Heart Failure II - Diagnosis & Treatment (complete) Flashcards Preview

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What are the major symptoms associated with heart failure as it relates to decreased cardiac output?


- Symptoms of decreased organ perfusion
- Decreased muscle perfusion (Fatigue, tiredness, sleepiness)
- Decreased gut perfusion (Anorexia, wasting)
- Decreased kidney perfusion (reduced urine output, progressive renal dysfunction/cardiorenal syndrome)
- exercise intolerance (inability to augment CO to meet increasing demands)


What are the major symptoms associated with heart failure as it relates to increased pulmonary venous pressure?

- Dyspnea on exertion
- Orthopnea (SOB when lying flat)
- Paroxysmal nocturnal dyspnea (PND) => delayed SOB, waking pts from sleep
- Acute pulmonary edema


Describe orthopnea

Lost venous blood pooling in legs


Describe PND

- Classically pts gets out of bed => walks around to relieve symptoms
- mobilization of edema from tissue through lymphatics back to blood stream


What are the major symptoms associated with heart failure as it relates to increased central venous pressure?

- Peripheral swelling/EDEMA
- Ascites
- Hepatic congestion
- Intestinal congestion (protein-losing enteropathy)


Describe the New York Heart Association Functional Classes

I: Asymptomatic
II: Symptomatic w/ moderate exertion
III: Symptomatic w/ minimal exertion
IV: Symptomatic at rest


Describe the ACC/AHA Heart Failure Stages

A: At high risk for HF but w/o structural heart disease or symptoms of HF (e.g. pts w/ HTN or CAD)

B: Structural heart disease but w/o symptoms of HF

C: Structural heart disease with prior or current symptoms of HF

D: Refractory HF requiring specialized interventions


What are the precipitating factors which make HF symptoms worse?

Increased circulating volume (preload)
- Na load in diet
- Renal failure

Increased pressure (afterload)
- Uncontrolled HTN (LV)
- Worsening aortic stenosis
- PE (RV)

Worsened contractility (inotropy)
- myocardial ischemia
- Initiation of negative inotropy (B-blocker, CCB)

- Bradycardia
- A Fib

Increased metabolic demands
- Fever, infection, anemia, hyperthyroidism, preggers

Non-adherence w/ HF meds *IMPORTANT*


Describe the variable clinical course of HF

- A non-linear course
- Usually episodic exacerbations w/ significant symptoms
- Pts rarely stay at a single NYHA class over time
- Usual course: progressive decline over time


What are the signs of low flow?

- Cool extremities
- Tachycardia
- Low pulse pressure


Why are cool extremities a sign of low flow?

- peripheral vasoconstriction
- redirects existing blood flow to vital organs (rather than periphery)


Why is tachycardia a sign of low flow?

Shows compensation for low SV


Why is low pulse pressure a sign of low flow?

Reflects low output


What are the signs of elevated left-sided filling pressures?

- Rales (fluid in lungs, wet aveoli)
- Hypoxia
- Tachypnea
- Sitting bolt upright
- Popping open of alveoli


What are the signs of elevated right-sided pressures?

- Edema (follow gravity => legs, sacrum, scrotum)
- Hepatic congestion
- Hepatomegaly
- Jugular venous distention (JVD)


Describe jugular venous distention

- Indicates an increased of central venous pressure
- When person is lying flat jugular vein will appear full => transmits pressure changes in RA as waves


Describe S3 gallops as a sign for heart failure

- rapid expansion of ventricular walls in early diastole
- HFrEF/dilated heart
- Ken-tuc-key (S1-S2-S3)


Describe S4 gallops as a sign for heart failure

- atria contracting forcefully in an effort to overcome abnormally stiff or hypertrophic LV
- Ten-ne-ssee (S4-S1-S2)

You CANNOt have S4 w/o coordinated atrial contraction


What types of imaging studies are most helpful in making a diagnosis of HF?

- Chest X-Ray
- Echocardiogram


How are CXR used to diagnose HF?

- Show enlarged cardiac silhouette in HFrEF
- Increased upper lobe vascular markings w/ acute decompensation
- Fluffy infiltrates of pulm edema
- pleural effusions


How are EKGs used to diagnose HF?

- No direct diagnosis possible
- Can infer HF from other findings
- Q waves: prior MI
- Increased voltage: LVH
- Arrhythmia


How are echos used to diagnose HF?

You can get this info from echos:
- Chamber size
- LV wall thickness
- Measures relaxation
- Valvular anatomy/function
- fillings pressures
- pulmonary pressures

Real time, non-invasive, no radiation, inexpensive


Describe right heart catheterization as a way to diagnose HF

- Plastic catheter put into major veins => floated through right heart into pulm a.
- Has balloon on end
- Measures pressures: CVP/RA, RV, PA, PCWP
- Measures flow, CO
- Resistances can be calculated from the above info


Describe natriuretic peptides

Secreted by myocardium in response to:
- Primary: ventricular stretch
- Secondary: hyperadrenergic state, RAAS activation, ischemia


How is BNP used to diagnose HF?

- Measured to rule out HF ***IMPORTANT*** (think pertinent negatives)
- Normal levels = <100 pg/mL
- unlikely to have HF with low BNP levels
- inconclusive at high levels