Heart Failure (CM) Flashcards Preview

Cardiology > Heart Failure (CM) > Flashcards

Flashcards in Heart Failure (CM) Deck (23):
1

The single most expensive disease

Heart failure

2

Goal to decreasing cost of HF

Reducing the number of hospitalizations by ensuring complete treatment and correctly applying chronic HF management guidelines

Also doing better patient education and following up within a few days 

3

Heart failure definition

 Syndrome in which disease: 

reduces cardiac output

increases venous pressures

and is accompanied by molecular abnormalities that cause progressive deterioration of the failing heart and premature cell death 

4

HF rates are rising because of what two factors?

Improved survival of MI

Aging population

5

What can the RAAS lead to that can be harmful long term? 

Vasoconstriction

Oxidative stress

 Cell growth 

Proteinuria 

LV remodeling 

Vascular remodeling 

6

Salt and water retention short and long term effects

short term augments preload

long term leads to pulmonary congestion and anasarca 

7

Vasoconstriction short and long term effects

Short term: maintains BP for perfusion of vital organs 

Long term: exacerbates pump dysfunction (excessive afterload), increases cardiac energy expenditure 

8

Sympathetic stimulation short and long term effects

Short term: increases HR and EF

Long term: increases energy expenditure

9

Key neurohormonal mediators in HF--bad

Norepinephrine 

Angiotensin II

Aldosterone 

Tumor Necrosis Factor 

Vasopressin

These stimluate hypertrophy, remodeling, fibrosis, apoptosis, fetal gene expression, contractile abnormalities. 

Lead to vasoconstriction, sodium and fluid retention, and endothelial dysfunction

10

Key neurohormonal mediators in HF--good

Natriutic peptides 

Nitric Oxide 

Prostacyclin 

Antihypertrophic, antiproliferative, and vasodilatory 

 

11

Causes of HF

Most common: 

  • Ischemia/Coronary Artery Disease (MC)
  • HTN
  • Valvular Heart Disease

Others: 

  • Congenital abnormalities 
  • Myocarditis (Viral/AIDS)
  • Toxins (EtOH, chemo)
  • Tachycardia/bradycardia 

12

New York Heart Association Functional Classification

Class I: No sxs with ordinary activity 

Class II: Slight limitation of physical activity. Ordinary physical activity results in dyspnea, angina, fatigue, palpitations. Comfortable at rest. 

Class III: Marked limitation. Less than ordinary physical activity results in dyspnea, angina, fatigue, palpitations. Comfortable at rest. 

Class IV: Unable to carry out any physical activity without symptoms. Symptoms may be present at rest. 

13

Stages of HF 

Aimed at promoting early recognition and treatment 

Stage A: At risk for development of HF (HTN, valvular disease, hx of MI, etc)

Stage B: Asymptomatic left ventricular dysfunction (Class I)

Stage C: Mild to moderate heart failure sxs (Class II-III)

Stage D: Severe HF symptoms not responsive to medical therapy (Class IV)

14

Clinical Symptoms of Heart Failure

Dyspnea

  • DOE, orthopnea, PND
  • Cough, hemoptysis 

Fatigue

Edema 

Others: 

  • chest discomfort, postural lightheadedness, dec'd mental acuity, bloating/nausea, weight gain, anorexia/weight loss, palpitation 

15

Physical Exam in HF 

BP, HR, RR--variable 

Distended neck veins

Heart--enlarged

  • murmurs
  • diminished tones 
  • gallop sounds

Lungs--crackles

  • wheezes, rhonchi
  • dullness to percussion 

Abdomen--distended 

  • Liver enlarged, ascities 

Extremities--edematous with diminished pulses 

Pallor, tired appearing

16

Physical exam and CXR can be quite nonspecific so use these adjunctive therapies...

Labs

EKG

Imaging 

17

Labs used in diagnosis of HF

Hemoglobin

Comprehensive metabolic panel (renal, liver tests)

Thyroid panel

Lipid panel 

BNP level 

18

BNP levels correlate with

Left ventricular end diastolic pressure and volume 

NYHA classes

Good at predicting clinical events

19

EKG in diagnosing HF 

Evaluate for: 

Prior MI 

LV Hypertrophy

COnduction abnormalities 

Ischemia 

20

Imaging in diagnosising HF

CXR: check for infiltrates, effusions, heart size

Echo/nuclear scans/Cardiac MRI: ventricular ftn 

21

Rapid assessment of hemodynamic status is based on what two factors?

Low perfusion at rest:

  • narrow pulse pressure
  • sleepy
  • low serum sodium
  • cool extremities
  • hypotension with ACEI
  • Renal dysfunction 

Congestion at rest: 

  • orthopnea, PND
  • JV distention 
  • Hepatomegaly 
  • Edema 
  • Rales 

22

Categories for rapid assessment of hemodynamic status 

A image thumb
23

HF exacerbating factors 

Non-compliance (with meds or sodium restriction)

NSAIDs (counteract ACEI)

Many other drugs (negative inotropes)

Intercurrent illnesses (i.e. fever, COPD)

Ongoing myocardial ischemia

Progression of valvular lesions

HTN 

Heat and humidity, cold