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Clinical Medicine II > Heart Failure > Flashcards

Heart Failure Flashcards

(107 cards)

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1
Q

Heart failure is an impaired ability of the heart to either _______ or _______.

A

relax or pump blood

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2
Q

impaired LV contractile function is known clinically as…

A

systolic dysfunction

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3
Q

abnormal LV cardiac relaxation, stiffness or impaired filling is known clinically as…

A

diastolic dysfunction

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4
Q

T or F

Systolic dysfunction causes diastolic dysfunction.

A

F. one doesn’t cause the other

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5
Q

can systolic and diastolic dysfunction coexist?

A

yes

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6
Q

Generally, isolated right heart pathology suggests an issue with what system?

A

pulmonary

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7
Q

pulmonary hypertension can contribute to what type of cardiac dysfunction?

A

right ventricle

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8
Q

LHF, HFrEF is systolic or diastolic?

A

systolic

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9
Q

LHF HFpEF is systolic or diastolic?

A

diastolic

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10
Q

what does ejection fraction measure?

A

ability of ventricles to eject blood/ventricular function

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11
Q

The below factors have a positive impact on what factor of stroke volume? Preload, Afterload, Contractility or HR?

Increased venous return

increased filling time

increased ventricular compliance

increased filling pressure

A

increased preload

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12
Q

The below factors have a positive impact on what factor of stroke volume? Preload, Afterload, Contractility or HR?

increased peripheral vascular resistance

increased aortic pressure

decreased arterial wall compliance

A

increased afterload

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13
Q

The below factors have a positive impact on what factor of stroke volume? Preload, Afterload, Contractility or HR?

SNS stimulation leading to inotropy

A

increased contractility

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14
Q

The below factors have a positive impact on what factor of stroke volume? Preload, Afterload, Contractility or HR?

SNS stimulation leading to chronotropy

A

HR

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15
Q

Abrupt damage to myocardium can occur in what condition?

A

MI

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16
Q

What two factors cause gradual damage to the myocardium leading to HF?

A

Increased pressure

Increased volume

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17
Q

Progressive damage to myocardium causes what two changes to the heart?

A

cardiac remodeling

declining heart function

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18
Q

Decreased perfusion to the kidneys leads to what two physiologic changes which lead to CHF?

A

overactive RAAS system

SNS stimulation

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19
Q

The progression of heart disease can be visualized as a cycle. What are the steps of this cycle?

A

heart disease

LEADING TO

decreased CO

LEADING TO

neurohormonal stimulation

LEADING TO

vasoconstriction and sodium retention

LEADING TO

increased resistance and ventricular dilation

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20
Q

A pt. presents with the following findings. What type of HF do you suspect?

  • clinical S/S of HF
  • reduced LVEF (40% or less)
  • increased LV ESV/EDV
A

HFrEF

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21
Q

HFrEF is also known as…

A

systolic heart failure

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22
Q

In HFrEF, _______ overload leads to ________ dilation and _________ remodeling

A

volume overload

chamber dilation

eccentric remodeling

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23
Q

HFrEF is caused by impaired contractility and high afterload. What conditions impair contractility and increase afterload?

A

Contractility: CAD, cardiomyopathy

Afterload: HTN

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24
Q

What is the normal range for LVEF?

A

50-55%

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25
HFpEF is systolic or diastolic dysfunction?
Diastolic Dysfunction
26
Impaired LV relaxation and decreased LV compliance lead to...
diastolic dysfunction
27
What happens to the LVEF and EDV in HFpEF?
normal
28
When the LV increases its dependence on atrial contraction for filling, what results?
left atrial enlargement
29
HFrEF is a ______ overload, while HFpEF is a ________ overload
rEF: volume overload pEF: pressure overload
30
what type of cardiac remodeling is seen in HFpEF?
concentric remodeling/hypertrophy
31
What risk factors do HFpEF and HFrEF have in common?
old age HTN CAD DM
32
Patients with HFpEF compared to HFrEF tend to...
be older have HTN overweight women
33
What is the most common cause of right heart failure?
LHF
34
The right heart is a low pressure, high compliance system, meaning it does not tolerate increases in ______
afterload
35
What conditions cause increased afterload in the right heart?
PE chronic pulmonary disease
36
What is the MC cause of heart failure?
CAD
37
A patient with CAD presents with the following sxs. What should you immediately suspect? dyspnea fatigue/weakness dependent edema weight gain nocturnal, nonproductive cough nocturia
heart failure
38
What is the progression of dyspnea as heart failure worsens?
DOE to orthopnea to PND to dyspnea at rest
39
HF has many of the normal cardiovascular risk factors like CAD, PVD, DM, HTN, and obesity. What endocrine disorders contribute to HF?
pheochromocytoma thyroid abnormality
40
What is an early finding in decompensation in patients with HF?
S3/S4 gallop
41
What findings should you expect to see on cardiac physical exam of patients with HF?
elevated JVD Displaced PMI S3/S4 gallop
42
What findings should you expect to see on skin physical exam of patients with HF?
edema
43
What findings should you expect to see on pulmonary physical exam of patients with HF?
Crackles at the bases
44
What findings should you expect to see on abdominal physical exam of patients with HF?
hepatomegaly hepatojugular reflux
45
LHF can present with the following S/S that are caused by... activity intolerance fatigue altered mental status
decreased CO
46
LHF can present with the following S/S that are caused by... cyanosis/hypoxia cough with frothy sputum orthopnea PND
pulmonary congestion
47
RHF can present with the following S/S that are caused by... dependent edema ascites JVD anorexia GI distress Hepatomegaly
congestion of peripheral tissues
48
A 70 year old smoker with a 20 pack year hx an DM presents with the following sxs. What should you immediately include in your DDx? - dysnea on exertion - diaphoresis - tachypnea - tachycardia - rales/crackles - S3 or S4
LHF
49
You are seeing a patient who has LHF. They report new onset of the following sxs. What should you immediately suspect? - edema - RUQ pain - JVD - Ascites
RHF
50
A patient presents with risk factors for heart disease and a CC of fatigue and weight gain. PE findings are as follows: Lungs: crackles at base, dyspnea, dry cough Cardiac: tachycardia, Skin: diaphoresis, edema. What diagnostic studies do you want to order?
ECG Echo CXR
51
In patients suspected of HF, EKG evaluates for...
ischemia, arrhythmias
52
You suspect a pt. has HF. You order an EKG, which comes back normal. This finding makes what cardiac condition unlikely?
systolic dysfunction
53
What can assist in evaluating for arrhythmia in patients suspected of HF?
holter monitor
54
What makes echo the most important diagnostic in evaluation of HF?
EF evaluation
55
On echo, systolic dysfunction can be suspected when what is visualized?
dilated left ventricle
56
On echo, diastolic dysfunction can be suspected when what is visualized?
left ventricular hypertrophy
57
What findings on CXR are suggestive of HF?
cardiomegaly cephalization of pulmonary vessels kerley b-lines pleural effusion
58
In patients with HF, exercise EKG is helpful in evaluating what?
degree of functional impairment ID of ischemic disease
59
Is cardiac catheterization routine in evaluation of HF?
no
60
What labs can be ordered to help evaluate HF?
cardiac enzymes CBC CMP (electrolytes, renal fxn, glucose, liver fxn) BNP NT-proBNP
61
cardiac enzymes are ordered for what reason?
evaluate for acute ischemia
62
why is a CBC useful in HF evaluation?
anemia, infx can exacerbate HF
63
What are BNP and NT-proBNP useful for?
diagnosing HF Risk stratification guiding Tx
64
Who should have natriuretic peptide biomarkers measured, according to 2017 ACC/AHA/HFSA guidelines
pts w/ dyspnea to support HF dx chronic HF on admission to hospital
65
Why would iron studies be useful in HF?
evaluate hemochromatosis as underlying cause
66
What could a thyroid panel tell you that is helpful for HF?
hypothyroidism can present as and exacerbate HF
67
what foods can help moderate risk for heart failure?
breakfast cereals fruits/veggies
68
How much exercise will moderate risk for HF?
5+ times per week
69
how much EtOH consumption is acceptable to lower risk of HF?
5-14 drinks/week
70
What is the recommended initial therapy for HFrEF?
ACE-I Diuretics
71
What is the recommended initial therapy for HFpEF?
ID and Tx of comorbid conditions diuretics for sx releif
72
What type of dysfunction is more common in elderly females with HTN/DM
diastolic dysfunction
73
DOC diuretic for HF?
furosemide (lasix)
74
Diuretic therapy in HF has a goal of what?
reducing dyspnea, edema, fluid overload
75
What must be monitored with diuretic therapy?
renal function, electrolytes. hypokalemia can occur
76
What drug is shown to reduce morbidity and mortality in symptomatic and asymptomatic HF?
ACE-I
77
What is the approach to dosing with ACE-I in HF?
titrate... start low, go slow
78
ACE-Is and ARBs have what effect that is beneficial for treating HF?
reduce afterload
79
If an ACE-I isn't tolerated due to cough, what can be substituted?
ARBs
80
What should be monitored with ACEs and ARBs?
BP, renal fxn, electrolytes
81
Which beta blockers improve morbidity and mortality for class II and III HF?
carvedilol, bisoprolol, metoprolol
82
Describe the dosing regimen for beta blockers...
dose slowly and only if clinically stable. start with ACE-I first.
83
What is the main side effect of beta blockers?
bradycardia
84
patients with chronic symptomatic HFrEF Class II or III who tolerate an ACE-I or ARB should replace with...
ARNI (entresto)
85
patients with at-rest dyspnea w/in last 6 months, or post-MI with systolic dysfunction can be treated with what drug?
Mineralcorticoid receptor antagonist (aldosterone antagonist + potassium-sparing diuretic)
86
What needs to be monitored when prescribing an MRA?
electrolytes, fluid balance, renal function
87
A patient with HF cannot take an ACE, ARB, or ARNI. What can be prescribed?
hydralazine plus isosorbide dinitrate
88
Hydralazine does what? Isosorbide does what?
Hydralazine: vasodilation Isosorbide dinitrate: decreased O2 demand, decreased preload
89
This drug can be used in patients with accompanying atrial fibrillation
Digoxin
90
Digoxin is what glass of drugs?
Inotropic agent
91
Which drug enhances exercise tolerance?
digoxin
92
How should digoxin dosing be approached and what serum levels must be maintained?
low dose, titrate. serum .5-.8ng/mL
93
are statins helpful in tx for HF?
no
94
When can you continue statin therapy with HF?
if already on for a different indication
95
What is a major predictor of high mortality in HF?
loss of ADLs
96
Education on heart failure should be direct at whom?
patient and family
97
Where should HF pts be treated?
specific heart failure clinic
98
What are the most common causes of death in heart failure patients
decompensation/pump failure and arrhythmia
99
cardiogenic pulmonary edema is most often a result of...
ADHF (MI, ischemia, mitral stenosis)
100
A patient presents with: dyspnea productive cough with pink frothy sputum diaphoresis abnormal breath sounds What do you suspect?
cardiogenic pulmonary edema
101
On CXR with cardiogenic pulmonary edema, what do you expect to find?
kerley b lines edema cardiomegaly
102
What is typically elevated in cardiogenic edema?
pulmonary capillary wedge
103
A patient presents to the clinic with the following sxs...what are these concerning for? cough dyspnea fatigue rapid peripheral edema orthopnea/PND
Acute decompensated heart failure
104
A PE of a patient reveals the following... what is this immediately concerning for? HTN JVD Tachypnea Accessory muscle use crackles Tachycardia S3/S4 New murmur LE edema
acute decompensated heart failure
105
What is the workup for ADHF>
``` ECG CXR pulseox ABGs CBC electrolytes renal/liver function cardiac enzymes BNP Echo ```
106
How is ADHF treated?
hospital admission with telemetry supp O2, sats >90% diuretics nitro
107
what electrolyte should be monitored in ADHF?
potassium

Clinical Medicine II (31 decks)

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