Heart Failure Flashcards by Jamaira Belmes

Cardinal clinical SYMPTOMS of heart failure

dyspnea

fatigue

How well did you know this?

Not at all

Perfectly

Clinical SIGNS of heart failure

edema

rales

How well did you know this?

Not at all

Perfectly

Depressed EF (<40%)

CAD- myocardial infarction and myocardial ischemia

Chronic pressure overload - HPN, obstructive valvular disease

Chronic volume overload - regurgitant valvular disease, intracardiac (L-R) shunting, extracardiac shunting

Chronic Lung Disease - Cor pulmonale, pulmonary vascular disorders

Nonischemic dilated cardiomyopathy - familial/genetic disorders, infiltrative disorders

Toxic/drug-induced damage - metabolic disorder, viral

Chagas disease

Disorders of rate and rhythm - chronic bradyarrhythmias and tachyarrhythmias

How well did you know this?

Not at all

Perfectly

Preserved Ejection fraction (>40 - 50%)

pathologic hypertrophy - HCOM, HPN

aging

endomyocardial disorders
restrictive cardiomyopathy - infiltrative disorders, storage disorders

fibrosis

How well did you know this?

Not at all

Perfectly

High Output States

metabolic disorders - thyrotoxicosis

nutritional disorders (beriberi)

excessive blood flow requirements - systemic AV shunting, chronic anemia

How well did you know this?

Not at all

Perfectly

Conditions that can lead w/ a depressed EF or preserved EF

myocardial infarction
myocardial ischemia
hypertension
obstructive valvular disease
infiltrative disorder
metabolic disorder

How well did you know this?

Not at all

Perfectly

NYHA Classification

Class I - px w/ cardiac disease but w/o resulting limitation of physical activity

Class II - px w/ cardiac disease w/ slight limitation of physical activity

Class III - px w/ cardiac disease w/ marked limitation of physical activity

Class IV - px w/ cardiac disease resulting in inability to carry on any physical activity w/o discomfort

How well did you know this?

Not at all

Perfectly

Orthopnea

Results from redistribution of fluid from the splanchnic circulation and lower extremities into the central circulation during recumbency with a resultant ↑ in pulmonary capillary pressure

How well did you know this?

Not at all

Perfectly

Paroxysmal Nocturnal Dyspnea

Refers to acute episodes of severe shortness of breath and coughing that generally occur at night d.t. INCREASED PRESSURE in BRONCHIAL ARTERIES

How well did you know this?

Not at all

Perfectly

Cheyne-Stokes Respiration

Periodic respiration or cyclic respiration: series of APNEA, HYPERVENTILATION and HYPOCAPNIA

How well did you know this?

Not at all

Perfectly

Pulmonary crackles (rales or crepitations)

Result from the transudation of fluid from the intravascular space into the alveoli

How well did you know this?

Not at all

Perfectly

Pleural effusion

Result from the elevation of pleural capillary pressure and the resulting transudation of fluid into the pleural cavities

How well did you know this?

Not at all

Perfectly

Hepatomegaly

An important sign in px with HF and may pulsate during systole if tricuspid regurgitation is present

How well did you know this?

Not at all

Perfectly

Assess cardiac rhythm and determine the presence of LV hypertrophy or prior MI (absence or presence of Q-waves)

ECG

How well did you know this?

Not at all

Perfectly

Classic Chest X-Ray Pattern In Patients with PULMONARY EDEMA

“butterfly” pattern of interstitial and alveolar opacities

Kerley B lines

peribronchial cuffing

evidence of prominent UPPER lobe vasculature

How well did you know this?

Not at all

Perfectly

Classic Chest X-Ray Pattern In Patients with PULMONARY EDEMA

“butterfly” pattern of interstitial and alveolar opacities

Kerley B lines

peribronchial cuffing

evidence of prominent UPPER lobe vasculature

How well did you know this?

Not at all

Perfectly

The most useful test that can provide semiquantitative assessment of LV size and function, presence or absence of valvular and/or regional wall motion abnormalities

2D Echo/Doppler

How well did you know this?

Not at all

Perfectly

The gold standard for assessing LV mass and volumes

Magnetic Resonance Imaging (MRI)

How well did you know this?

Not at all

Perfectly

Most useful index of LV function

EF (stroke volume divided by end-diastolic volume)

How well did you know this?

Not at all

Perfectly

Released from the failing heart and sensitive markers for the presence of HF with depressed EF

B-type natriuretic peptide (BNP)

N-terminal pro-BNP (NT-proBNP)

How well did you know this?

Not at all

Perfectly

Newer biomarkers that can be used for determining the prognosis of HF patients

soluble ST-2 and galectin-3

How well did you know this?

Not at all

Perfectly

NOT routinely advocated for patients with HF but useful for assessing the need for cardiac transplantation in patients with advanced HF

Exercise Testing

How well did you know this?

Not at all

Perfectly

Form the cornerstone of pharmacotherapy lead to attenuation of decline and improvement in cardiac structure

RAAS blockers

β-blockers

• Interferes with RAAS by inhibiting conversion of angiotensin I to angiotensin II

ACE - I

Used if the px is ACE-intolerant

Angiotensin Receptor Blockers

Interferes with sustained activation of the adrenergic nervous system particularly B1 activation

Beta-blockers

Inhibits action of aldosterone on the collecting duct

Aldosterone Antagonist

Reduces the HR by inhibition of “funny channels” in the SA node

Ivabradine

Recommended to replace ACE-I in ambulatory HFrEF patients who remain symptomatic despite optimal therapy

Angiotensin Receptor Neprilysin Inhibitor (ARNI) ARB - valsartan neprilysin inhibitor - sacubitril

Asymptomatic LV Dysfunction (NYHA I)

ACE I or ARB B-blocker (if post MI) Aldosterone antagonist (if recent MI)

Symptomatic HF (NYHA II)

ACE I or ARB Diuretic (if with fluid retention) B-blocker Aldosterone antagonist

Worsening HF (NYHA III-IV)

``` ACE I or ARB Diuretic B-blocker Aldosterone antagonist Digoxin ```

End stage HF (NYHA IV)

``` ACE I or ARB Diuretic B-blocker Aldosterone antagonist Digoxin ```

Rapid onset or worsening symptoms/signs of HF Life threatening

Acute Decompensated Heart Failure (ADHF)

peripheral edema orthopnea dyspnea on exertion usually no/minimal volume overload

Acute Hypertensive HF

severe dyspnea tachypnea tachycardia frank pulmonary edema

Cardiogenic Shock

end-organ hypoperfusion oliguria confusion cool extremities

First line therapy in volume overloaded patients w/ pulmonary congestion

Diuretics furosemide bumetanide

Initial therapy for hypertensive AHF (hypertensive emergency) decreases venous tone to optimize preload decreases arterial tone (or afterload)

Vasodilators nitroglycerin isosorbide dinitrate

Used for patients w/ hypotension, end-organ hypoperfusion or shock sec to myocardial pump failure

Inotropic Agents dobutamine dopamine

Considered for cardiogenic shock despite inotropic support

NE | high dose dopamine

Good perfusion and no congestion

Warm and Dry adjust oral therapy

Good perfusion but with congestion

Warm and Wet if HPN predominates: vasodilators and diuretics if congestion predominates: diuretics, vasodilators

With hypoperfusion but no congestion

Cold and Dry fluid challenge then inotropic support if still hypoperfused

With hypoperfusion and w/ congestion

Cold and Wet SBP >90 mmHg: vasodilators, diuretics consider inotropic agents if refractory SBP <90 mmHg: inotropic agents, consider vasopressors, diuretics when perfusion is corrected and consider mechanical circulatory support

Framingham Diagnostic Criteria for HF

``` MAJOR PND or orthopnea neck vein distention rales cardiomegaly acute pulmonary edema S3 gallop increased venous pressure >16 cmH20 hepatojugular reflux ``` ``` MINOR ankle edema night cough dyspnea on exertion hepatomegaly pleural effusion vital capacity decreased by 1/3 from maximal capacity tachycardia .>120 bpm ``` MAJOR or MINOR - weight loss >4.5 kg in 5 days in response to treatment 2 MAJOR or 1 MAJOR + 2 MINOR

MC cause of systolic dysfunction --> L sided HF

CAD

MC cause of diastolic dysfunction --> L sided HF

concentric LVH d.t. HPN

MC cause of R sided HF

L sided HF

Earliest cardinal symptom of L sided HF

dyspnea

Earliest cardinal sign of L sided HF

L sided S3

Most sensitive index of cardiac function

ejection fraction

Single most important bedside measurement to estimate volume status

JVP

Most important mechanism of dyspnea in HF

pulmonary congestion w/ accumulation of interstitial or intraalveolar fluid --> activates juxtacapillary J receptors

Cornersyone of modern therapy for HF w/ depressed EF

ACE-I/ARBS and Beta Blockers

Gold standard in assessing anatomy and physiology of the heart and associated vasculature

cardiac catheterization and coronary angiography