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Flashcards in L28 Deck (21):
1

2 types of HF

HFpEF = systolic dysfxn
HFrEF = diastolic dysfxn
Same clinical presentation: orthopnea, PND, DOE, peripheral edema

2

What is low EF

3

Calculate EF

EF = SV/EDV
= amt out / total filling amt

4

What does systolic vs diastolic dysfxn mean for HF?

Diastolic dysfxn = inadequate LV filling at normal pressures
Systolic dysfxn = inadequate LV ejection

5

What are 3 reasons you might not be filling LV completely - HFpEF

1. LV hypertrophy - excessive muscle means ↓compliance
2. CAD --> ischemia = stiffer
3. Restrictive cardiomyopathy

6

What is restrictive cardiomyopathy? How does this look on ECHO?

Tissue invading myocardium that change the muscle properties (compliance)
See bilateral atrial dilation - small ventricles w/ huge atrial

7

What does ↓LV compliance (filling) lead to? 2 things:

1. ↑LV EDP
2. ↓SV

8

What does ↑LV EDP lead to?

Pulm edema

9

pEF or rEF - more common in:
- Older pts
- Women

pEF

10

Compensation for ↓CO w/ HF

1. ↑renin - AGT2 - aldosterone = volume expansion
2. ↓baroreceptor firing -> ↑sympa tone (↑NE) -> ↑contractility
GOAL = ↑afterload & HR to restore CO

11

Why do HF pts get peripheral and pulm edema?

Overcompensation with RAAS

12

The Law of LaPlace says that LV wall stress equals

LV wall stress = (LV radius x LV pressure) / 2x LV thickness
A dilated LV w/ thin walls = high wall stress
- Hypertrophy to ↓that stress

13

pEF or rEF - treat with med

rEF only!!

14

Which meds improve survival of rEF pts

BBs
ACE/ARBs
Aldosterone antagonists
Hydralazine-nitrates

15

Which med improve symptoms of rEF pts

Diuretics
Inotropes

16

Why give vasodilators

↓Afterload
- Better LV ejection = ↑SV
NO change contractility

17

Caution about spironolactone

Hyperkalemia deaths

18

Which pt populations respond bet to hyrdalazine nitrates?

African americans

19

Why put in an internal cardioverter defribrilators

= Biventricular pacing
Ventricular resynchronization
For HFrEF only

20

Should you put HFpEFs on diuretics?

Sure! Also have compensatory volume overload and diuretics not a part of neuro-hormonal axis that rEF pts don't respond to

21

LV cavity size in rEF vs pEF

rEF - normal or dilated
pEF - normal +/- LVH