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PANCE 2.0 > Cardiology #8 (Heart Failure) > Flashcards

Cardiology #8 (Heart Failure) Flashcards

1
Q

What is the MCC of heart failure?

A

CAD (such as post-MI)

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2
Q

MCC of left-sided heart failure

A

CAD and HTN

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3
Q

MCC of right-sided heart failure

A

Left sided heart failure
-Other causes: pulmonary disease (COPD, pulmonary HTN), Mitral stenosis

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4
Q

Explain ejection fraction, heart murmur, ventricular walls, and LV chamber size in terms of types of heart failure

A

Systolic: decreased ejection fraction, S3 gallop, thin ventricular walls, dilated LV chamber
Diastolic: preserved EF, S4 gallop, thick ventricular walls, small LV chamber

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5
Q

Name 5 predisposing factors for heart failure

A

-CAD (MC)
-HTN
-Valvular heart disease
-Obesity
-Diabetes
-Pulmonary disorders (COPD, Pulmonary HTN)

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6
Q

Explain what systolic heart failure is

A

Pumping problem due to weakened, thin, or overly compliant ventricles.

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7
Q

MC etiologies of systolic heart failure

A

-Post MI (thinning of ventricles because muscle has broken down)
-Dilated cardiomyopathy
-Valvular heart disease (Aortic stenosis)

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8
Q

What is diastolic heart failure?

A

Filling problem due to stiff, thickened ventricles

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9
Q

Etiologies of diastolic heart failure

A

-Longstanding HTN
-Valvular heart disease (Aortic stenosis)
-Cardiomyopathies (Restrictive and Hypertrophic)

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10
Q

Symptoms of left-sided heart failure

A

-All related to the lungs
–Dyspnea, orthopnea (how many pillows do you need to sleep)
–Fatigue
–Chronic, nonproductive cough
–Productive cough with pink, frothy sputum
–Rales, rhonchi, wheezing, tachypnea
–Cheyne-Stokes Breathing: deeper, faster breathing with periods of apnea
–Dusky, pale skin. Cool extremities

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11
Q

Explain why left-sided HF is the most common cause of right-sided HF?

A

If the blood is backing up from the left side to the lungs and it keeps backing up, eventually is goes back into the right side of the heart and hypertrophies that side

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12
Q

Symptoms of right-sided heart failure

A

-Peripheral edema, pitting edema, cyanosis
-JVD
-GI and hepatic congestion: anorexia, nausea, vomiting, hepatojugular reflux (increased JVP with liver palpation), hepatosplenomegaly

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13
Q

Explain the four classes of the New York Heart Association functional classes of heart failure

A

Class I: no symptoms, no limitation of physical activity
Class II: mild symptoms, slight limitation of physical activity, no problems with ADL’s
Class III: only comfortable at rest, even normal ADL’s produce marked limitations
Class IV: symptoms even at rest, severe limitation of physical activity

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14
Q

Best INITIAL test for heart failure what is seen on it

A

Chest xray: cardiomegaly, pleural effusion
–Cephalization of fluid: pushing fluid to apices of lungs.
–Kerley B Lines: lymphatic edema at lung periphery
–Butterfly or Batwing Appearance: fluid backing up into perihilar and hilar area

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15
Q

Another test used to diagnose heart failure initially is

A

BNP

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16
Q

What is BNP

A

Hormone secreted by the cardiomyocytes of the heart in response to stretching of the ventricles and fluid overload

17
Q

If BNP > ____, it is suggestive of heart failure

A

> 100

18
Q

Be aware, BNP can also be elevated in a patient with _______. Also, in _____ patients, BNP can be decreased

A

kidney failure

low in obese patients

19
Q

An ECG is important in diagnosing heart failure because…

A

Patients with systolic/reduced EF HF, 98% of them will have an abnormal ECG.
Patients with diastolic HF will often have a normal ECG

20
Q

Best diagnostic overall for heart failure

A

Echo: can determine EF, check ventricular walls, etc.

21
Q

What is the most important determinant of prognosis in a patient with heart failure?

A

Ejection fraction: <35% associated with increased mortality

22
Q

Initial treatment for heart failure

A

-Smoking cessation
-< 2 grams of sodium daily
-< 2 liters of fluid daily
+ Pharm Therapy

23
Q

What are the 4 drug classes that decrease mortality in a heart failure patient?

A

BB
Ace/ARB
Spironolactone
Hydralazine + Nitrate

24
Q

Best medication for systolic heart failure

A

Ace inhibitors (Lisinopril, Captopril, Enalapril, Ramipril, Benazepril)

25
Q

How do ACE inhibitors work to help systolic heart failure?

A

-Decrease ventricular remodeling
-Decrease after load (resistance that heart faces to pump – makes it easier to pump)

26
Q

What medication works better than ACE inhibitors and is a combination drug, ARNI?

A

Entresto

-Decreases ventricular remodeling and also reverses it. (Not sure if this will be asked on there or not)

27
Q

How do Beta Blockers work in heart failure?

A

Blocks the detrimental effects of catecholamine release. Decreases remodeling.
-2nd line for most patients. Most patients will be on an ACE and BB

28
Q

Potassium Sparing Diuretics are an _____ antagonist. Name two drugs in this class

A

Spironolactone and Eplerenone

29
Q

Hydralazine and Nitrate decrease _______

A

afterload (helping the heart pump more easily)

30
Q

Loop diuretics (Furosemide, Torsemide) do not decrease mortality. On the contrary, they are just used for symptom relief. How do these drugs work?

A

Inhibit water transport across Loop of Henle
-Flush out a large volume of sodium and water

31
Q

Positive inotropes, such as ____, _____, and _____ help them pump more effectively. They are used last line, in patients that have tried everything else.

A

Digoxin
Dobutamine
Dopamine

32
Q

Side effects of positive inotropes

A

GI symptoms
Visual symptoms (yellow green color changes)
Bradycardia
Headache
Confusion

33
Q

Treatment for diastolic heart failure

A

-Treat underlying cause (HTN, Afib, etc.)

34
Q

What is acute decompensated heart failure?

A

The patient has heart failure and all of a sudden they just got much worse

35
Q

Symptoms of decompensated heart failure

A

-Fatigue
-Peripheral edema
-Dyspnea
-Very sick, very fluid overloaded

36
Q

Acute decompensated heart failure treatment

A

-LMNOP
–Lasix
–Morphine
–Nitrates (Venodilators) – Nitroglycerin
–Oxygen
–Position: upright, legs dangling over bed. Positive Pressure (ventilation)

PANCE 2.0 (62 decks)

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