THESE)
Cardiomegaly Cephalization of pulmonary vessels (pulmonary vessels more prominent at apex of lung) Kerley B-lines (interstitial edema) Pleural effusions Butterfly sign if pulmonary edema is present🦋
37
What labs are we going to get when we think our patient has CHF?
Cardiac enzymes- make sure its not ischemic CBC- anemia/infection may exacerbate CMP Brain-type Natriuretic Peptide (BNP)*****
38
What is Brain Natriuretic Peptide (BNP)?
Its a marker for heart failure, because it is released in response to the stretching of ventricular wall.
39
What do higher BNP levels (usually over 400) indicate?
Worse prognosis/outcome of CHF
40
If your BNP is less than _______, it is safe to rule out CHF
100
41
If your BNP is over ______, you can safely say you have CHF.
400
42
According to NYHA functional classification, if your patient has no limitation of physical activity, they are in what class of CHF?
Class I
43
According to NYHA functional classification, if your patient has a slight limitation of physical activity, where ordinary physical activity results in SOB, fatigue, or palpitations, what class are they in?
Class II | Ex: SOB when mowing the lawn
44
According to NYHA functional classification, if your patient has marked limitation of physical activity, where any ordinary physical activity results in SOB and fatigue, what class are they in?
Class III Ex: getting up to pee, walking to kitchen, or folding laundry make them short of breath
45
According to NYHA functional classification, if your patient is unable to do ANY physical activity without discomfort, and they may have symptoms at rest, what class are they?
Class IV
46
Reducing (Preload/afterload) will diminish congestive symptoms
Preload
47
Reducing (preload/afterload) will improve cardiac function
Afterload
48
What two drugs do ALL patients with HFrEF get right away?
ACE-inhibitor Diuretics
49
What is the preferred type of diuretic for CHF?
Loop diuretics. Thiazides may added for a synergistic effect
50
How much Lasix do you start your CHF patient on?
20-40 mg
51
How much weight loss should you expect to see when you start your CHF patient on Lasix?
1kg/day
52
How do you find the right dose of ACE-inhibitor for your patient?
Start low, and slowly titrate to target dose
53
What are the 2 common side effects of ace inhibitors?
HYPERkalemia Cough
54
Do ace inhibitors reduce preload or afterload?
Afterload
55
If your patient is not tolerating the ACE-inhibitor you put them on, or their cough is too much to handle, what can you do?
Replace it with an ARB
56
So you’ve started your patient on their Lasix and their ace inhibitor, and you’ve decided that a beta-blocker may be helpful for them. What do you need to do?
Make sure they are ~stable~ on their ace and Lasix first Make sure they are not in acute decompensation Start with a low dose and slowly titrate up
57
What is the main side effect of beta blockers?
Bradycardia
58
Will beta-blockers decrease morbidity and mortality?
Yes
59
Will adding digoxin to your CHF patient’s cocktail have any effect on their mortality?
No. But it is great for Symptomatic relief! Remember it increases contractility of the heart, so it might help them mow their lawn more or whatever they like to do.
60
If a patient can not do their normal activities do daily living, what does that mean?
Higher mortality rate | Bathing, dressing, transferring from bed or chair, walking, eating, toileting, grooming
61
What is this: | “Medically-supervised program to slow, stabilize, or reverse the progression of CVD”
Cardiac rehabilitation
62
Should your CHF patient be on a statin?
Will NOT help their systolic heart failure (HFrEF) BUT if they’re already on one for something else, continue it
63
Is there a good prognosis for patients with heart failure?
No 30-40% die in 1 year 60-70% die in 5 years :(
64
What are the most common causes of death when a patient has heart failure?
Progressive pump failure (decompensation) Malignant arrhythmias
65
What are the 8 drugs that can worsen heart failure?
NSAIDS Metformin Cilostazol Erectile dysfunction drugs Antiarrhythmics Tricyclic antidepressants Itraconazole Carbamazepine
66
What is Acute Decompensated Heart Failure?
Just like what it sounds like....it can be new or an exacerbation of chronic disease. Either way it is an EMERGENCY.
67
Is Acute Decompensated Heart Failure a big deal?
Yes. It is VERY SEVERE, and is a EMERGENCY
68
What usually causes cardiogenic pulmonary edema?
Acute Decompensated Heart Failure
69
How will a patient present if they have cardiogenic pulmonary edema?
Shortness of breath Pink frothy sputum Sweating Rales/crackles, wheezing, rhonchi
70
What will you see on a CXR if your patient has cardiogenic pulmonary edema?
Kerley B lines Edema Cardiomegaly
71
What is “flash” pulmonary edema
Cardiogenic pulmonary edema that is really dramatic, and requires you to act even faster to implement initial therapy.
72
What will you find on physical exam of your patient in acute decompensated heart failure?
HTN JVD Breathing fast Accessory muscle use Crackles Tachycardia S3/S4 gallop New murmur Edema in legs
73
How will a patient with acute Decompensated heart failure present?
This stuff rapidly became much worse: Cough shortness of breath Fatigue Peripheral edema
74
How do you manage your patient in acute decompensated heart failure?
Admit to hospital Oxygen Diuretics Nitro Opioids maybe
75
What is the most common type of heart failure?
Left ventricular systolic dysfunction

Clin Med Exam 1(Lauren) (8 decks)

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