Both Heart Failure Lectures Flashcards
released in response to increased cardiac wall tension
BNP
what might you expect to see on CXR in heart failure?
3
- englarged heart
- pulmonary edema
- pleural effusions
increased amplitude of the P wave indicates
left atrial enlargement
left axis with increased QRS voltage indicates
LVH
what might you expect to see on EKG in heart failure?
- increased P wave voltage
- increased voltage of QRS
- tall T wave in V2-V3
- T-wave abnormality in II, III, aVF
maybe signs of previous MI
poor R wave progression in V leads can be nonspecific for
anterior MI
what might you expect on physical exam for a patient in heart failure?
- weight gain
- elevated BP and HR
- elevated JVP
- S3 and S4
- murmurs
- PMI shifted laterally
- orthopnea
clinical finding with high specificity but low sensitivity in patients with advanced heart failure
rales
JVD is a sign of volume
overload
the main goal of the physical exam in heart failure is to assess
both volume and perfusion states
ejection fraction equation
EDV-ESV/EDV
normal ejection fraction
50-70%
definition of heart failure
symptoms/signs caused by structural/functional cardiac abnormality
corroborated by one of the following:
* elevated natriuretic peptide levels
* objective evidence of pulmonary/systemic conjestion (CXR)
HF w/ LVEF <40%
HFrEF
HF with LVEF >50%
HF with preserved EF
HF secondary to lung disease via elevated pulmonary artery pressure
cor pulmonale
seen with COPD
elevated blood pressure in the pulmonary arterial circulation above MAP
pulmonary hypertension
why is the HF epidemic growing?
improved management of cardiac disease
modifiable risk factors for HF
- hypertension
- CAD
- older age
- diabetes
- obesity
- smoking
- valvular disease
- a fib
uses invasive hemodynamics to directly measure filling pressures/volume status
right heart catheterization
characterizes pulmonary hypertension and provides information to calculate cardiac output
right heart catheterization
underlying causes of HF
- CAD
- hypertension
- myocardial disease
- valvular disease
- pericardial disease
fundamental causes of HF
- RAAS activation
- sympathetic nervous system activation
- remodeling
common symptoms of HF
- dyspnea
- orthopnea
- fatigue
- S3
- rales
- JVD
- pitting edema
is HFrEF systolic or diastolic dysfunction?
systolic
HFrEF is often secondary to
- ischemia
- MI
- dilated cardiomyopathy
is HFpEF systolic or diastolic dysfunction?
diastolic
HFpEF is often secondary to
myocardial hypertrophy
right sided HF most often results from
left sided HF
isolated right HF due to pulmonary cause
cor pulmonale
symptoms of left sided HF
- orthopnea
- paroxysmal nocturnal dyspnea
- pulmonary edema
symptoms of right sided HF
- congestive hepatomegaly
- JVD
- peripheral edema
pulmonary edema is a sign of […] sided heart failure
left
due to increased left atrial pressure
pulmonary edema can result in […] heard during inspiration
crackles
usually in HF, crackles are heard in the […] of the lung
base
what lab value is often elevated in CHF patients due to myocardial strain?
natriuretic peptides
N terminal pro BNP has greater […] in heart failure than BNP
diagnostic and prognostic value
intial diagnostic testing for CHF includes:
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- CXR
- echo
- BNP levels
- EKG
when might a cardiac biopsy be necessary for CHF?
- giant cell myocarditis
- cardiac amyloidosis
early satiety after eating and GI symptoms are related to […] sided HF
right
cold extremities and tachycardia indicate low
cardiac output
low perfusion
[…] is a concerning sign that someone in HF is decompensating
tachycardia
treat inpatient
normal LV ejection fraction
HFpEF
elevated left ventricular EDP
and elevated left atrial pressure
HFpEF
etiologic causes of HF
drugs/alcohol
thyrotoxicosis
vitamin or mineral deficiency -beriberi
cardiomoypathy
tachycardia/arrythmia
valvular heart disease
chagas
which 3 beta blockers are indicated for treatment in HF
bisoprolol
metoprolol succinate
carvedilol
inhibits the reabsorption of sodium and chloride in the ascending loop of Henle
loop diuretics
furosemide
drug used to manage edema associated with CHF, renal disease, and cirrhosis
furosemide
loop diuretic
diuretic that can be utilized for sequential nephron blockade to augment loop diuretics for extreme volume overload
metolazone
improves survival in systolic HF patients
carvedilol
[HPrEF] beta blocker
contraindicated in systolic heart failure patients
amlodopine
[HFrEF]
common side effect of SGLT 2 inhibitors
GU mycotic infections
d/t glucosuria
more likely to have renal and lung disease, and hypertension
HFpEF
low stroke volume relative to LV EDV
HFrEF
CAD is common in which types of HF patients?
both HFpEF and HFrEF
the need to decrease HF therapy due to symptomatic hypotension and renal dysfunction is a red flag for
stage D HF
may need surgical intervention or palliative care
ICDs reduce the risk of […] in patients for LV systolic dysfunction
SCD
persistently reduced LV systolic function has a higher likelihood of
arrhythmias
treat with ICD
MRA agents can cause
hyperkalemia
to reduce wall stress due to longstanding high pressure and volume, the LV cavity
dilates
high risk for HF but without structural changes/symptoms
stage
stage A
patient populations at risk of Stage A HF
- HTN
- CAD
- DM
- obesity
- metabolic syndrome
- using cardiotoxins
- family hx of cardiomyopathy
drugs for Stage A HF
- ACE/ARB for vascular disease or DM
- statins as appropriate
goals of therapy: stage A HF
- healthy lifestyle
- prevent CAD
- prevent LV structural abnormalities
structural heart disease without signs or symptoms of HF
stage
stage B
patient populations at risk for stage B HF
- previous MI
- LVH
- low EF
- asymptomatic valvular disease
goals of therapy: stage B HF
- prevent HF symptoms
- prevent further remodeling
drugs: stage B
- ACE/ARB
- beta blockers
surgical therapy: stage B
ICD
revascularization surgery
structural heart disease with prior or current symptoms of HF
stage
stage C
patient populations at risk for stage C HF
known structural heart disease with signs and symptoms
stage C HF can be divided into two categories
HFpEF
HFrEF
treatment HFpEF
- diuresis
- treat comorbidities
- revascularization surgery where appropriate
refractory HF
stage
stage D
