9 HF 1 Flashcards
HF Definition
an abnormality of myocardial function is responsible for the failure of the heart to pump blood at a rate required for adequately metabolizing ___
- not a ___ disease state, but a final common pathway for CV disease (CAD, HTN, valvular Dz, cardiomyopathies)
tissues
single
Types and Causes of HF
HFrEF - ___ EF
- ___ dysfunction: decreased ___
- HF symptoms with EF < ___ %
- caused by ___ ventricle
reduced
- systolic, contractility
- 40%
- dilated
Types and Causes of HF
HFpEF - ___ EF
- ___ dysfunction: impairment in ___ relaxation/filling
- HF symptoms with EF > ___ %
- combo of ___ and ___ dysfunction
- ___ is the most common cause ( >60%)
preserved
- diastolic, ventricular
- 50%
- systolic, diastolic
- HTN
Types and Causes of HF
HFmrEF - ___ EF ( ___ - ___ %)
HFimpEF - ___ EF ( > ___ %), previously had ___
mildly reduced, 41-49%
improved, 40, HFrEF
Determinants of LV Performance (SV)
1) ___ - venous return; LV end-diastolic volume
2) ___ - force generated at any given LVEDV
3) ___ - aortic impedance and wall stress
LVEDV = left ventricular end-diastolic volume
preload
contractility
afterload
Heart Failure Pathophysiology
Compensatory Response - pros and cons
response: increased ___ due to Na/Water retention
pros
- optimize ___ via Frank-Starling mechanisms
cons
- pulmonary/systemic ___ and ___
- increased ___
preload
- SV
- congestion, edema
- MVO2
MVO2 = Myocardial oxygen consumption
Compensatory Response - pros and cons
response: vasoconstriction
pros
- maintain BP in face of reduced ___
- shunt blood from nonessential tissues to the ___
cons
- increased ___
- increased afterload decreases ___ and further activates the compensatory responses
- CO
- heart
- MVO2
- SV
MVO2 = Myocardial oxygen consumption
Compensatory Response - pros and cons
response: tachycardia and increased contractility ( ___ activation)
pros
- maintain ___
cons
- increased ___
- shortened diastolic ___ time
- beta receptor ___ and decreased responsiveness
- ventricular ___
- increased risk of ___ cell death
SNS
- CO
- MVO2
- filling
- downregulation
- arrhythmias
- myocardial
MVO2 = Myocardial oxygen consumption
Compensatory Response - pros and cons
response: ventricular hypertrophy and ___
pros
- maintain ___
- reduce myocardial wall stress, decreases ___
cons
- ___ and ___ dysfunction
- risk of ___ cell death and ischemia
- risk of ___
- fibrosis
remodeling
- CO
- MVO2
- diastolic, systolic
- myocardial
- arrhythmias
MVO2 = Myocardial oxygen consumption
Drug-Induced HF
reduce contractility (negative ionotropes):
- antiarrhythmics: ( ___ and ___ )
- beta blockers
- calcium channel blockers ( ___ and ___ )
- ___
- disopyramide, flecainide
- verapamil, diltiazem
- itraconazole
Drug-Induced HF
Direct cardiac toxins:
- ___ , epirubicin, daunomycin, CYP, trastuzumab, bevacizumab, 5-FU, blue cohosh, imatinib, lapatinib, sunitinib, ethanol, ___ , amphetamines
doxorubicin, cocaine
Drug-Induced HF
Na and water retention/Na load
- ___ , androgens, estrogens
- ___ and COX-2 inhibitors
- ___ and pioglitazone
- ___ containing drugs
- glucocorticoids
- NSAIDs
- rosiglitazone
- Na
Clinical Presentation of HF
- shortness of breath
- swelling of feet and legs
- chronic lack of energy
- difficulty sleeping due to breathing problems
- swollen/tender abdomen with loss of appetite
- cough with frothy sputum
- increased urination at night
- confusion and impaired memory
Clinical Presentation of HF
right ventricular failure (primarily systemic ___ congestion)
symptoms:
- ___ pain, anorexia, nausea, bloating, constipation
signs:
- ___ edema , ___ venous distension, ___ reflux, ___ megaly, ascites
venous
- abdominal
- peripheral, jugular, hepatojugular, hepatomegaly
Clinical Presentation of HF
left ventricular failure (primarily ___ congestion)
symptoms
- ___ on exertion, orthopnea, paroxysmal ___ dyspnea, tachypnea, bendopnea, ___, hemoptysis
signs:
- rales, ___ gallop, ___ edema, pleural effusion, Cheyne-Stokes respiration
pulmonary
- dyspnea, nocturnal, cough
- S3, pulmonary
Clinical presentation of HF
nonspecific findings
symptoms:
- ___ intolerance, fatigue, weakness, nocturia, ___ symptoms
signs:
- ___ cardia, pallor, cyanosis, ___ megaly
exercise, CNS
tachycardia, cardiomegaly
major s/s of pulmonary congestion
- DOE
- orthopnea
- PND
- rales
- pulmonary edema
- bendopnea
- dyspnea on exertion
- need pillows to sleep
- paroxysmal nocturnal dyspnea (sudden SOB while sleeping)
- SOB when bent over (tying shoe)
major s/s of systemic venous congestion
- ___ edema
- JVD
- HJR
- ___ megaly
- ascites
- peripheral
- jugular venous distension
- hepatojugular reflux
- hepatomegaly
HJR = press on liver, see
laboratory/clinical assessment of HF
initial lab assessment
- CBC, serum ___ , BUN, Cr, TFTs
- ___
- chest X-ray
natriuretic peptides
- ___ ( > 35 pg/mL)
- ___ (>125 pg/mL)
electrolytes
ECG
BNP
NT-proBNP
laboratory/clinical assessment of HF
evaluation of LV function and measurement of ___
- ___
- nuclear testing (single ___ emission computed tomography, MUGA)
- cardiac catheterization
- MRI and CT
MUGA = multigated acquisition scan
EF
ECG
photon
classification of patients with HF
NYHA class I
patients with cardiac disease but ___ resulting limitations of physical activity
without
classification of patients with HF
NYHA II
patients with cardiac disease resulting in ___ limitations of physical activity
slight
classification of patients with HF
NYHA III
patients with cardiac disease resulting in ____ of physical activity
limitations
classification of patients with HF
NYHA IV
patients with cardiac disease resulting in ___ to carry on any physcial activity without ___
inability
discomfort
T or F: Class I patients have symptoms
False;
class I patients have asymptomatic Dz, classes II-Iv have symptomatic Dz
Classification of patients with chronic HF - AHA staging
stage A
___ risk of developing HF
- no s/s of HF
examples
- systemic HTN, CAD, DM
high
Classification of patients with chronic HF - AHA staging
stage B
___ heart disease that is strongly associated with HF but no s/s of HF
examples:
- LVH or fibrosis
- LV dilatation or ___ contractility
- asymptomatic valvular heart disease, previous ___
structural
- hypocontractility
- MI
Classification of patients with chronic HF - AHA staging
stage C
current or prior ___ of HF associated with underlying ___ heart disease
examples:
- dyspnea or fatigue due to ___
- ___ pateints receiving treatment for prior HF symptoms
symptoms, structural
- LVSD
- asymptomatic
LVSD = Left ventricular systolic dysfunction
Classification of patients with chronic HF - AHA staging
stage D
___ structural heart disease and marked symptoms of HF at ___ despite maximal medical therapy and which require specialized inervention
examples
- frequently ___ for HF
- cannot be safely discharged from the hospital.
- awaiting heart ___
- continuous ___ support at home along with mechanical circulatory assist device
- hospice
advanced, rest
- hospitalized
- transplantation
- IV
important definitions
asymptomatic rEF
- asymptomatic ___
- no HF symptoms with EF < ___ %
LVSD
40%
important definitions
HFrEF
- HF symptoms with EF < ___ %
40%
important definitions
HFimpEF
- previous symptoms/rEF now ___
improved
important definitions
HFmrEF
- HF symptoms with EF ___ - ___ %
41-49%
Therapy based on stage
High Risk for HF
- stage ___
Asymptomatic rEF
- stage ___
- NYHA class ___
HFrEF
- stage ___ or ___
- NYHA class ___ - ___
- reduced LV EF with symptoms
A
B
I
C, D, II-IV
General Measures
Exercise
- caution during ___ symptoms
- regular exercise is encouraged
- cardiac rehabilitation should be assessed in each patient
- dynamic exercise to increase HR to ___ - ___ % of maximum for 20 - 60 min 3-5 times/week
acute
60-80%
Dietary Measures
Sodium intake should be restrcted to ___ - ___ grams/day as possible
- patients with severe HF may require< ___ grams/day
Patients with EtOH induced HF should abstain totally
- in others, no more than ___ drinks/day for men, ___ drink/day for women
Fluid intake: restriction to < ___ L/day in patients with ___
- or if treatment with ___ is difficult in maintaining fluid volume
- 2-3
- 2
- 2
- 1
- 2
- hyponatremia
- diuretics
General measures
- weight monitoring
- smoking cessation
- immunizations
- replace ___
- appropriate ___ disease management
electrolytes
thyroid
