Heart Failure – Part 2: Clinical Manifestations and Diagnosis Flashcards Preview

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Flashcards in Heart Failure – Part 2: Clinical Manifestations and Diagnosis Deck (31):
1

3 major symptoms of Cardiac Failure

↓ Cardiac output

↑ Pulmonary venous pressure (Left-sided)

↑ Central venous pressure (Right-sided)

2

↑ Central venous pressure (Right-sided) causes

edema

* symptoms of Cardiac Failure

3

↑ Pulmonary venous pressure (Left-sided) causes

breathlessness

* symptoms of Cardiac Failure

4

↓ Cardiac output causes

Symptoms of decreased organ perfusion

* symptoms of Cardiac Failure

5

Symptoms of low flow

↓ cerebral perfusion
↓ muscle perfusion
↓ gut perfusion
↓ kidney perfusion

6

↓ cerebral perfusion (low flow) causes

Sleepiness, confusion

7

↓ muscle perfusion (low flow) causes

Fatigue, weakness

8

↓ gut perfusion (low flow) causes

Anorexia, Wasting (cachexia)

9

↓ kidney perfusion (low flow) causes

Reduced urine output
Progressive renal dysfunction

10

Symptoms of ↑ left-sided pressure

↑ Pulmonary venous pressure=

Breathlessness (dyspnea)
Dyspnea on exertion
Orthopnea
Paroxysmal nocturnal dyspnea
Acute pulmonary edema

11

Orthopnea or orthopnoea is shortness of breath (dyspnea) which occurs when _______

lying flat, immediate

12

Delayed SOB, waking patients from sleep
Classically patient gets out of bed and ambulates to relieve symptoms
Relates to mobilization of edema from tissue through lymphatics back into blood stream

Paroxysmal nocturnal dyspnea (PND)

13

Symptoms of ↑ right-sided pressure

↑ Central venous pressure (RV failure)=
Peripheral swelling / dependent edema
Ascites
Hepatic congestion
Intestinal congestion (protein-losing enteropathy)

14

Precipitating factors producing acute or worsening symptoms

**Increased circulating volume (preload)= Sodium load in diet

Increased pressure (afterload)

Worsened contractility (inotropy)

Arrhythmia (rate)

Increased metabolic demands

**Non-adherence with HF medications

15

Paroxysmal nocturnal dyspnea (PND)

Delayed SOB, waking patients from sleep
Classically patient gets out of bed and ambulates to relieve symptoms
Relates to mobilization of edema from tissue through lymphatics back into blood stream

16

Symptoms generally define the severity of the disease, ex?

Disease severity is one of the strongest predictors of death in heart failure.

17

Symptoms are often determine therapy e.g.

more aggressive therapies are indicated for more advanced disease)

18

Signs of low flow

Cool extremities
Tachycardia
Low pulse pressure (difference between systolic and diastolic pressure)

19

Tachycardia in HF is

Compensate for low stroke volume

20

Signs of ↑ left-sided pressure

Rales (pulmonary crackles)
Hypoxia
Tachypnea
Sitting bolt upright

21

Signs of ↑ right-sided pressure

Edema
Follow gravity (legs, sacrum, scrotum)
Hepatic congestion / hepatomegaly
Jugular venous distention (JVD)

22

S3 is thought to be caused by rapid expansion of the?

ventricular walls in early diastole

23

S4 is caused by atria contracting forcefully in an effort to?

overcome an abnormally stiff or hypertrophic LV

24

Co-existing conditions which predispose to HF

HEART DISEASE:
CARDIAC RISK DISORDERS:
ABSENCE OF NON-HF CAUSES OF DYSPNEA

25

Differential diagnosis for HF Signs and Symptoms

Pulmonary disease
Sleep apnea
Obesity
Deconditioning
Anemia
Renal failure
Hepatic failure
Venous stasis / lymphedema
Depression

26

Natriuretic Peptides (BNP)

B-type natriuretic is secreted by the myocardium in response to;
Primary: ventricular stretch (measure of preload)

Secondary: hyperadrenergic state, RAAS activation, ischemia

27

Diagnostic use of BNP

Elevations are most often due to HF

28

negative predictive value of BNP is more useful meaning

a low BNP makes HF unlikely as the cause of symptoms, + does not help when HF is already known

29

EKG in HF

No direct diagnosis of HF

30

Echocardiography Provides

LVEF (systolic function)
Chamber size (dilation)
LV wall thickness (hypertrophy)
Measures of relaxation (diastology)
Valvular anatomy and function
Estimated filling pressures (LA, CVP)
Estimated pulmonary pressures (pulmonary hypertension)

31

catheter introduced thru veins &then “floated” through the r. heart to pulmonary a

Has a balloon on the end of it to help blood flow carry it into the lungs

The balloon also allows a branch of the pulmonary artery to be occluded so that the downstream pressure can be measured, which is equivalent to the ______________

(Procedure: Swan-Ganz catheter)

left atrial pressure / left-sided filling pressure.