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Flashcards in Heart Failure Diagnosis Deck (50)
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1

3 Major Symptoms of Heart Failure

1) decr cardiac output due to decr organ perfusion

2) incr pulm venous pressure (left sided) --> breathlessness

3) incr central venous pressure (right sided) --> edema

2

Symptoms of Low Flow

1) decr cerebral perfusion (confusion)
2) decr muscle perfusion (fatigue)
3) decr gut perfusion (anorexia/wasting)
4) decr kidney perfusion (decr urine output and renal dysfunction)

3

Effect of low flow on Starling Curve

Shift curve downward due to decr SV for a given pressure

4

Symptoms of Left sided pressure/increased pulm venous pressure

1) breathlessness (dyspnea)

2) dyspnea on exertion

3) orthopnea

4) paroxysmal noctural dyspnea

5) acute pulm edema due to fluid retention/incr LA pressure so fluid from pulm vasculature enters interstitial space and then alveoli (hypoxia)

5

Effect of incr left sided pressure on Starling curve

given point shifts right due to incr pressure

6

Difference between orthopnea and paroxysmal noctural dyspnea

Orthopnea = immediate SOB lying flat

Paroxysmal Nocturnal dyspnea= delayed SOB wake from sleep and walk around

7

Why does walking around improve paroxysmal nocturnal dyspnea

Mobilizing edema from tissue through lymph back into blood stream

8

Why does orthopnea occur?

lost venous pooling of blood in the legs

9

Symptoms of incr right sided pressure/incr central venous pressure

1) peripheral edema in lower extrem (older)
2) ascites (younger)
3) Hepatic congestion
4) intestinal congestion

10

Right sided failure = Effect of Edema in HF on Starling forces

Increased central venous pressure upsets balance between Starling forces

now increase oncotic P so pump more fluid into interstitum

11

Factors that lead to worse symptoms

1) incr circulating volume (preload) with sodium

2) increased pressure (afterload)

3) decr inotropy

4) arrhythmia

5) incr metabolic demands (fever, infection)

6) non-adherence with HF meds

12

examples of increased pressure (afterload) that can worsen symptoms

1) uncontrolled HTN
2) worse aortic stenosis
3) pulm embolism

13

examples of decr inotropy that can worsen symptoms

1) MI
2) beta blocker or Ca2+ channel blocker

14

NYHA class
1
2
3
4

1) asymptomatic

2) symptomatic with mod exertion

3) symptomatic with minimal exertion

4) symptomatic at rest

15

AHA/ACC HF stage 1

at risk for HF but not structural heart disease or symptoms

16

AHA/ACC HF stage 2

structural heart disease (prior MI, LVH and low EF) but no signs/symptoms of HF

17

AHA/ACC HF stage 3

structural heart disease with prior/current signs and symptoms (HFpEF) and (HFrEF)

18

AHA/ACC HF stage 4

Refractory HF

marked symptoms at rest

19

What is important about HF course?

variable course

episodic exacerbations and rarely single NYHA over time

but usually progressive decline over time

20

Physical exam
Signs of low flow

1) cool extremities - peripheral vasocosntriction to redirect flow to vital organs

2) tachycardia- compensate for low SV

3) low pulse pressure - low output

21

Physical Exam
Signs of elevated left sided pressure

1) rales due to wet alveoli opening

2) hypoxia

3) tachypnea

4) bolting upright

22

PHysical exam
signs of elevated right sided pressures

1) edema - follows gravity (legs, sacrum, scrotum)

2) hepatic congestion

3) JVD = central venous pressure

23

what does JVD measure

RA filling pressure

24

What is JVD a sign of

increased central venous pressure

right heart failure

25

how many Waves in JVD

Triphasic= 3

26

A wave

atrial contraction

27

C wave

closing of the tricuspid valve early in systole

28

v wave

movement of RV annulus and tricuspid valve backward at the end of systole (before the valve opens)!

29

S4 heart sound

before S1

atria contract forcefully to overcome stiff/hypertrophic LV

30

S4 present in AFIB

NO NOT IN AFIB