Chapter 31: Chronic Heart Failure Flashcards
How does HF occur
when the heart is not able to supply sufficient oxygen-rich blood to the body, because of impaired ability of the ventricle to either fill or eject blood
Symptoms of HF are usually related to _____, which commonly presents as ___ and ___
fluid overload
SOB & edema
What is performed when HF is suspected
An ECHO
An ECHO provides an estimate of
LVEF, which is a measurement of how much blood is pumped out of the left ventricle (the main pumping chamber of the heart) with each contraction
An EF < 40% indicates ___ dysfunction, or HFrEF
systolic
Which ACC/AHA stage is described:
At high risk for development of HF, but without structural heart disease or symptoms of HF (e.g. HTN, CAD, DM, obesity, metabolic syndrome)
Stage A
Which ACC/AHA stage is described:
Structural heart disease present, but without signs or symptoms of HF (e.g. LVH, low EF, valvular disease, previous MI)
Stage B
Which ACC/AHA stage is described:
Structural heart disease with prior or current symptoms of HF (e.g. known structural heart disease, SOB and fatigue, reduced exercise tolerance)
Stage C
Which ACC/AHA stage is described:
Advanced structural heart disease with symptoms of HF at rest despite maximal medical treatment (refractory HF requiring specialized intervention)
Stage D
Which NYHA Functional Class is described:
No limitations of physical activity. Ordinary physical activity does not cause symptoms of HF (e.g. fatigue, palpitations, dyspnea)
NYHA Class I
Which NYHA Functional Class is described:
Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity (e.g. walking up a flight of stairs) results in symptoms of HF
NYHA Class II
Which NYHA Functional Class is described:
Marked limitation of physical activity. Comfortable at rest but minimal exertion (e.g. bathing, dressing) causes symptoms of HF
NYHA Class III
Which NYHA Functional Class is described:
Unable to carry any physical activity without symptoms of HF, or symptoms of HF at rest (e.g. SOB while sitting in a chair)
NYHA Class IV
Which labs are increased in HF
Increased BNP, Increased NT-proBNP
What are left-sided signs and symptoms of HF
- Orthopnea: SOB when lying flat
- Paroxysmal nocturnal dyspnea (PND): nocturnal cough and SOB
- Bibasilar rales: cracking lung sounds heard on lung exam
- S3 gallop: abnormal heart sound
- Hypoperfusion (renal impairment, cool extremities)
General signs and symptoms of HF
- Dyspnea (SOB at rest or upon exertion)
- Cough
- Fatigue, weakness
- Reduced exercise capacity
What are right-sided signs and symptoms of HF
(think of congestion)
- Peripheral edema
- Ascites: abdominal fluid accumulation
- Jugular venous distention (JVD): neck vein distension
- Hepatojugular reflux (HJR): neck vein distension from pressure placed on the abdomen
- Hepatomegaly: enlarged liver d/t fluid congestion
What is cardiac output
volume of blood that is pumped by the heart in 1 minute
How is cardiac output calculated
CO = HR x SV
HFrEF is a low cardiac output state, which the body compensates for by activating neurohormonal pathways to _____ or the _____. This can temporarily increase CO, but chronically leads to myocyte damage and _____
increase blood volume
force or speed of contractions
cardiac remodeling
The main pathways activated in HF are the ___, the ___ and ___
RAAS
SNS
vasopressin
Ang II causes
vasoconstriction
Aldosterone causes
Na and water retention
Vasopressin causes
Vasoconstriction and water retention
