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PDAT5 CV > 28 - Heart Failure > Flashcards

28 - Heart Failure Flashcards

1
Q

Heart Failure

Definition / Cardinal Manifestations

A

Clinical Syndrome
Inability of the heart to pump enough blood
to meet the metabolic demands of the body

Cardinal Manifestations:
Dyspnea** / **Fatigue** / **Fluid Retention

PROGRESSIVE if NOT TREATED

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2
Q

Ejection Fraction

How is it Measured?

A

Portion of the total ventricular blood volume that is ejected during each contraction.

Normal: > 50%

ECHCOCARDIAGRAM
&
CARDIAC MRI
most accurate

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3
Q

HF-rEF

Definition

A

HF-rEF = SYStolic Dysfunction = Dilated Cardiomyopathy

EF** **< 40%

Impaired Ventricular CONTRACTION
Results from:
Loss of Muscle Mass / Pressure / Volume Overload

DILATED / LARGE CHAMBERS

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4
Q

HF-pEF

Definition

A

HF-pEF = DIAStolic Dysfunction

EF** **> 50%

Impaired Ventricular RELAXATION
Results from:
VENTRICULAR STIFFNESS

THICK WALLS
Heart is strong, but the blood in the cavity is ALREADY NOT ENOUGH

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5
Q

Pathophysiology

HF-pEF

A

Ventricular Stiffness
LVH = Left Ventricular Hypertrophy – HTN
Myocardial Ischemia (MI)
Infiltrative Diseases: Amyloid / Sarcoid
Endomyocardial Fibrosis

Epidemiology:
50% of HF pts, but associated with less MORTALITY vs rEF

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6
Q

Pathophysiology

HF-rEF

A

PROGRESSIVE DISEASE

Initial Cardiac Insult:
MI / HTN
Idopathic/genetic - Valve abnormalities
Viral / Alcohol / Drugs / Pregnancy / Tachycardia
VV
PRIMARY DAMAGE
VV
Compensatory Mechanisms
↑Preload/Vasoconstriction/TachyCardia–>Ventricular Remodel
VVV
Secondary Damage by NEUROHORMONES

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7
Q

HF-rEF
Compensatory Mechanisms

A

↑PRELOAD / ↑AFTERLOAD
Chronic Volume Overload + ↑MVO2

TACHYCARDIA
↓Diastolic Filling Time –> Arythmias
↓B-receptor regulation

VASOCONSTRICTION

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8
Q
  • *Neurohormones in HF**
  • *BAD NEUROHORMONES –> Vasoconstriction & Na Retention**
A

RAAS + SNS
Angiotensin 2 - RENIN - NorEpinephrine

Endothelin / Vasopressin / Aldosterone

AT2 –> Cardiac Fibrosis

Renin / NE –> Myocyte Necrosis / Arrhythmias / ↓Inotropy

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9
Q
  • *Neurohormones in HF**
  • *BENEFICIAL HORMONES** –> VasoDILATION / Natriuretic
A
  • *Nitric Oxide_ / _Natriuretic Peptides (ANP/BNP)**
  • *Bradykinin / Prostacyclin**

NO
Vasodilator –> protects against ventricular remodeling
↓BV in HF

Natriuretic Peptides
↑proportional to degree of volume/pressure overload
inhibits RAAS + SNS
Offsets effects of toxic neurohormones
Vasodilation / Promotes natriuresis

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10
Q

Mainstays of HF-rEF Therapy?

A
  • *RAAS INHIBITORS**
  • *ACE / ARB / Aldosterone Antagonist**

BETA BLOCKERS
offset the effects of SNS-Activation

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11
Q

Function of BNP in Assessing HF

A
  • *BNP < 100**
  • *CAN RULE OUT HEART FAILURE**
  • *BNP >400**
  • *useful in HF diagnosis**

>450 <50y/o

>900 50-75y/o

>1800 >75y/o

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12
Q

Heart Failure Diagnostic Assessment

A

Chest X-ray
Cardiomegaly / pulmonary edema

ECG
prior MI / LVH / rhythm

Ejection Fraction
echocardiogram or cardiac MRI

Natiuretic Peptides
BNP/ANP released from myocardial tissue in response to ventricle stretch

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13
Q

HF SYMPTOMS / PHYSICAL EXAM

Backwards Flow

Heart can’t process all the volume –> ↑PRESSURE in previous Vessels

Leaky Fluid –> in other organs

A

Fluid BACKED UP in Abdominal Space
Ab Pain / Anorexia-Nausea / Bloating-Constipation / Ascites

Fluid Backed up in LUNGS

  • *PND = Paroxysmal Nocturnal Dyspnea** (fluid in lungs when SLEEP)
  • *Orthopnea / Tachypnea / Dyspnea / COUGH**
  • *Bibasilar RALES (RRR) / Pulmonary Edema / S3 GALLOP** / Pleural Effusion

Other
Pitting Edema / JUGULAR VENOUS DISTENSION
HJR = Hepatojugular Reflux / HEPATOMEGALY

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14
Q

HF SYMPTOMS / PE

FORWARD FLOW

Symptoms from NOT ENOUGH OXYGEN –> TISSUES

A

Dyspnea on Exersion / Exercise Intolerance
Fatigue / Weakness

Tachycardia / Pallor / Cyanosis of Digits

  • *Confusion / Alterned Mental Status**
  • not enough oxygen reaching BRAIN*
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15
Q

HF Assessment

NYHA
FUNCTIONAL CLASS 1

A

NYHA Class 1

No Symptoms
w/
Ordinary Physical Activity

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16
Q

HF Assessment

NYHA
FUNCTIONAL CLASS 2

A

NYHA Class 2

Symptoms
w/
Ordinary Physical Activity

17
Q

HF Assessment

NYHA
FUNCTIONAL CLASS 3

A

NYHA Class 3

Symptoms
w/
LESS THAN ORDINARY EXERTION

DAILY ACTIVITES = Dressing Up / Walking / Showering

18
Q

HF Assessment

NYHA
FUNCTIONAL CLASS 1

A

NYHA Class 4

Symptoms at REST

Sitting / Standing / Laying

19
Q

HF Asessment

AHA
STAGE A

A

AHA STAGE A

  • *High Risk for HF**
  • *+**
  • without Structural Heart Disease or Symptoms*
20
Q

HF Asessment

AHA
STAGE B

A

AHA STAGE B

  • *Structural Heart Disease = low EF**
  • *+**
  • without SIGNS or SYMPTOMS*
21
Q

HF Asessment

AHA
STAGE C

A

AHA STAGE C

  • *Structural Heart Disease = low EF**
  • *+**
  • *Prior or Current Symptoms**
22
Q

HF Asessment

AHA
STAGE D

A

AHA STAGE D

REFRACTORY HF
requiring:
Specialized Interventions = End Stage

23
Q

HEART FAILURE

Patient Education

A
  • *SODIUM RESTRICTION**
  • *fluid restriction ~2L/day –> advanced patients ONLY**

Daily WEIGHTS

Exercise / Weight Reduction

Alcohol Avoidance

DRUGS THAT MAY EXACERBATE HF
NSAIDs / COX-2
Antiarrhythmics / Non-DHP CCB
Chemo Drugs / Gabapenting
Rosiglitazone / Pioglitazone
GLUCOCORTICOIDS

24
Q

Drugs that may Exacerbate HF

A

NSAIDs** + **COX-2 Inhibitors

Most AntiArrhythmics / Non-DHP CCBs

Gabapentin / Glucocorticoids

Rosiglitazone / Pioglitazone

SOME Chemotherapeutic Drugs

PDAT5 CV (30 decks)

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