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PHRM 845 > 9 HF 1 > Flashcards

9 HF 1 Flashcards

1
Q

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)

A

tissues
single

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2
Q

Types and Causes of HF

HFrEF - ___ EF
- ___ dysfunction: decreased ___
- HF symptoms with EF < ___ %
- caused by ___ ventricle

A

reduced
- systolic, contractility
- 40%
- dilated

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3
Q

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%)

A

preserved
- diastolic, ventricular
- 50%
- systolic, diastolic
- HTN

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4
Q

Types and Causes of HF

HFmrEF - ___ EF ( ___ - ___ %)

HFimpEF - ___ EF ( > ___ %), previously had ___

A

mildly reduced, 41-49%
improved, 40, HFrEF

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5
Q

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

A

preload
contractility
afterload

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6
Q

Heart Failure Pathophysiology

A
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7
Q

Compensatory Response - pros and cons

response: increased ___ due to Na/Water retention

pros
- optimize ___ via Frank-Starling mechanisms

cons
- pulmonary/systemic ___ and ___
- increased ___

A

preload
- SV
- congestion, edema
- MVO2

MVO2 = Myocardial oxygen consumption

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8
Q

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

A
  • CO
  • heart
  • MVO2
  • SV

MVO2 = Myocardial oxygen consumption

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9
Q

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

A

SNS
- CO
- MVO2
- filling
- downregulation
- arrhythmias
- myocardial

MVO2 = Myocardial oxygen consumption

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10
Q

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

A

remodeling
- CO
- MVO2
- diastolic, systolic
- myocardial
- arrhythmias

MVO2 = Myocardial oxygen consumption

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11
Q

Drug-Induced HF

reduce contractility (negative ionotropes):
- antiarrhythmics: ( ___ and ___ )
- beta blockers
- calcium channel blockers ( ___ and ___ )
- ___

A
  • disopyramide, flecainide
  • verapamil, diltiazem
  • itraconazole
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12
Q

Drug-Induced HF

Direct cardiac toxins:
- ___ , epirubicin, daunomycin, CYP, trastuzumab, bevacizumab, 5-FU, blue cohosh, imatinib, lapatinib, sunitinib, ethanol, ___ , amphetamines

A

doxorubicin, cocaine

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13
Q

Drug-Induced HF

Na and water retention/Na load
- ___ , androgens, estrogens
- ___ and COX-2 inhibitors
- ___ and pioglitazone
- ___ containing drugs

A
  • glucocorticoids
  • NSAIDs
  • rosiglitazone
  • Na
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14
Q

Clinical Presentation of HF

A
  • 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
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15
Q

Clinical Presentation of HF

right ventricular failure (primarily systemic ___ congestion)

symptoms:
- ___ pain, anorexia, nausea, bloating, constipation

signs:
- ___ edema , ___ venous distension, ___ reflux, ___ megaly, ascites

A

venous
- abdominal
- peripheral, jugular, hepatojugular, hepatomegaly

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16
Q

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

A

pulmonary
- dyspnea, nocturnal, cough
- S3, pulmonary

17
Q

Clinical presentation of HF

nonspecific findings
symptoms:
- ___ intolerance, fatigue, weakness, nocturia, ___ symptoms

signs:
- ___ cardia, pallor, cyanosis, ___ megaly

A

exercise, CNS
tachycardia, cardiomegaly

18
Q

major s/s of pulmonary congestion

  • DOE
  • orthopnea
  • PND
  • rales
  • pulmonary edema
  • bendopnea
A
  • dyspnea on exertion
  • need pillows to sleep
  • paroxysmal nocturnal dyspnea (sudden SOB while sleeping)
  • SOB when bent over (tying shoe)
19
Q

major s/s of systemic venous congestion

  • ___ edema
  • JVD
  • HJR
  • ___ megaly
  • ascites
A
  • peripheral
  • jugular venous distension
  • hepatojugular reflux
  • hepatomegaly

HJR = press on liver, see

20
Q
A
21
Q

laboratory/clinical assessment of HF

initial lab assessment
- CBC, serum ___ , BUN, Cr, TFTs
- ___
- chest X-ray

natriuretic peptides
- ___ ( > 35 pg/mL)
- ___ (>125 pg/mL)

A

electrolytes
ECG
BNP
NT-proBNP

22
Q

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

A

EF
ECG
photon

23
Q

classification of patients with HF

NYHA class I
patients with cardiac disease but ___ resulting limitations of physical activity

A

without

24
Q

classification of patients with HF

NYHA II
patients with cardiac disease resulting in ___ limitations of physical activity

A

slight

25
Q

classification of patients with HF

NYHA III
patients with cardiac disease resulting in ____ of physical activity

A

limitations

26
Q

classification of patients with HF

NYHA IV
patients with cardiac disease resulting in ___ to carry on any physcial activity without ___

A

inability
discomfort

27
Q

T or F: Class I patients have symptoms

A

False;
class I patients have asymptomatic Dz, classes II-Iv have symptomatic Dz

28
Q

Classification of patients with chronic HF - AHA staging

stage A
___ risk of developing HF
- no s/s of HF

examples
- systemic HTN, CAD, DM

A

high

29
Q

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 ___

A

structural
- hypocontractility
- MI

30
Q

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

A

symptoms, structural
- LVSD
- asymptomatic

LVSD = Left ventricular systolic dysfunction

31
Q

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

A

advanced, rest
- hospitalized
- transplantation
- IV

32
Q

important definitions

asymptomatic rEF
- asymptomatic ___
- no HF symptoms with EF < ___ %

A

LVSD
40%

33
Q

important definitions

HFrEF
- HF symptoms with EF < ___ %

A

40%

34
Q

important definitions

HFimpEF
- previous symptoms/rEF now ___

A

improved

35
Q

important definitions

HFmrEF
- HF symptoms with EF ___ - ___ %

A

41-49%

36
Q

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

A
B
I
C, D, II-IV

37
Q

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

A

acute
60-80%

38
Q

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

A
  • 2-3
  • 2
  • 2
  • 1
  • 2
  • hyponatremia
  • diuretics
39
Q

General measures

  • weight monitoring
  • smoking cessation
  • immunizations
  • replace ___
  • appropriate ___ disease management
A

electrolytes
thyroid

PHRM 845 (62 decks)

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