Cardio ppt 3 - Exam 6 Flashcards
CHF patho?
Heart is unable to pump blood at a sufficient rate for demand of tissues
Final pathway of essentially every significant pathologic cardiac condition
How does the heart compensate for demand?
Frank-Starling mechanism
Hypertrophy (remodeling) with or without dilation
Hormonal activation
What hormones are activated when the heart is compensating for demand?
Norepinephrine
Renin-Angiotenison- aldosterone
Atrial natriuretic peptide
Cardiac Pathologic causes
of CHF?
Hypertension
Myocardial infarction
Valve abnormalities
Ventricle preload or afterload disturbance
Heart rate
Non-cardiac high output failure causes of CHF?
Thyrotoxicosis - can cause a catecholamine increase which increase HR and increase demands
Severe anemia
CHF prevalence ?
2% of US population
10% of people over age 80
Typical labs for dx CHF?
BNP - high indicates HF
CXR - fluid in heart? or crackles?
Echocardiography - how bad is
the HF?
EKG
CHF BNP level?
N-terminal pro-BNP
Elevated
CHF CBC finding?
anemia
CHF BMP finding?
BUN elevated
Creatinine elevated
Potassium - elevated
Sodium - hypoatremia
kidneys gets creamed with CHF
CHF LFT finding?
elevated
Hepatojugular reflux
Cardiac enzymes CHF findings?
Troponin - elevated
CK-MB - elevated
CHF CXR imaging ?
Cardiomegaly
Cephalization - lung marking in apex of lung
Interstitial edema - Kerley B lines - atelectasis
Alveolar Fluid
Bilateral pulmonary effusion
Venous dilation - batwing hilum
CHF EKG findings?
LVH
low voltage
arrhythmia
conduction defects
new / old MI
CHF Echo findings monitor?
most useful imaging study
monitor ejection fraction - a key diagnostic and prognostic indicator in CHF
CHF Echo findings assess?
size and function of chambers
valve abnormalities
pericardial effusion
shunting - inappropriate movement of blood
segemental wall abnormality
Other studies for CHF?
Cardiac catheterization - Evaluate atherosclerosis , CO
Stress imaging or radionucleotide angiography - assess cause or severity of disease
TSH
Iron studies - hemochromatosis
Stage A Heart Failure ?
high risk of developing CHF
Stage B Heart Failure ?
Structural heart disease - evidence ; no symptoms
Stage C Heart Failure ?
Structural heart disease w/ symptoms - PND, Dysnpnea on extertion
Stage D Heart failure ?
Advanced structural heart disease , symptoms at res
Dyspnea and everything at rest, and even worse with exertion t
CHF prognosis
5 year mortality 50%
<5% yearly mortality rate for no symptoms (Stage B)
30% yearly mortality rate for severe symptoms (Stage D)
NYHA classification I definition?
No limitation to physical activity
activity does not cause fatigue, dyspnea, anginal pain
NYHA classification II definition?
Slight limitation to physical activity
NYHA classification III definition?
marked limitation to physical activity
NYHA classification IV definition?
symptoms even at rest - unable to engage in physical activity - STAGE D
Typical CHF patient treatment?
LABAD
lifestyle changes - lose weight
Diuretic - Loop - furosemide - often first thing ordered cause the fluid and has most symptomatic relief
ACEI - lisinopril
BB - metoprolol
Aldosterone antagonist - sprinolactione - increase mortality
Digoxin - decrease symptoms - ATPase inhibitor , positive inotrope and negative chronotorpic effects
Treatments to consider for CHF?
Digoxin
Ivabradine
Pacemaker - consider at mobitz II and 3rd degree
Defibrillator - if EF is less than 30%
LVAD - stethoscope will hear no heart beat
Heart transplant - option
Removing calcium channel blockers - good for HTN not so good for HF - cause some increase in mortality ( amilodipine and now they are developing HF you may want to consider taking them off it ) -
long acting nitrates can be used but used for more acute HF presentation - helps with pain - but it mainly helps move fluid from lungs to other areas to help with diuresis - LOOK UP
What is more important in patient education with CHF ?
evaluate for reversible causes
Lifestyle modifications for CHF?
Progressive aerobic exercise
sodium reduction
smoking cessation
alcohol cessation
stress reduction
What diuretics do you used for CHF?
Thiazide (better for HTN) or LOOP ( better for CHF) shorter acting
they offer symptomatic relief especially for RSHF
What is the only effective medication for Diastolic HF?
Diuretic
What medications used for CHF decrease mortality?
ACEI or ARB
BB
What medications used for CHF decrease symptoms?
Digoxin - inotrope
Surgery or procedures for CHF patients?
ICD
Biventricular Pacemaker
When do you consider ICD for CHF patients?
if EF below 35% - percentage when to start to consider it
When do you consider a pacemaker for CHF patients?
if QRS is prolonged
What is used in severe cases of CHF?
LVAD - left ventricular assist device
Intra-aortic balloon pump - counter pulsation - allows more blood flow to the coronaries
Heart transplant
LCHF patho?
Inadequate pumping or filling of the left ventricle
LCHF patho - systolic?
Inadequate pumping causes decreased forward flow and organ perfusion
Reduced ejection fraction
Ultimately to back up to pulmonary circulation
LCHF patho - diastolic?
Inadequate filling
Creates back flow to pulmonary circulation
LCHF common causes?
Hypertension
Ischemic heart disease
Aortic or mitral valve disease
Primary myocardial diseases
LCHF history?
pulmonary issues
Dyspnea - exertional Orthopnea PND unproductive cough fatigue exercise intolerance
LCHF physical exam?
S3 gallop - systolic -
S4 gallop - diastolic
bibasilar crackles
occasional wheezing
parasternal lift - heave
Large apical impulse
Pulse pressure narrow - systolic and diastolic are close together
S3 is a ventricular gallop and it is a sign of ________ CHF and LV is __________.
systolic
compliant - LV is like a bag
S$ is a atrial gallop and it is a sign of __________ CHF and LV is ___-_________.
diastole
non-compliant LV - cannot fill
RCHF patho?
Abnormal filling or contractility of the right ventricle
Leads to systemic back up of venous blood
Especially to liver
Common causes of RCHF?
LCHF
COPD
pulmonary HTN
History of patient with RCHF?
Peripheral edema - biggest complaint
Decreased appetite
Nausea
Nocturia -when patient lays down at night the fluid is returned to the vasculature system and goes to the kidneys which then try to get rid of it
Physical exam on a patient with RCHF you will see what?
JVD - hepatojugular reflux
pitting pedal edema
variable BP
hepatomegaly
What medication offers the most symptomatic relief in RCHF patients?
Diuretics - Loop - furosemide
