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RC Test 2 > B4.028 Heart Failure: Clinical Manifestations and Treatment > Flashcards

B4.028 Heart Failure: Clinical Manifestations and Treatment Flashcards

1
Q

why is the HF population growing?

A

improved management of chronic cardiac disease

MI/HF/arrhythmia management

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2
Q

what is the definition of heart failure?

A

structural or functional cardiac abnormality

inability to adequately supple blood to metabolizing body tissues (inability to meet the body’s metabolic needs)

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3
Q

systolic cardiac dysfunction

A

impaired ability (usually LV) to eject blood

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4
Q

diastolic cardiac dysfunction

A

impaired ability of the LV to fill with blood

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5
Q

why is the diagnosis of HFpEF challenging?

A

largely a diagnosis of exclusion of other potential noncardiac causes of symptoms suggestive of HF

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6
Q

what are the 3 classes of causes of heart failure?

A 
underlying causes (diseases)
fundamental causes (pathophysiologic mechanisms)
precipitating causes (stimuli for deterioration)
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7
Q

HF underlying causes (diseases)

A 
CAD
hypertension
myocardial disease
valvular disease
pericardial disease
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8
Q

examples of myocardial disease that can cause HF

A 
dilated
infiltrative
inflammatory
hypertrophic
stress cardiomyopathy (Takotsubo)
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9
Q

examples of valvular diseases that can cause HF

A 
usually left sides
aortic stenosis
aortic regurg
mitral stenosis
mitral regurg
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10
Q

examples of pericardial disease that can cause HF

A

tamponade

constrictive pericarditis

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11
Q

what are the fundamental causes of HF?

A

increased hemodynamic burden or impaired myocardial O2 delivery triggers mechanisms that

  • impact contractility (inotropic state)
  • may promote increased TPR (increased afterload)
  • promote sodium and fluid retention (increased preload)
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12
Q

which systems are activated in HF

A

renin-angiotensin
SYM nervous system
remodeling-structural myocardial changes

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13
Q

precipitating causes of HF

A 
inappropriate reduction of therapy
arrhythmias
MI 
infection
PE
unrelated illness
drug side effects (NSAIDs)
cardiac toxins
severe stress
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14
Q

what factors need to be addressed to treat HF?

A

underlying etiologies
precipitating causes
deleterious reflex responses

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15
Q

what is LV dysfunction?

A

a pathophysiologic condition that can lead to the clinical syndrome of HF (5x more likely)
early recognition and treatment can limit progression

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16
Q

how do HF patients present?

A

decreased exercise tolerance
fluid retention
discomfort at rest (SOB, orthopnea)
increased TPR/ peripheral vasoconstriction

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17
Q

HF risk factors

A 
hypertension
CAD
older age
diabetes
obesity
smoking
valvular heart disease
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18
Q

diastolic dysfunction risk factors

A

older age
female gender
hypertension

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19
Q

what % of people have systolic vs diastolic HF

A

2/3 systolic

1/2 diastolic

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20
Q

what is a physical exam finding of peripheral vasoconstriction?

A

cool skin

cyanosis

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21
Q

ancillary tests for the diagnosis of HF

A 
EKG
CXR
echo
CMR
blood chemistry (BNP)
22
Q

what is BNP

A

brain natriuretic peptide
increased hormone level with increase ventricular wall stress due to PV overload
BNP < 100 acute HF not likely
BNP >500 acute HF likely
can’t distinguish systolic from diastolic

23
Q

EKG findings typical of HF

A 
prior MI
ventricular hypertrophy
arrhythmias
conduction abnormalities
low voltage
24
Q

CXR findings typical of HF

A

pulmonary edema/ vascular congestion

cardiomegaly (LV-LA-right heart)

25
things to check on and echocardiogram for HF
``` EF (norm 50-70%) chamber sizes wall thickness regional wall motion abnormalities valve abnormalities doppler assessment of diastolic function ```
26
ACCF/AHA stages of HF
A: at high risk, but without structural disease or symptoms B: structural heart disease but without signs or symptoms of HF C: structural heart disease with prior or current symptoms of HF D: refractory HF requiring specialized interventions
27
NYHA functional classes of HF
I. no limitation of physical activity, ordinary physical activity does not cause symptoms II. slight limitation of physical activity, comfy at rest but ordinary physical activity results in symptoms III. marked limitations of physical activity, comfy at rest, but less than ordinary activity causes symptoms IV. unable to carry on any physical activity without symptoms, symptoms at rest
28
evidence based treatments for systolic HF
vasodilators (nitrates, apresoline) b-blockers (carvedilol, bisoprolol, metoprolol) ACE inhibitors, angiotensin receptor blockers (ARB), aldosterone antagonists
29
new meds for systolic HF
LCZ696: entresto (sacubitril/valsartan) | corlanor (ivabradine)
30
agents for symptom management in systolic HF
``` diuretics- reduce preload inotropic agents (dobutamine, milrinone, digoxin) - augment contractility ```
31
how does digoxin augment contractility
inhibits Na/K ATPase to decrease extrusion of Na+ and increase it intracellularly increased intracellular Na+ inhibits the Na+/Ca2+ exchanger to decrease extrusion of Ca2+ and increase it intracellularly
32
stage A treatment options
risk factor reduction patient and family education treat HTM, diabetes, dyslipidemia
33
stage B treatment options
ACE inhibitors of ARBs in all patients | B-blockers in some patients
34
stage C treatment options
ACE inhibitors and B-blockers in all patients dietary sodium restriction, diuretics, digoxin cardiac resynchronization if bundle block present revascularization, mitral valve surgery consider multidisciplinary team aldosterone antagonist
35
stage D treatment options
inotropes VAD, transplantation hospice
36
primary goals of advanced HF management
improved survival and reduced readmissions
37
how are recommendations classified?
``` class I-III class I benefit >>>risk class IIA benefit >>risk class IIb benefit > risk class III no benefit or harmful ```
38
how are levels of evidence classified?
level A: multiple populations evaluated (multiple random clinical trials or meta analysis) level B: limited populations evaluated (single trial or nonrandomized studies) level C: very limited populations evaluated (consensus opinion)
39
nonpharmacological interventions for stage C HF
``` I-B specific education I-A exercise training IIa-C sodium restriction IIa-B CPAP for sleep apnea IIa-B cardiac rehab ```
40
class I treatment protocol for HFpEF
BP control | diuretics for symptom relief
41
when do you use diuretics in stage C HFrEF?
whenever someone has fluid retention, class I rec
42
when do you use ACE inhibs in stage C HFrEF?
all patients, class I rec
43
when do you use ARBs in stage C HFrEF?
patients where ACE inhibs don't work, class I rec
44
when do you use b-blockers in stage C HFrEF?
all stable patients, class I rec
45
when do you use aldosterone antagonists in stage C HFrEF?
``` NYHA class II-IV HF with LVEF <35% patients following acute MI with LVEF <40% ```
46
when do you use hydralazine/isosorbide dinitrate in stage C HFrEF?
African americans with NYHA class III-IV HF
47
when do you use anticoagulation in stage C HFrEF?
chronic HF with AF and additional risk factors for cardioembolic stroke selection of anticoagulant should be individualized
48
what is an ICD?
implantable cardioverter defibrillator small device in chest/abdomen with leads in heart uses electrical pulses to help control life threatening arrhythmias
49
what is CRT?
cardiac resynchronization therapy | sequentially paces cardiac ventricles in a more synchronized and physiologic pattern
50
what are the recs for stage D HF?
``` water restriction inotropic support mechanical circulatory support LVAD (left ventricular assist device) cardiac transplantation ```
51
surgical/ percutaneous/ transcatheter interventional treatments of HF
CABG PCI (percutaneous coronary artery intervention) aortic or mitral valve surgery resection of ventricular aneurysm

RC Test 2 (17 decks)

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