6: Heart Failure Flashcards
This is the most common Medicare diagnosis-related group and more money is spent for diagnosis and treatment than any other diagnosis.
Heart Failure
Mortality rates in HF are based upon this study, which is somewhat outdated d/t newer treatments.
Framingham Heart Study (1990-1999)
What is the definition of HF?
Clinical syndrome characterized by specific symptoms that results from any cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.
Why is HF preferred over CHF?
Not all patients have volume overload at the time of diagnosis.
T/F There is no single diagnostic test for HF because it is largely a clinical diagnosis that is based on a careful history and physical examination.
True
A problem with contraction of the heart.
Systolic HF
A problem with relaxation of the heart.
Diastolic HF
What is the ejection fraction in systolic HF?
EF <50%
Right- or Left-Sided HF?
SOB/DOE
Right
Left
Right- or Left-Sided HF?
Fatigue
Right
Left
Right- or Left-Sided HF?
GI Symptoms
Right
Right- or Left-Sided HF?
Epistaxis
Right
Right- or Left-Sided HF?
PND, Orthopnea
Left
Right- or Left-Sided HF?
Cough
Left
Right- or Left-Sided HF?
Edema
Right
Right- or Left-Sided HF?
Ascites
Right
Right- or Left-Sided HF?
Elevated JVP
Right
Right- or Left-Sided HF?
+ Hepatojugular Reflex (HJR)
Right
Right- or Left-Sided HF?
Rales/Crackles
Left
Right- or Left-Sided HF?
Tachycardia
Left
Right- or Left-Sided HF?
S3/S4 Gallop
Left
Right- or Left-Sided HF?
Displaced PMI
Left
Right- or Left-Sided HF?
Cool Extremities
Left
Common causes of HF?
HTN CAD MI Valvular Heart Disease Myocarditis Arrhythmias Toxins
Modifiable risk factors for HF?
Elevated LDL-C Cigarette smoking Hypertension Low HDL-C (<40 mg/dL) Metabolic syndrome
What are nonmodifiable risk factors for HF?
Age/gender (men >45, women >55)
Family history:
CHD in male first-degree relative <55
CHD in female first-degree relative <65
Class 1, 2, 3, or 4 of HF?
Patients with no limitation of activities; they suffer no symptoms from ordinary activities.
Class 1
Class 1, 2, 3, or 4 of HF?
Patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion.
Class 2
Class 1, 2, 3, or 4 of HF?
Patients with marked limitation of activity; they are comfortable only at rest.
Class 3
Class 1, 2, 3, or 4 of HF?
Patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest.
Class 4
Stage A, B, C, or D of HF?
High risk for developing HF.
Stage A
Stage A, B, C, or D of HF?
Asymptomatic LV dysfunction.
Stage B
Stage A, B, C, or D of HF?
Past or current symptoms of HF.
Stage C
Stage A, B, C, or D of HF?
End-stage HF.
Stage D
What medications do you assess in HF?
Proarrhythmic/QTc prolongation
Cytochrome P450
NSAIDs
Which labs are needed in HF?
CBC CMP + Mg Fasting BG/A1C Lipids TSH UA/Microalbumin BNP
What additional testing might you consider in HF?
Fasting transferritin ANA HIV Lyme antibody Cardiac biopsy
Which 8 diagnostic tests could be used in HF?
ECT EST Echo stress Med stress test (Radionuclide perfusion imaging) Cardiac Cath Coronary Calcium Cardiac CT Cardiac MRI Impedance cardiography (noninvasive hemodynamic monitoring)
What can be helpful in risk stratifying a patient with possible CAD?
Coronary Calcium
If avoiding a cardiac cath, what test can be used to look for narrowing of arteries?
Cardiac CT
Not widely available for use in the clinical setting. Test used mainly for research purposes.
Cardiac MRI
What test can be used to help assess fluid status when making medication adjustments?
Impedance cardiography (noninvasive hemodynamic monitoring)
Why is polysomnography considered in HF testing?
Sleep testing is used b/c obstructive sleep apnea can both cause and worsen symptoms of HF.
