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RC Test 2 > B4.028 - Heart Failure Treatments > Flashcards

B4.028 - Heart Failure Treatments Flashcards

1
Q

what is the growth of HF population due to

A

improved management of cardiac disease

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2
Q

systolic cardiac dysfunction

A

impaired ability to eject blood

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3
Q

diastolic cardiac dysfunction

A

impaired ability of LV to fill with blood

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4
Q

clinically what is heart failure

A

inability to adequately supply blood to metabolizing body tissues

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5
Q

What is HFpEF

A

heart failure with preserved ejection fraction diastolic HF

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6
Q

which type of HF has had therapies shown to be effective

A

HFrEF

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7
Q

what is HFrEF

A

Heart failure with reduced ejection fraction Systolic HF

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8
Q

underlying causes of HF

A
  1. coronary artery disease 2. Hypertension 3. myocardial disease 4. valvular disease 5. pericardial disease
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9
Q

what are the types of Myocardial disease that can lead to HF

A

dilated infiltrative inflammatory hypertrophic stress cardiomyopathy

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10
Q

what are valvular diseases that can cause HF

A

aortic stenosis aortic regurgitation mitral stenosis mitral regurgitation

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11
Q

pericardial disease that can cause HF

A

tamponade constrictive pericarditis

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12
Q

describe the fundamental causes of HF

A

increased hemodynamic burden or impaired myocardial oxygen delivery triggers biochemical and physiological mechanisms that impact contractility and may promote vasoconstirtion and increased resistance, as well as sodium and fluid retnention

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13
Q

what are some systems that can be fundamental causes of HF

A

renin angiotensin system activation

sympathetic nervous system activation

remodeling due to myocardial changes

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14
Q

what are precipitating causes of HF

A

inappropriate reduction of therapy arrhythmias MI infection PE unrelated illness Drugs cardiac toxins severe stress

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15
Q

what is HF (type of condition)

A

syndrome

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16
Q

patients with asymptomatic LV dysfunction are 5x more likely to develop what

A

HF clinical syndrome

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17
Q

presentation of HF

A

decreased exercise tolerance manifestations of fluid retention discomfort at rest increased TPR

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18
Q

heart failure risk factors

A

HT coronary artery disease DM obesity smoking valvular heart disease

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19
Q

diastolic dysfunction risk factors

A

female older HT

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20
Q

is systolic or diastolic HF more common

A

systolic

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21
Q

what happens to PMI in HF

A

may be shifted left

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22
Q

describe characteristic age of people with diastolic and systolic HF

A

diastolic - elderly systolic - any ages, 50-70

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23
Q

typical sex of diastolic and systolic HF

A

diastolic - female systolic - male

24
Q

left ventricular cavity size in diastolic and systolic HF

A

diastolic - usually normal, LVH systolic - usually dilated

25
Q

which heart sound is associated with systolic and diastolic HF

A

diastolic - S4 systolic - S3

26
Q

what are tests to run for HF Dx

A

ECG CXR Echo CMR Blood chemistry (BNP)

27
Q

what can an echo tell you

A

EF Chamber sizes Wall thickness Regional wall motion abnormalities valve abnormalities doppler assessment of diastolic function

28
Q

what is BNP

A

seen in acute heart failure increased hormone level with increased ventricular wall stress due to pressure/volume overload

29
Q

what levels of BNP are needed for a diagnosis fo HF

A

<100 - acute HF unlikely >500 - acute HF likely

30
Q

what are the classes of heart failure

A

class 1 - asymptomatic class 2 - symptoms with heavy exertion class 3 - symptoms with mild exertion class 4 - symptoms at rest

31
Q

what are the determinants of stroke volume

A

preload contractility afterload heart rate cardiac output LV contraction, wall integrity, valve competence HR

32
Q

what are the medical treatment options for Systolic HF

A

Vasodilators Beta blockers ACE Inhibitors Entresto Corlanor

33
Q

what do vasodilators do in CHF

A

reduce preload and afterload

34
Q

what do beta blockers do in SHF

A

reduce HR and sympathetic overactivity

35
Q

what are the beta blockers for HF

A

carvedilol, bisoprolol, metoprolol succinate

36
Q

what medications for SHF dont improve outcome but have a role in symptom management

A

digoxin - inotropic agents diuretics

37
Q

what is stage A SHF and what do you treat with

A

High risk no symptoms preventative, lifestyle changes, risk factor reduction

38
Q

what is stage B SHF and how do you treat

A

structural heart disease, no symptoms ACE inhibitors or ARBs in all patients; beta blockers in selected patients

39
Q

what is stage C SHF and how do you treat

A

structural disease, previous or current symptoms ACE inhibitors and beta blockers in all

40
Q

what is stage D SHF and how do you treat

A

refractory symptoms inotropes

41
Q

describe stage A HF and what goals of treatment/treaments are

A
42
Q

what is stage B HF and what are the goals of treatment/treatments

A
43
Q

what is stage C HF and what are goals of treatment/treatments for it

A
44
Q

what is stage D HF and what are goals of treatment/treatments for it

A
45
Q

Describe stage A HF medical interventions

A
46
Q

Stage B HF recommendations

Structural heart disease but without signs or symptoms of HF

A
47
Q

Stage C nonpharma interventions

A

Also: continuous positive airway pressure (CPAP) for sleep apnea

Cardiac rehab

48
Q

pharm therapy for stage C HFrEF

A

Beta blockers

Aldosterone antagonists

hydralazine and isosorbide dinitrate (vasodilators)

49
Q

should you give calcium channel blockers to stage C HF paitents?

A

God NO

50
Q

Describe the magnitute of benefit for Stage C HFrEF for ACE I, Beta blockers, aldosterone antagonists, hydralazine/nitrate

A
51
Q

what are treatment options for HFpEF

A
52
Q

what are device treatments for stage C HFrEF

A

ICD - uses electrical pulses or shocks to help control life-threatening arrhythmias, especially those than can cause sudden cardiac arrest/death

CRT - sequentally paces cardiac ventricles in a more synchronized and physiologic pattern

53
Q

what are treatments for stage D HF

A

water restriction

inotropic support

mechanical circulatory support

LVAD

cardiac transplantation

54
Q

what are the most recommended therapies for hospitalized HF patients

A
55
Q

what are surgical/percutaneous/transcatheter interventional treatments of HF

A

CABG

PCI

aortic or mitral valve surgery

resection of ventricular aneurysm

RC Test 2 (19 decks)

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