Assesment Of HF Flashcards by Eric Adler

Which HF patients should get cathed

Anyone presenting with HF who gas angina or ischemia unless no revascularization options (class I)
Or chest pain (class ii)

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Which HF patients should have noninvasive imaging

To define likelyhood of cad

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How does spect work?

Retained by viable myocytes

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Stitch trial
What modalities?
Define viability? (%, segments)

80% spect, 20% dob echo
Uptake 50% in 11 segments
P.03, P.21 if adjust for other variables

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Patterns of gadilinium in dcm

30% mid wall

15% sub endocardium (like cad)

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Utility of MRI in sarcoid

FDG pet?

Very useful. Predicts future sd (11 xrate).

Can follow rx.

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Utility of sympathetic innervation by mIBG

If h/m > 1.6 survival greater than 85%

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Who should get serial Ef

Change in clinical status
Optimizing rx  (4-6 months)

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What is rvswi. What numbers are concerning

(Mpap-wedge)Ci/hr

>300

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Fick co

Vo2(125)/a-v o2 differencexhgbx14

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Class 1 indications for bx

New onset HF (less than 2w)

2-12 weeks with arrhythmia, av block, or fail to respond to care

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Which Stage a patients should get echoes

Cad, valvular disease, fh in first degree relative

Afib, ECG Abn, ventricular arrhythmia, Abn physical exam

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Recs for initial assessment of HF

Thorough h and p
Careful hx of drugs, alternatives etc
Ability of adl
Volume status, orthostatic

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Labs to get in initial assessment

CBC, UA, lytes, lipids, Hgb a 1c, lft thyroid

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What imaging should be done in initial assessment.

Cxr, echo, radionucleotide, coronary angiograms if angina or

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How does 6 min walk test work

Need a 100 foot hallway
Change of 50m significant
Not useful for monitoring pharmacologics, but made a difference in CRT

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Who should get cpet

Dispensaries between objective and physical findings
Distinguishing HF from non HF causes
Candidacy for cardiac transplant
Need for cardiac rehab
Employment capabilities

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What is anerobic threshold

Change in vco2/vo2 slope or when ve/vO2> ve/vc02

Defined by highest oxygen uptake obtained without a sustained increase in lactate.

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Rer

Ratio of co2/o2

If below 1 have not reached anaerobic threshold

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Ve/vco2 slope

If greater than 35 bad prognostic predictor as is oscillatory breathing.

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When do you get an echo in patients with HF

4-6 months after optimization of therapy and if change in clinical status

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Ongoing assessment of HF

Functional capacity volume status labs assess prognosis.

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Cpex class I
Class 2

Rer >1.05
Beta blocker <12, no 14
Class 2a if 50% of predicted
2b should base on lean body mass in the obesse

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What is dyspnea index

End expiratory ve/mvv

Closer to 1 worse the pulmonary function

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Minnesota vs Kccq

Minnesota lower is better | Kccq higher is better.

Who should get angiography

Cor angiography is reasonable if known or suspected cad and HF.

Guidelines for noninvasive imaging in HF

HF, known cad and no angina | 2b to assess ischemic disease

Utility of spect/thallium

Thallium goes thru na potissium exchanger

Define scar by MRI

Look for gdfm uptake

Imaging of cardiac amyloid

Diffuse sub endocardial t1

Pet scans in sarcoidosis

Hyper enhanced fdg

Determine prognosis in hemochromatosis

Look at t2 star.

What is 23 mibg

Look at h/m ratio. If greater than 2/1

If you have heart failure and angina

Get angiography

Impact of viability

If you have viability 1. Predicts mortality 2. Predicts improvement 3. Viability imaging predicts outcomes

Cass trial

Randomized trial of med therapy versus surgery. No aspirin bb ace etc Only 3 v cad had improvement.

Bari

Multivessel cad: pci versus bypass | Less than 10% had HF

Stitch trial

No difference in medicine or surgery Ef <35 Could not have left main disease.

Who should have Cabg

Left main or equivelant, plad with 2 or 3 v disease | Significant viability

Mitral valve surgery

1. Should not do if secondary to ventricular dilation.

Indications for as surgery

Symptoms, low ef, undergoing Cabg

Low flow low gradient echo

2a to do dobutamine.

Define contractile reserve in aortic stenosis

Contractile reserve if cardiac index increased by 20%

Aortic insufficiency guidelines

Class I symptomatic or asymptotic if ef < 50.

Pulm pressures in constriction and restriction

Restriction has higher pulmonary pressures.

Constriction

B bump high peaked e prime

Balloon pump inflation

Early inflation loose dichrotic notch Late inflation occurs before dichrotic notch Late deflation goes into s2 Early deflation minimizes Afterload reduction

Indications for vad bt

Listed 1A or1b Nyha 4

Criteria for dt

Lv ef Dependence on inotropes for 14 days Dependence on iabp for 7 days

Who should get an echo

Hx:Cad, valvular, fh of 1st degree, ekg:Afib/flutter, EKG lvh lbb or q waves, ventricular arrhythmias Pe: cardiomegally, s3, or murmurs.

Who should get an ace

Ef< 40 CVD DM plus risk factor or smoker

What to ask about at follow up

``` Functional capacity Weight Compliance Arrhythmias Ischemia ```

The 10 commandments of sympomatic heart failure (10 class Ia guidelines).

1. All Class I 2. Diuretics/Salt restriction 3. ACE 4. Beta Blocker 5. Arb if no ACE. Spirinolactone and Hydral/NTG for AA 6. Avoid NSAIDs, antiarryhtmics and ccbs 7 Exercise Training 8. AICD for secondary prevention for all patients with reduced lv function 9. AICD for primary prevention 10. CRT if 120 with or without ICD

Afib goals in hf

rate or rhythm control

What is breathing reserve: | What is dyspnea index

Mvv-peak Ve/ mvv Should be >30% Mvv = fev1X35 DI= peak ve/mvv (should be <. 50)

2 things hemodynamically that favor construction

Redp > 1/3 rvesp | Discordance

3 things that favor restriction

Pas > 50 Lvedp-rvesp > 5 Concordance

Differences between central and obstructive sleep apnea

Central: 5 apneac episodes/hr Obstructive: 10 s of effort but no breathing

Cpex variables that predict mortality.

``` Vo2 < 35 Lean vo2< 19 Predicted less than 50% O2 pulse less than 10cc At < 11 cc ```

Who are stage a patients

Diabetes, metabolic syndrome Hypertensive, atherosclerosis, obesity Using cardiac toxins Fhx of cm

Eight 1a things to do for initial assesment of HF

1. Pe: Bp, volume status, orthostasis 2. Hx of toxins 3. Functional status/adls 4. EKG 5. Echo 6. Cath if have angina 7. Labs: CBC, chem, UA, lfts, lipids thyroid hormone

A c x v y

``` A atria fills (s4, pr ) X atrial relaxes Qrs C av valve closes V atria fills (s2, tp segment). Y tricuspid valve opens up. ```

When does pa diastolic and systolic occur

Diastolic occurs with peak qrs | Systolic occurs at t wave