02.12 Heart Failure and Cor Pulmonale Flashcards
Most common lung disease that causes cor pulmonale
COPD
Dilation and hypertrophy of the right ventricle in response to disease of the pulmonary vasculature and or lung parenchyma
Cor pulmonale
Clinical manifestations of cor pulmonale
dyspnea, orthopnea, PND, abdominal pain , ascites
Tachypnea, elevated JVP, hepatomegaly, bipedal edema, cyanaosis
Most common cause of RV failure
LV failure
Right ventricular hypertrophy, right axis deviation
Enlargement of central main pulmonary artery and hilar vessels
Cor pulmonale
Impaired ability of the ventricle to fill with blood
Heart failure with preserved ejection fraction
Impaired ability to eject blood
Heart failure with reduced ejection fraction
Cardinal clinical symptoms of heart failure
Dyspnea and fatigue
Cardinal clinical signs of heart failure
Edema and rales
Main causes of death in heart failure
Sudden cardiac death (arrythmic death)
Progressive HF
According to Framingham Criteria: ____ die within 1 year (28% M, 24% F), while ____ die within 5 years (59% M, 45% F)
30-40%
60-70%
Compensatory mechanism for heart failure
Activation of RAAS and adrenergic nervous system
Increased myocardial contractility and vasoconstriction
Release of vasodilating molecules
Changes include myocyte hypertrophy, alterations in contractile properties, progressive loss of myocytes, beta-adrenergic desensitization, abnormal myocardial energetics and metabolism, reorganization of the cellular matrix
LV remodeling
Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitations, dyspnea or anginal pain
Class I (NYHA)
Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitations, dyspnea or anginal pain
Class II
Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain
Class III
Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased
Class IV
Framingham criteria: ___ major and ___ minor
2, 1
Major criteria based according to Framingham
PND Neck vein distention Rales Cardiomegaly Acute pulmonary edema S3 gallop Increased JVP (>16 cm) Hepato-jugular reflux Weight loss > 4.5 kg in 5 days
Minor Framingham criteria
Bilateral ankle edema Nocturnal cough Dyspnea on exertion Hepatomegaly Pleural effusion Decrease in vital capacity Tachycardia
In determining the cause of HF, assess:
Severity, hemodynamic profile, response to therapy
Late abdominal signs of HF
Ascites
Jaundice
Cardiac manifestations of HF
Cardiomegaly (PMI displaced)
Apex beat > 2.5 cm (LVH)
S3 (ventricular contration)
S4 (atrial contraction)
High negative predictive value for detection of HF
ECG
Most useful for detection of LV function
2D echo/doppler
Provides comprehensive analysis of cardiac anatomy and function
Gold standard for assessment of LV mass and volume
Useful in determining other cardiac causes like amyloidosis and hemosiderosis
MRI
Sensitive markers for HF
Useful for prognosis, disease severity, optimal therapy guide
BNP/NT
Useful prognostic marker
ST2
In exercise testing, peak oxygen uptake of ____ is associated with poor prognosis (indication for transplant)
< 14 ml/kg
Preload unloader
Diuretics (furosemide, spironolactone, indapamide)
Afterload unloader
Vasodilator (ACE-I, ARBs)
Criteria for discharge
24h of stable fluid status, blood pressure, renal function on the oral regimen planned for home
Free of dyspnea or asymptomatic hypotension while at rest and walking on the ward
