Cardiology: Congestive Heart Failure Flashcards
Define congestive heart failure
clinical condition caused by ability of the heart to pump enough blood to maintain fluid and metabolic homeostasis
Name 5 risk factors for CHF?
CAD HTN cardiomyopathy valvular heart disease DM
how is CHF classified? 4
American Heart Association/American College of Cardiology-based on clinical syndromes
New York Heart Association (NYHA)-functional severity
left sided vs right-sided failure
systolic vs nonsystolic failure
how is systolic dysfunction defined? 2
EF< 50%
Increased left ventricular end diastolic volume
how is systolic dysfunction caused?
inadequate left ventricular contractility or increased afterload
how does the heart compensate for decreased EF and increased preload? what law is this? what happens when compensation fails? 2
hypertrophy
ventricular dilation
Frank-Starling Law
compensation fails causing increased myocardial work and worsening systolic function
A man was admitted for a CHF exacerbation with low EF. The patient is now ready for discharge, and his medications include furosemide, and metoprolol. What is the nxt step in management?
Add and ACEI to this pts current regimen ACEI have been shown to have a + mortality benefit when used with beta-blockers in NYHA class II-IV heat failure patients
Name some signs and symptoms of systolic heart failure?
mc=extertional dyspnea
progresses to orthopnea, paroxysmal nocturnal dyspnea (PND), and rest dyspnea
chronic cough, fatigue, peripheral edema, nocturia, and/or abdominal fullness
name 5 findings on PE for systolic heart failure?
parasternal lift an elevated and sustained left ventricular impulse S3/S4 gallop JVD peripheral edema
what will a CXR show in systolic heart failure?
cardiomegaly, cephalization of pulmonary vessels, pleural effusions, vascular congestion, interstitial edema, and prominent hila. figure 2.1-7
what will ECHO show in systolic heart failure?
will show EF and ventricular dilation
what lab abnormalities will show in systolic heart failure?
BNP>500pg/mL
increased creatinine (sometimes)
decreased Na in later stages
what will ECG show in systolic heart failure?
usually non diagnostic
can help show underlying causes-AF, and old MI, or LVH
What two CHF medications provide symptomatic relief for systolic HF and confer no mortality benefit?
diuretics and digoxin
What is treatment for acute pulmonary congestions in pt with systolic HF management? use LMNOP mnemonic
Lasix Morphine Nitrates Oxygen Position (upright)
What underlying causes can be corrected in treating systolic HF?
arrhythmias
MI
drugs (CCBs, antiarrhythmics, NSAIDs, alcohol, thyroid and valvular disease, high-output states)
what drugs do you give to aggressively diuresis someone with acute systolic HF?
loop and thiazide diuretics
what should be given to treat all patients with acute systolic HF? What do you give if they can’t tolerate it? what should be avoided?
ACEIs
ARBs
Beta-blockers should be avoided if pt is decompensated but can be started once euvolemic
Describe NYHA functional classification of CHF?
Class I- no limitation of activity, no symptoms with normal activity
Class II- slights limitation of activity, comfortable at rest or with mild exertion
Class III- marked limitation of activity, comfortable only at rest
Class IV- any physical activity brings on discomfort, symptoms present at rest
left sided, right sided, or both?
- dyspnea predominates
- fluid retention predominates
- S3/S4 gallop
- bilateral basilar rales
- JVD
- hepatojugular reflex
- pleural effusions
- pulmonary edema
- hepatomegaly,ascites
- orthopnea, paroxysmal nocturnal dyspnea
- dyspnea predominates=left
- fluid retention predominates=right
- S3/S4 gallop=both
- bilateral basilar rales=left
- JVD=right
- hepatojugular reflex=right
- pleural effusions=left
- pulmonary edema=left
- hepatomegaly,ascites=right
- orthopnea, paroxysmal nocturnal dyspnea=left
What lifestyles changes are used to treat chronic systolic HF?
limit salt intake
limite fluid intake
treat co-morbid conditions
what medications are used to prevent remodeling of the heat and decrease mortality for NYHA class II-IV pts? 2 what should be avoided?
long term beta blockers
ACEIs/ARBs
avoid CCBs
what 2 medications are recommended for chronic systolic HF if underlying cause is prior MI?
daily ASA
statin
what medication combination can prevent fluid overload in pt with chronic systolic HF?
loop diuretics +/- thiazide
