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

Heart Failure Flashcards

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1
Q

Which stages of ACC/AHA are considered “at risk” for heart failure?

Which stages are considered “heart failure”

A

at risk = stage A and B

heart failure = stage C and D

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2
Q

What physical findings are associated with pulmonary congestion associated with left heart failure

A 
pulmonary edema
cough with frothy pink sputum 
cyanosis 
orthopnea
PND
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3
Q

You’re doing a physical exam on someone who has acute heart failure. What do you see/hear/feel?

(7 things)

A
  1. Edema
  2. JVD
  3. Crackles at bases
  4. displaced PMI
  5. S3/S4 gallop
  6. hepatomegaly
  7. hepatojugular reflex
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4
Q

What is a reasonable response for the edema to diminish in a patient who started furosemide (Lasix)

A

1kg/day weight loss

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5
Q

goals of therapy:

reducing afterload will have what desired effect

A

improve cardiac function

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6
Q

What labs do you order when evaluating for heart failure?

A
  1. cardiac enzyme to rule out acute ischemia
  2. CBC
  3. CMP
  4. Brain-type natriuretic peptide (BNP)

(THESE ARE THE MAIN FOUR)

others : UA, lipid, thyroid, iron

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7
Q

Which stage of NYHA classification

ordinary physical activity does not cause breathlessness, fatigue, or palpitations

A

Stage 1

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8
Q

Which stage of NYHA classification

ordinary physical activity results in undue breathlessness, fatigue, or palpitations

A

Stage 2

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9
Q

A patient with suspected heart failure should get what diagnostic tests? (3)

A
  1. EKG
  2. echo
  3. Chest x-ray
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10
Q

Which diagnostic exam is the most useful in determining heart failure

A

echo

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11
Q

the most common type of heart failure is

A

left ventricular systolic dysfunction

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12
Q

A patient with a Brain-type natriuretic peptide (BNP) less than 100 has a ________ prognosis

A patient with a Brain-type natriuretic peptide (BNP) greater than 400 has a ______ prognosis

A

good

poor

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13
Q

If a patient has a Brain-type natriuretic peptide (BNP) less than 100, what can you rule out?

A

heart failure

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14
Q

What is important to remember about starting a patient on ACE inhibitors for the first time?

A

titrate to maximum/target dose
monitor for hyperkalemia
they may get a cough

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15
Q

NYHA classification is based on

A

limitations of activity

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16
Q

Which type of heart failure is associated with reduced ejection fraction? (less than 40%)

A

systolic/ HFrEF

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17
Q

What are the four findings on a chest x-ray that are suggestive of heart failure

A
  1. cardiomegaly
  2. cephalization of pulmonary vessels (more prominent at the apex of the lungs to compensate for fluid filled base)
  3. Kerley-B lines (interstitial edema)
  4. Pleural effusions
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18
Q

cardiomegaly is a cardiac to thoracic ratio of:

A

greater than 50%

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19
Q

What are the four basic principles of treatment of heart failure

A
  1. manage underlying cause
  2. manage precipitating cause
  3. control symptoms of failure
  4. review medications
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20
Q

right heart failure is due to a ____ pressure, _____ compliance system

A

low pressure, high compliance system

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21
Q

the most common cause of heart failure (either side)

A

coronary artery disease

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22
Q

Which stage of NYHA classification

breathlessness, fatigue, or palpitations at rest

A

Stage 4

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23
Q

What is the most common cause of right heart failure

A

left heart failure

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24
Q

What physical findings are associated with congestion of peripheral tissues associated with right heart failure

A

peripheral edema
RUQ pain
JVD
ascites

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25
acute heart failure most important symptoms
1. DYSPNEA (DOE--> orthopnea --> PND--> dyspnea at rest) 2. fatigue/weakness 3. dependent edema 4. weight gain (10/12 lbs in A DAY) 5. cough- nocturnal, nonproductive
26
Which type of diuretics do you give to HF patients
loop
27
pathophysiology of left heart failure is characterized by elevated ______
left ventricular filling pressures
28
What is significant about left ventricular compliance with HFpEF
decreased compliance - inability to relax
29
structural heart disease + asymptomatic is what stage of the ACC/AHA
Stage B
30
In HFrEF, what is different about the left ventricular volume?
increased
31
Which type of heart failure is associated with volume overload
HFrEF / systolic
32
HFrEF is what kind of dysfunction + symptoms of heart failure?
systolic
33
inotropy is another term for
contractility
34
at risk for HF and asymptomatic is what stage of the ACC/AHA
Stage A
35
What medication would you consider for a patient with at rest dyspnea within past 6 months, or is post-MI with systolic dysfunction
Mineralcortocoid Receptor Antagonist (MRA) Aldoseterone antagonist, potassium-sparing dieretic, spironolactone, eplerenone
36
What medication would you consider for a patient with atrial fibrillation? Does this reduce mortality or management of sxs?
Digoxin sxs only
37
chronotropy is another term for
heart rate
38
What abnormality will you SEE on an echo with systolic dysfunction
dilated left ventricle ******
39
What is the most common cause of death associated with heart failure?
decompensation (progressive pump failure) | malignant arrhythmias
40
Elongating myocytes is what kind of chamber remodeling
eccentric
41
Left heart failure = congestion of _________ | Right heart failure = congestion of _________
Left heart failure = congestion of pulmonary | Right heart failure = congestion of peripheral tissues
42
Which improves symptoms and which reduces morbidity and mortality? ACE inhibitors versus loop diuretics
loop diuretics = symptoms ACE inhibitors = reduces morbidity and mortality
43
Thickening myocytes is what kind of chamber remodeling
concentric
44
ACC/AHA classification system is based off of:
structural manifestations of the disease
45
dramatic form cardiogenic alveolar pulmonary edema is defined as
"flash" pulmonary edema
46
When is Brain-type natriuretic peptide (BNP) released?
in response to stretching of the ventricle wall
47
What is your initial dose of loop diuretics for patients with HF? What is the name of the medication?
20-40 mg furosemide (Lasix)
48
What is the role of statins in heart failure?
not helpful in patients with systolic HF appropriate if already on statins for a different indication at the time they develop HF
49
What is the MARKER for heart failure?
Brain-type natriuretic peptide (BNP)
50
What abnormality will you SEE on an echo with diastolic dysfunction
left ventricle hypertrophy *******
51
refractory heart failure + specialized interventions is what stage of the ACC/AHA
Stage D
52
8 drugs that can WORSEN heart failure
1. NAIDs 2. Metformin 3. Cilostazol 4. PDE-5 inhibitors (dick drugs) 5. Antiarrhythmics 6. Tricyclic antidepressants 7. Itraconazole 8. Carbamazepine (for nerve pain, seizures, BPD)
53
Where are patients best treated for heart failure?
heat failure clinic
54
if your patient has acute decompensated heart failure and they have HYPOtension, what does that indicate?
shock
55
Which medication should you never administer during acute decompensation
beta blockers
56
When would you use cardiac catheterization for heart failure?
active CAD- like an acute MI | not routine for HF
57
diastolic dysfunction is defined by impaired
relaxation
58
systolic dysfunction is defined by impaired _____
contractility
59
What is the major difference in the management of HFpEF versus HFrEF?
``` HFpEF = manage comorbidities (diastolic) HFrEF = mange the HFrEF (systolic) ```
60
structural heart disease + prior or current symptoms of HF is what stage of the ACC/AHA
Stage C
61
How does the sympathetic nervous system compensate when stroke volume is decreased
increased heart rate
62
Which heart sound is associated with acute heart failure
s3/s4 gallop
63
HFpEF is what kind of dysfunction + symptoms of heart failure
diastolic
64
Which medication can also be toxic, and you must monitor serum levels?
Digoxin
65
In patients with HFpEF versus HFrEF, they tend to be:
older more frequently have HTN overweight women
66
how can you tell the difference between systolic and diastolic heart failure on an echo?
``` diastolic = normal EF (50-55%) systolic = less than 40% ```
67
Which type of heart failure is associated with increasing pulmonary venous pressure
HFpEF / diastolic
68
If you suspect a patient has heart failure and they have a NORMAL ekg, what can you rule out?
systolic heart failure "highly unlikely"
69
You have admitted your patient to the hospital for acute decompensated heart failure, what is the management plan?
O2 diuretics nitro opioids (or alternative pain management because the faculty is too afraid to tell us to give opioids and avoid it like the plague)
70
goals of therapy: reducing preload will have what desired effect
diminish congestive symptoms
71
What type of remodeling is associated with HFpEF
HFpEF = diastolic = hypertropy = concentric remodeling
72
Which type of heart failure is associated with increased formation of tissue fluid such as peripheral edema, and ascities
right heart failure
73
with myocardial disease, there is impaired ventricular performance or ventricular arrhythmias, what is the first line compensation?
neurohormonal stimulation: overactivation of RASS (alter CO thru plasma volume control) SNS increase heart rate
74
Causes of HFrEF
impaired contractility due to CAD or cardiomyopathy | High afterload due to HTN
75
What can happen when you start a stable patient on beta blockers (patient should ALWAYS be stable if you are starting beta blockers)
can worsen the clinical picture, exacerbate failure when the first start
76
Which type of heart failure is associated with pressure overload
HFpEF / diastolic
77
Which stage of NYHA classification less than ordinary physical activity such as getting up to go to the bathroom causes breathlessness, fatigue, or palpitations
Stage 3
78
pulmonary edema on a chest x-ray
butterfly pattern | always bilateral
79
What type of chamber remodeling is associated with HFrEF
HFrEF = systolic = progressive chamber dilation and eccentric remodeling
80
Recommended initial pharmacologic therapy for HFrEF
(systolic) ACE inhibitor Diuretic

Clin Med Exam 1 (Shelby) (10 decks)

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