Cardiac Clinical Med 3 (Miller) Flashcards
What is HF with preserved ejection fraction defined as?
- LVEF >50%
What is HF with reduced ejection fraction defined as?
- LVEF < 40%
How does HFrEF occur?
- Begins with direct injury to myocardium or a disease state that leads to reduced contraction of the ventricles
What are some CV etiologies that can cause HFrEF?
- CAD
- Cardiomyopathies
- Myocarditis
- Valvular diseases
- Cardiac infections
What are some non-cardiac causes of HFrEF?
- Endocrine (thyroid disorders)
- Systemic diseases
- High intake of alcohol and other illicit drugs
- Following chemotherapy for cancer
What are the shared risks of HF?
- Age
- DM
- Smoking
- HTN
- Atherosclerosis
- Obesity
- Metabolic syndrome
What are some risk factors specifically for HFrEF?
- Male
- LVH
- Bundle branch block
- Previous MI
What are some risk factors specifically for HFpEF?
- Older age
- Female
- HTN
- A fib
What are some symptoms of congestion in HF?
- Dyspnea on exertion
- Paroxysmal nocturnal dyspnea
- Orthopnea
- Nocturnal cough
- Weight fluctuations
- Edema
What are some symptoms of hypoperfusion?
- Exercise intolerance
- Fatigue
- Decreased mentation
- Cold intolerance
What do we look for in the medical history to help make a diagnosis of heart failure?
- Identify risk factors, existing precipitating factors, comorbid conditions
- Identify family history of sudden cardiac death or clinical HF
- Assess medications
- Identify exacerbating conditions
- Assess diet
What is the goal in diagnosis of HF?
- Identify the etiology of HF
- Identify prognostic factors
- Provide information about patient management
What devices can we use to help diagnose HF?
- EKG
- CXR
- Labs (assess renal function, serum potassium)
- Echocardiography
What do the labs help us look at when diagnosing HF?
- Look at renal funciton and serum potassium
- Cardiac biomarkers like BNP and NT BNP
What will be found on echocardiography in someone with HF?
- Reduced LVEF
- Atrial and ventricular chamber dilation or hypertrophy
- Valvular dysfunction
- Pericardial pathology
- Elevated ventricular filling pressures
What are the objectives of treating and managing HF?
- Improve symptoms
- Improve quality and duration of life
- Prevent hospital admission
What is a way to improve the symptoms of HF?
- Give diuretics
What is a way to prevent remodeling of the heart in order to improve the quality and duration of life?
- Treat patient with ACEi or B-blocker
- If still symptomatic, give MR antagonist
What treatment option gives the best overall quality of life in those with HFrEF?
- Cardiac transplantation
How do we treat individuals with HFpEF?
- Without HTN, there is no evidence in giving any medications except diuretics
- Identify and treat comorbidities because that is what kills people (not the HF)
How does Cor Pulmonale develop?
- In response to pulmonary HTN
What is the common mechanism in cor pulmonale?
- Pulmonary HTN and increased RV afterload are sufficient to alter RV structure and function
What are the symptoms of cor pulmonale?
- Generally related to underlying lung disorder
- Leads to systemic congestion like LE swelling or ascites
How is cor pulmonale diagnosed?
- EKG (signs of pulmonary HTN: right axis and RV hypertrophy)
- CXR (show enlargement of pulmonary arteries
- 2D TTE
What is the treatment and management of cor pulmonale?
- Maintain oxygen delivery to tissues (keep SaO2 above 90%)
- Optimize volume status (diuretics, fluid, Na restriction)
- Provide hemodynamic support
- Manage arrhythmias
- Activity restriction
- Palliative care
How is HF prevented?
- Identify, treat, and prevent conditions that lead to HF like HTN, hyperlipidemia, DM, obesity, smoking
What is stage A of HF prevention?
- Prevent the development of CV disease and ventricular structural abnormalities
- Counselling for appropriate dietary and exercise modifications
What is stage B of HF prevention?
- Prevent the development of further cardiac remodeling and symptomatic HF through the appropriate initiation of heart failure specific therapies
