Cardiac Clinical Medicine Part 3: Heart Failure Flashcards
What are the cardinal clinical symptoms of heart failure?
What are the signs?
1) Dyspnea and fatigue
2) Edema and rales
HF with preserved ejection fraction (“HFpEF”) is defined as?
HF with reduced ejection fraction (“HFrEF”) is defined as?
Which makes up 50% of all HF cases?
1) LVEF ≥50%
2) LVEF <40%
3) HFrEF
What happens to the wall of the myocardium with HFpEF?
What happens to it with HFrEF?
1) Thickened
2) Thins and weakens
What is the most common cause of HFrEF?
CAD
What are some risk factors for HFrEF?
1) Male
2) LVH
3) Bundle branch block
4) Previous MI
5) Smoking
What are some risk factors for HFpEF?
1) Older age
2) Female
3) HTN
4) Afib
When is the diagnosis of HF most challening?
In its early stages
What are some HF symptoms of congestion?
1) Dyspnea
2) Paroxysmal nocturnal dyspnea
3) Nocturnal cough
4) Weight fluctuations
What are some HF symptoms of hypoperfusion?
1) Exercise intolerance
2) Fatigue
3) Cold intolerance
What is the cardiac biomarker for HF?
BNP
What imaging is recommended with suspected HF?
Echocardiography (2D TTE)
What is class A of ACCF and AHA staging?
Class B?
Class C?
Class D?
A) High risk of HF but without structural heart disease
B) Structural heart disease but without symptoms of HF
C) Structural heart disease with symptoms of HF
D) Refractory HF requiring specialized intervention
Which ACCF and AHA class are majority of the patients in?
Class B
The NYHA functional classification (I-IV stages) is based on?
Ability to perform physical activity and if it causes symptoms of heart failure
What helps improve the symptoms of HFrEF?
Diuretics
Improving quality and duration of life due to HFrEF is based on?
What is the initial therapy to accomplish this?
If they are still symptomatic what should be done?
1) Preventing remodeling
2) ACEi and Beta-blockers
3) Add Mineralocorticoid antagonist
In the absence of HTN, evidence does not support treating HFpEF with any medication except?
What is important in the long-treatment of HFpEF?
1) Diuretics
2) Treat comorbidities
Cor Pulmonale develops in response to?
What is responsible for about half of these cases?
1) Chronic pulmonary HTN
2) COPD and chronic bronchitis
What does Cor Pulmonale lead to?
Increased RV afterload sufficient to alter RV structure and function
What symptoms are associated with cor pulmonale?
1) LE swelling
2) Increased abdominal girth from ascites
What sign is seen in the neck with cor pulmonale?
In the heart?
In the lungs?
1) Elevated JVP
2) Tricuspid murmur and S3 gallop
3) Wheezing/rales
What will ekg show with cor pulmonale?
Right axis deviation and RV hypertrophy
What imaging may be used for diagnosing cor pulmonale when 2D TTE is not clear?
MRI and cardiac catheterization
