9.8.2013(Heart Failure) Flashcards
Stage A heart failure
No symptoms No structural disease Only risk factors present CAD hypertension DM toxins Cardiomyopathy
Precipitants of heart failure
Infection Volume overload Thyroid dysfunction Myocardial ischemia Hypertension Arrythmias Alcohol NSAID CCB doxorubicin Pulmonary embolism
Rx of stage A heart disease
Dietary modifications
Treat hyperlipidemia
ACE inhibitors for HTN
Stage B heart failure
Abnormal LV systolic function
MI
valvular Heart disease
No symptoms
Rx of stage B heart failure
ACEI
beta blockers
Stage C heart failure
Structural HF with symptoms
Rx of stage C heart disease
ACEI
beta blockers
Diuretics
Digoxin
Stage D heart failure
Heart failure symptoms refractory to maximal medical management
Rx of stage D heart failure
Mechanical assist devices
Cardiac transplantation
Continuous IV inotropic support
BNP levels and heart failure
BNP>400 in the absence of renal failure is specific
BNP<100 has high negative predictive value
Testing to be done in new onset heart failure without CAD
HIV hepatitis Hemochromatosis ANA,ANCA Amyloidosis Pheochromocytoma
Role of cardiac MRI in assessing heart failure
Valvular disease Amyloidosis Sarcoidosis Myocarditis Previous MI
Role of cardiopulmonary exercise testing in heart failure
Assessment for heart transplantation
Role of coronary angiography in heart failure
In pts with angina or evidence of ischemia in ECG or stress testing unless they are not candidates for revascularisation
Effects of beta blockers in heart failure
Improves ejection fraction,exercise tolerance,NYHA class
Time taken for improvement in LV function after instituting Betablocker therapy
2-3 months
Adverse cardiac effects immediately reduced after institution of Betablocker therapy
Arrythmias
Sudden cardiac death
Adverse reactions that may occur after initiation of Betablocker therapy
Volume retention and worsening of heart failure symptoms,these improve with use of diuretics