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Clin Med II- Exam 1 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Heart failure definition

A

structural/functional cardiac disorder that impairs ability of ventricle to fill or eject blood (inadequate perfusion)

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2
Q

Most common HF

A

left-sided systolic dysfunction (contractile)

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3
Q

Diastolic HF

A

abnormal cardiac relaxation, stiffness or filling

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4
Q

Main cause of right-sided HF

A

left sided HF

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5
Q

HFrEF

A

HF w/ reduced EF

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6
Q

Normal EF

A

50-55%

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7
Q

Reduced LVEF

A

<40% (systolic dysfunction if asymptomatic)

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8
Q

Signs of HFrEF

A 
EF <40%
s/s of HR
Increased LV volumes
eccentric remodeling (dilation, cardiomyocytes elongate)
"systolic heart failure"
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9
Q

Systolic HF =

A

systolic dysfunction + clinical s/sx

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10
Q

Causes of HFrEF

A 
impaired contractility (CAD, cardiomyopathy)
High afterload (HTN)
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11
Q

HFpEF

A

preserved EF >50%
s/s of HF
Diastolic dysfunction (on echo)
Abnormal mechanical properties of ventricle (impaired relaxation, decreased LV compliance)
Concentric remodeling/hypertrophy (pressure overload)
“Diastolic heart failure”

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12
Q

Pathophys of HFpEF

A

LV diastolic pressure (determined by volume of blood and compliance) – when elevated, will increase pulmonary venous pressure (dyspnea, exercise intolerance, and pulmonary congestion)

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13
Q

Pathophys of HFrEF

A

myocardial disease –> impaired ventricular performance –> neurohormone stimulation –> vasoconstriction/sodium retention –> increased impedence/ventricular dilation –> more impairment

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14
Q

Causes of HFpEF

A 
HTN +/- LV hypertrophy
aging
CAD
DM
sleep disorder
obesity
kidney disease
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15
Q

HFpEF people tend to be

A

older
HTN
overweight
women

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16
Q

Pathophys of right sided HF

A

elevated pressures in RA (usually do to L. sided HF) –> increased pressure in veins/capillaries –> increased formation of tissue fluid (edema/ascites)

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17
Q

HF risk factors

A 
CAD
Smoking
HTN
Overweight
DM
Valvular heart disease
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18
Q

Most common cause of heart failure

A

CAD

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19
Q

Symptoms of HF

A 
DYSPNEA (DOE- orthopnea - PND - dyspnea at rest)
Cough (nocturnal, nonproductive)
FATIGUE/WEAKNESS
DEPENDENT EDEMA
WEIGHT GAIN
Ascites
RUQ discomfort/early satiety
Nocturia
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20
Q

Signs of FH

A 
edema
elevated JVD
crackles at the bases
displaced PMI
S3/S4 gallop (early find in decompensation)
hepatomegaly
hepatojugular reflux
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21
Q

Clinical presentation of LHF

A

decreased CO - activity intolerance, fatigue, decreased perfusion signs (confusion)

pulmonary congestion - cyanosis, hypoxia, pulmonary edema (cough w/ frothy sputum, orthopnea, PND)

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22
Q

Clinical presentation of RHF

A 
dependent edema (weight gain)
ascites
JVD
GI congestion
hepatic congestion
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23
Q

Dx modalities for HF

A

ECG
Echo
Chest radiograph

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24
Q

ECG

A

look for ischemia, arrhythmias

normal ECG = systolic dysfunction unlikely

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25
Q

Most useful for diagnosis of HF

A

Echo

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26
Q

Echo

A

EF >50-55% is normal
Systolic: <40%
diastolic: normal EF

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27
Q

Echo in systolic

A

EF <40%

dilated left ventricle

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28
Q

Echo is diastolic

A

EF normal

Left ventricle hypertrophy

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29
Q

Chest radiograph purpose

A

cardiomegaly (cardiac to thoracic ration >50%); rule out pulmonary etiology

30
Q

*CXR suggestive of HF

A

Cardiomegaly
Cephalization of pulmonary vessels
Kerley B-lines (interstitial edema)
Pleural effusions

31
Q

Labs for HF

A 
Cardiac enzymes (ischemia?)
CBC (anemia/infection exacerbating HF)
CMP (electrolytes, glucose (DM), renal function (impairment?), LFT if hepatic congestion is present
32
Q

Best marker for dx of HF

A

Brain-type natriuretic peptide (BNP)

33
Q

What is BNP?

A

Released in response to ventricular wall stretching;
elevated BNP = HF (>100 but often >400);
Higher BNP = worse prognosis
not used to monitor, mainly just for diagnosis

34
Q

BNP <100

A

rule out HF

35
Q

Abnormal BNP

A

> 100

36
Q

Pro-BNP

A

> 450: HF likely
300-350: HF less likely
<300: unlikely

37
Q

Other panels to consider with HF

A

UA
Lipid panel
Thyroid (hypothyroidism can present as HF, exacerbate HF)
iron study (hemochromatosis as underlying HF cause)

38
Q

Stages of HF

A

Stage A: risk factors
B: structure damage but asymptomatic
C/D: sx + damage

39
Q

Function Classification

A

Class 1: no limitation
Class 2: slight SOB/limited during ordinary physical activity
Class 3: marked limitation (getting up to go to bathroom)
Class 4: unable to carry on any physical activity; sx at rest

40
Q

Goals of HF therapy

A

reduce preload: diminish congestive sx.

Reduce afterload: improve cardiac function

41
Q

Initial tx for HFrEF

A

ACEI

Diuretic (loop prefrred, thiazide added for synergistic effect)

42
Q

Tx for HFpEF

A

tx of co-morbidities

diuretics for symptomatic relief

43
Q

Diuretic

A

Type: Loop
Drug: 20-40 mg Furosemide (Lasix); others: bumetanide or torsemide
Goal: reduce fluid overload (relieve dyspnea, peripheral edema)
Monitor renal function, electrolytes (hypokalemia, CMP)
Response: 1kg/day weight loss

44
Q

ACEI

A

Goal: reduce morbidity and mortality in symptomatic and asymptomatic patients
Method: decrease afterload, RAAS blockade
How: titrate to max/target dose
Monitor: BP, renal function, electrolytes (hyperkalemia)
SE: cough

45
Q

Can cause hypokalemia

A

Diuretic

46
Q

Can cause hyperkalemia

A

ACEI, ARB, MRA

47
Q

Angiotensin II Receptor Blockers (ARBs)

A

used if ace inhibitors aren’t tolerated (people who persistently cough)
improve morbidity, mortality and sx
Method: decreased afterload, RAAS blockade
Monitor: BP, renal function, electrolytes (hyperkalemia)

48
Q

Beta-blockers

A 
Use: class Ii to III HF, and probably IV
decrease morbidity and mortality
Types: -lol drugs
Dose slowly: start ACEI until stable, then administer beta-blocker if stable
SE: bradycardia
49
Q

Contra for beta-blocker

A

acute decompensation

50
Q

Mineralcorticoid Receptor Antagonist (MRA)

A

aldosterone antagonist
potassium-sparing diuretic
Drugs: spironolactone, eplerenone
Indication: dyspnea at rest w/i past 6 months; post MI w/ systolic dysfunction
lower mortality
Criteria: GFR >30 mL/min
Monitor: electrolytes, fluid balance, renal function (hyperkalemia)

51
Q

May cause bradycardia

A

beta-blockers

52
Q

Digoxin

A

improve sx and decrease hospitilization rates (no effect on mortality)
Indication: concomitant a fib
Effect: enhances exercise tolerance
start low dose (0.125 mg or less) and monitor serum levels (0.5-0.8)

53
Q

Use for HF with a fib

A

Digoxin

54
Q

Non-pharm tx for HF

A 
stop smoking
restrict alcohol
sodium restriction (2-3g/day)
exercise
normal weight
vaccines
55
Q

ADLs

A

loss predicts higher mortality rate

56
Q

Best manages HF

A

HF clinic (specialized providers, increased compliance, improved outcomes, ensures national benchmarks)

57
Q

Cardiac rehab

A

slows, stabilizes or revers progression of CVD (counseling, med management, support, exercise, nutrition); supervised by cardiologists and PAs

58
Q

Most common cause of death in HF

A

progressive pump failure (decompensation) and malignant arrhythmias

59
Q

Triggers for decompensation

A 
uncontrolled HTN
tachyarrhythmias (a fib, tachy)
ischemia
renal dysfunction
anemia
Chronic lung disease
pulmonary embolism
endocrine abnormalities (DM, hyper/hypothyroid)
infection
nonadherence to diet/drug
60
Q

Drugs that worse HF

A 
NSAIDs
metformin (DM)
Cilostazol
PDE-5 inhibitors: sildenafil (viagra), tadalafil (vialis), vardenafil (levitra)
Antiarrhthmics
TCAs
Itraconazole
Carbamazepine
61
Q

Acute decompensated HF (ADHF)

A

EMERGENT, SEVERE
new or exacerbation of chronic disease
determine cause (diet, nonadherence, drug interxn, CAD, anemia, infection, DM etc)
ELEVATED LEFT-SIDED FILLING PRESSURE AND DYSPNEA, W/ OR W/O PULMONARY EDEMA

62
Q

Cardiogenic pulmonary edema

A

potentially fatal cause of acute respiratory distress;

usually a result of ADHF (acute MI, ischemia or mitral stenosis)

63
Q

Presentation of cardiogenic pulmonary edema

A

CXR: kerley B, edema, cardiomegaly; pulmonary capillary wedge pressure elevated (>25)
dyspnea
productive cough
diaphoresis
crackes/rales on exam, wheezes and rhonchi

64
Q

“flash” pulmonary edema

A

dramatic form of cardiogenic alveolar pulm. edema
URGENT
may occur w/ MI, mitral regurgitation, HTN crisis, acute aortic regurg, stress cardiomyopaty

65
Q

Tx for flash pulm edema

A

standard tx for pulm edema plus venous and arterial vasodilators

66
Q

butterfly pattern on CXR

A

pulmonary edema

67
Q

Clinical presentation of ADHF

A

cough, dyspnea, fatigue and/or peripheral edema (which rapidly become severe)
orthopnea, PND leading up to presentation

68
Q

PE of ADHF

A

HTN, JVD, tachypneic, accessory muscle use, crackles, tachy, S3/S4 gallop, new murmur, LE edema

69
Q

Hypotension

A

SHOCK! in ADHF

70
Q

Don’t give what in ADHF

A

Fluids!

71
Q

Management of ADHF

A

admit: monitor vitals, I&Os, renal function, etc; telemetry 24-48 hrs

Give oxygen
Diuretic
Nitroglycerin- reduce preload and capillary wedge pressure
Monitor Potassium

Clin Med II- Exam 1 (7 decks)

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