Cardiology_Heart Failure Flashcards
What is heart failure?
- The heart’s ability to pump is inadequate and unable to maintain the body’s circulatory needs.
What are the two types of heart failure?
- Systolic Dysfunction and diastolic dysfunction.
Describe Systolic Dysfunction
- dilated left ventricle with impaired ability to contract
Describe diastolic dysfunction
left ventricle appears normal but has impaired ability to relax and fill
what is a normal ejection fraction?
More than 55%
Which has a normal EF, systolic or diastolic HF?
- Diastolic HF
describe the role of antihypertensives in the treatment of heart failure
- decrease afterload so the heart pumps against less resistance.
How does chronic atrial fibrillation affect a patient with heart failure?
- tachycardia and decreased atrial contraction worsens since left ventricular filling, so AF rate control is important.
What agents should be used to achieve AF rate control?
- BB
- CCB
what is BNP?
- Brain natriuretic peptide
- It is released from the heart ventricle myocytes when they are stretched.
What is a normal BNP?
< 100 pg/mL
What is the BNP level seen in heart failure?
- > 500 pg/mL
- 100 - 500 pg/mL is inconclusive
What are some common symptoms of leftsided heart failure?
- Weakness in dyspnea with exertion (sometimes even at rest)
- paroxysmal nocturnal dyspnea
- Orthopnea
- cough
- wheezing
- Pink, frothy sputum.
What are some symptoms of right sided heart failure?
- abdominal pain and bloating
- nausea and vomiting
- Anorexia
- constipation.
What are some physical signs of right sided heart failure?
- peripheral edema
- jugular venous distension
- hepatosplenomegaly
- hepatojugular reflux
- ascites
What are some common CXR findings found in HF patients?
- pleural effusions
- pulmonary edema
- cephalization of pulmonary vessels
- cardiomegaly (cardiothoracic ratio > 50%)
List cardiovascular diseases that lead to HF
- IHD
- HTN
- Valvular disease
- cardiac rhythm disorders
- cardiomyopathies
Describe the mechanisms by which IHD may cause HF
- Chronic ischemia causes sub-optimal myocardial function
- Previous MI leading to LV dysfunction and subsequent remodeling
What therapeutic strategies should be applied to HF patients with IHD?
- medical treatment for angina.
- Direct efforts to modify cardiac risk factors.
- Consideration of surgery( stenting, angioplasty, coronary artery bypass grafting)
List the recommended lifestyle modifications for HF patients.
- dietary salt limitations
- exercise
- weight loss
- alcohol/smoking cessation
what class of medication is used to treat fluid overload in both the acute and chronic settings?
- diuretics (usually loop diuretics e.g. furosemide)
In the setting of heart failure, which antihypertensives have been shown to increase patient survival?
B
- BBs e.g Carvedilol, Metoprolol succinate
- ACE inhibitors
- ARBs
- Spironolactone.
What are some physical findings of left-sided HF?
- bilateral pulmonary crackles(rales)
- S3 gallop
- displaced PMI (point of maximal impulse)
How have BBs and ACE inhibitors specifically been shown to improve survival?
- by reducing heart remodeling and decreasing sympathetic tone ( less stress on the heart).
