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).
What medications should be initiated for secondary prevention of further cardiovascular events in heart failure?
statins and aspirin.
What additional medication combination may be of benefit to African American patients with heart failure?
hydralazine combined with nitrates.
What general medical conditions may lead to heart failure?
- SLE
- hemochromatosis
- sarcoidosis
- cocaine abuse
- alcohol abuse.
What inflammatory disease is a significant cause of heart failure?
- myocarditis
list some causes myocarditis
- coxsackievirus B
- Influenza
- adenovirus
- HIV
- rheumatic fever
- Shaggers disease
- Lyme disease
What lab findings may be abnormal in this patients with myocarditis?
- erythrocyte sedimentation rate elevation
- creatine kinase/troponin elevation.
- T wave inversion, oh ST elevation on the ECG.
What are some common causes of acute exacerbation of heart failure ?
- infection
- anemia
- acute myocardial infarction
- Dietary indiscretions such as high salt or water intake.
How do you manage new onset of acute exacerbation of heart failure recurring hospitalization?
- place patient on telemetry
- give IV diuretics
- monitor fluid balance and electrolytes closely
- administer oxygen
- control comorbidities especially hypertension,
- evaluate precipitating causes of heart failure.
How do you evaluate precipitating causes of heart failure?
- ECG
- echocardiogram
- chest X ray
- blood tests.
What blood test should you order in the setting of acute onset of heart failure?
- complete blood count
- basic metabolic panel
- liver function tests
- cardiac enzymes.
