Heart failure highlights Flashcards
(28 cards)
Heart failure:
1) Is a spectrum of disease caused by what?
2) Diagnosis of HF is based on presence of ____________ heart disease with current or previous symptoms
1) Impaired ventricular filling and contraction
2) structural
A lot of Txs for HTN, like thiazide diuretics, treat _________load, but strong diuretics will help with ______load
afterload; preload
List some symptoms of volume overload
Dyspnea, orthopnea, edema, abdominal pain from hepatic congestion, and distention from ascites
List some Sx of Reduction in cardiac output (reduced SV & EF)
Fatigue, weakness (aggravated by exertion)
What are the 3 major manifestations of volume overload in HF?
1) Pulmonary congestion
2) Peripheral edema
3) Elevated jugular venous pressure
List some key exam findings in HF
1) Pulmonary congestion
2) Peripheral edema
3) Elevated JVD
Pulmonary congestion: ________ is more prominent in acute or subacute disease; chronic HF typically manifests as _____________________.
rales; peripheral edema
HF diagnosis is based on presence of _____________ heart disease + current or previous _______________.
structural; symptoms
In the acute care setting, ACC/AHA recommend use of a BNP level less than 100 pg/mL and an NT pro-BNP level less than 300 pg/mL to __________acute HF
rule out
Given the association with ACS and troponin elevation and the link between MI and acute HF development, measurement of _______________________ levels should be routine in patients who present with acutely __________________ HF.
troponin I or T; decompensated
Define each of the 4 stages of HF
1) Stage A: at risk
2) Stage B: “pre-heart failure”
3) Stage C: HF
4) Stage D: end-stage HF
Which stage of HF is a pt in if they have structural changes, but w/o h/o S/S (past or present), and can be seen on echocardiogram?
Stage B
Structural changes and previous or current symptoms of HF describes which stage of HF?
Stage C
Symptomatic HF refractory to guideline directed medical therapy (GDMT) is defined as what stage?
Stage D
What does stage B of HF require?
Echocardiogram
EF can change; EF distinction will always consider the ____________ EF as a reference point
lowest
( e.g., if it was low and now normal, it is improved; if it was normal and now low, it is reduced)
List the NYHA grades of functional status of HF
1 = no symptoms
2 = mild symptoms, slight limitation with ordinary activity
3 = no symptoms at rest, significant limitations in ordinary activity
4 = symptoms at rest & severe limitations with ordinary activity
_______________________ (“flozin” drugs) should be used in patients with DM or at increased risk of CVD
SGLT-2 inhibitors
Stage B of HF; HFrEF despite being asymptomatic Tx:
1) What should you Tx them with?
2) What if they have a h/o ACS with HFrEF?
1) ACEi (ARB as alternative if ACEi not tolerated)
2) Cardioprotective BB
Patients with symptoms (Stage C/D) should receive all ________ components of guideline directed medical therapy
four
What are the 4 components of Tx?
1) Renin-angiotensin system inhibitors
2) B-blockers
3) Mineralocorticoid receptor antagonist
4) SGLT-2 inhibitors
ARNi recommended in patients with HFrEF and NYHA class ______ or ______
II or III
True or false: All components of guideline directed medical therapy benefit patients with HFmrEF
True
What are the 2 ways to Tx HFimEF
Classically, HF treatment based on EF, so GDMT would be stopped
VS
HF patients with improved EF – stop GDMT and results in relapse within 6 months
