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Hf Boards > Assesment Of HF > Flashcards

Assesment Of HF Flashcards

1
Q

Which HF patients should get cathed

A 
Anyone presenting with HF who gas angina or ischemia unless no revascularization options (class I)
Or chest pain (class ii)
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2
Q

Which HF patients should have noninvasive imaging

A

To define likelyhood of cad

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3
Q

How does spect work?

A

Retained by viable myocytes

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4
Q

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

A

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

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5
Q

Patterns of gadilinium in dcm

A

30% mid wall

15% sub endocardium (like cad)

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6
Q

Utility of MRI in sarcoid

FDG pet?

A

Very useful. Predicts future sd (11 xrate).

Can follow rx.

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7
Q

Utility of sympathetic innervation by mIBG

A

If h/m > 1.6 survival greater than 85%

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8
Q

Who should get serial Ef

A 
Change in clinical status
Optimizing rx  (4-6 months)
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9
Q

What is rvswi. What numbers are concerning

A

(Mpap-wedge)Ci/hr

>300

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10
Q

Fick co

A

Vo2(125)/a-v o2 differencexhgbx14

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11
Q

Class 1 indications for bx

A

New onset HF (less than 2w)

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

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12
Q

Which Stage a patients should get echoes

A

Cad, valvular disease, fh in first degree relative

Afib, ECG Abn, ventricular arrhythmia, Abn physical exam

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13
Q

Recs for initial assessment of HF

A

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

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14
Q

Labs to get in initial assessment

A

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

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15
Q

What imaging should be done in initial assessment.

A

Cxr, echo, radionucleotide, coronary angiograms if angina or

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16
Q

How does 6 min walk test work

A

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

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17
Q

Who should get cpet

A 
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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18
Q

What is anerobic threshold

A

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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19
Q

Rer

A

Ratio of co2/o2

If below 1 have not reached anaerobic threshold

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20
Q

Ve/vco2 slope

A

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

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21
Q

When do you get an echo in patients with HF

A

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

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22
Q

Ongoing assessment of HF

A

Functional capacity volume status labs assess prognosis.

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23
Q 
Cpex class I
Class 2
A

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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24
Q

What is dyspnea index

A

End expiratory ve/mvv

Closer to 1 worse the pulmonary function

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25
Q

Minnesota vs Kccq

A

Minnesota lower is better

Kccq higher is better.

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26
Q

Who should get angiography

A

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

27
Q

Guidelines for noninvasive imaging in HF

A

HF, known cad and no angina

2b to assess ischemic disease

28
Q

Utility of spect/thallium

A

Thallium goes thru na potissium exchanger

29
Q

Define scar by MRI

A

Look for gdfm uptake

30
Q

Imaging of cardiac amyloid

A

Diffuse sub endocardial t1

31
Q

Pet scans in sarcoidosis

A

Hyper enhanced fdg

32
Q

Determine prognosis in hemochromatosis

A

Look at t2 star.

33
Q

What is 23 mibg

A

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

34
Q

If you have heart failure and angina

A

Get angiography

35
Q

Impact of viability

A

If you have viability

  1. Predicts mortality
  2. Predicts improvement
  3. Viability imaging predicts outcomes
36
Q

Cass trial

A

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

37
Q

Bari

A

Multivessel cad: pci versus bypass

Less than 10% had HF

38
Q

Stitch trial

A

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

39
Q

Who should have Cabg

A

Left main or equivelant, plad with 2 or 3 v disease

Significant viability

40
Q

Mitral valve surgery

A
  1. Should not do if secondary to ventricular dilation.
41
Q

Indications for as surgery

A

Symptoms, low ef, undergoing Cabg

42
Q

Low flow low gradient echo

A

2a to do dobutamine.

43
Q

Define contractile reserve in aortic stenosis

A

Contractile reserve if cardiac index increased by 20%

44
Q

Aortic insufficiency guidelines

A

Class I symptomatic or asymptotic if ef < 50.

45
Q

Pulm pressures in constriction and restriction

A

Restriction has higher pulmonary pressures.

46
Q

Constriction

A

B bump high peaked e prime

47
Q

Balloon pump inflation

A

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

48
Q

Indications for vad bt

A

Listed
1A or1b
Nyha 4

49
Q

Criteria for dt

A

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

50
Q

Who should get an echo

A

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

51
Q

Who should get an ace

A

Ef< 40
CVD
DM plus risk factor or smoker

52
Q

What to ask about at follow up

A 
Functional capacity
Weight
Compliance
Arrhythmias
Ischemia
53
Q

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

A
  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
  7. AICD for secondary prevention for all patients with reduced lv function
  8. AICD for primary prevention
  9. CRT if 120 with or without ICD
54
Q

Afib goals in hf

A

rate or rhythm control

55
Q

What is breathing reserve:

What is dyspnea index

A

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

56
Q

2 things hemodynamically that favor construction

A

Redp > 1/3 rvesp

Discordance

57
Q

3 things that favor restriction

A

Pas > 50
Lvedp-rvesp > 5
Concordance

58
Q

Differences between central and obstructive sleep apnea

A

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

59
Q

Cpex variables that predict mortality.

A 
Vo2 < 35
Lean vo2< 19
Predicted less than 50%
O2 pulse less than 10cc
At < 11 cc
60
Q

Who are stage a patients

A

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

61
Q

Eight 1a things to do for initial assesment of HF

A
  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
62
Q

A c x v y

A 
A atria fills  (s4, pr )
X atrial relaxes Qrs
C av valve closes
V atria fills  (s2, tp segment).
Y tricuspid valve opens up.
63
Q

When does pa diastolic and systolic occur

A

Diastolic occurs with peak qrs

Systolic occurs at t wave

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