Week 13 Handout CHF Flashcards
What is Congestive Heart Failure (CHF)?
CHF impairs cardiac output, fluid regulation, and oxygenation—all critical to anesthesia management. It reduces the heart’s ability to handle perioperative stress.
What is the perioperative mortality rate for CHF?
Approximately 10% for elective surgery and up to 30% in abdominal surgery.
What is CHF in relation to non-cardiac surgery?
CHF is a major independent predictor of adverse outcomes in non-cardiac surgery.
What is the pathophysiology of CHF?
CHF is a syndrome of impaired perfusion from a failing heart, leading to myocardial dysfunction and a cycle of progressive decompensation.
What are the effects of myocardial dysfunction in CHF?
It leads to SNS and RAAS activation, ventricular remodeling, increased systemic vascular resistance (SVR), fluid retention, and increased arrhythmia risk.
What is the NYHA Functional Classification for CHF?
Class I: No limitation with ordinary activity. Class II: Slight limitation, symptoms with exertion. Class III: Marked limitation, symptoms with daily activity. Class IV: Symptoms at rest; severe disability.
What are the stages of the ACC/AHA Staging System?
Stage A: Risk for heart failure; no structural disease. Stage B: Structural disease; asymptomatic. Stage C: Structural disease with symptoms. Stage D: Refractory CHF; requires advanced support.
What is the key goal in preoperative evaluation for CHF?
Stabilize CHF prior to surgery.
What medications should be continued for CHF patients preoperatively?
Beta blockers and statins.
What should be assessed in CHF patients preoperatively?
Functional status, volume status, and consider cardiac consult if decompensated CHF.
What is required if the ejection fraction (EF) is unknown?
An echocardiogram is required if the EF is unknown, the patient has dyspnea, or symptoms have changed.
How is Ejection Fraction (EF) interpreted?
Normal: >50–60%, Mild: 41–49%, Moderate: 26–40%, Severe: <25%.
What are standard intraoperative monitors for CHF patients?
ECG, SpO₂, NIBP, ETCO₂.
What is the goal of intraoperative management for CHF patients?
Optimize perfusion, oxygenation, and prevent myocardial stress.
What does the Frank-Starling Curve explain?
It explains the relationship between myofibril stretching during diastole from a specific end-diastolic volume (EDV) and the ejected stroke volume (SV).
What is Goal-Directed Fluid Therapy (GDFT)?
Small boluses (200–250 mL) + response assessment.
What are pharmacologic considerations for CHF patients?
Avoid drugs that cause tachycardia, hypotension, or decreased contractility.
What is a common arrhythmia in CHF patients?
Atrial fibrillation, which increases stroke risk and loss of atrial kick.
What are regional anesthesia considerations for CHF patients?
No technique is clearly superior; individualize the plan, use lower doses, and avoid large volume neuraxial blocks.
What postoperative considerations are important for CHF patients?
Monitor oxygenation and perfusion, early mobilization, and resume home medications ASAP.
Which of the following statements about the pathophysiology of CHF is correct?
A. CHF is primarily a disorder of volume overload with no neurohormonal involvement.
B. CHF leads to activation of the SNS and RAAS systems, contributing to fluid retention and
increased SVR.
C. CHF only affects the left ventricle, leaving the right heart unaffected.
D. The primary pathology of CHF is an inability of the heart to increase stroke volume with
increased preload.
Answer: B
Rationale: CHF activates the sympathetic nervous system (SNS) and the renin-angiotensin-
aldosterone system (RAAS), leading to compensatory mechanisms that worsen fluid retention
and increase systemic vascular resistance (SVR), further straining the heart (Nagelhout et al.,
2023. p. 519).
Why is perioperative fluid management challenging in CHF patients?
A. CHF patients have an increased Frank-Starling reserve, allowing for aggressive fluid
administration.
B. CHF patients are highly preload-dependent and require large volumes of fluid to maintain
cardiac output.
C. CHF patients have a blunted Frank-Starling response the is shifted to the right
D. CHF patients have a more linear curve as it shifts up and to the left compared to a normal
Frank-Starling curve.
Answer: C. CHF patients have a blunted Frank-Starling response the is shifted to the right
Rationale: CHF patients often have a diminished ability to handle excess preload, as their
Frank-Starling response is blunted and shifted to the right compared to a healthy starling curve.
Overloading them with fluids can lead to pulmonary congestion and edema (Nagelhout et al.,
2023. p. 489).
What is the primary reason CHF patients are at higher risk for intraoperative
arrhythmias?
A. Structural remodeling of the myocardium increases arrhythmogenic potential.
B. CHF patients have excess parasympathetic tone, leading to bradyarrhythmias.
C. CHF patients have an enhanced Frank-Starling mechanism, making arrhythmias more likely.
D. CHF patients have reduced sensitivity to catecholamines, decreasing arrhythmia risk.
Answer: A. Structural remodeling of the myocardium increases arrhythmogenic potential.
Rationale: Structural changes (hypertrophy, fibrosis) create a risks for arrhythmias in CHF
patients (Nagelhout et al., 2023. p
Which intraoperative monitoring modality provides the most dynamic assessment of
CHF patients’ cardiac function?
A. Standard ECG
B. Central Venous Pressure (CVP)
C. Arterial Line
D. Transesophageal Echocardiography (TEE)
Answer: D. Transesophageal Echocardiography (TEE)
Rationale: TEE allows real-time assessment of ventricular function, preload status, and volume
responsiveness, making it the most effective intraoperative monitoring tool for CHF patients
(Nagelhout et al., 2023. p. 196).
