CHF Flashcards
Complex clinical syndrome that results from either structural or functional impairment of ventricular filling or ejection of blood
Congestive heart failure
Cardinal clinical symptoms
Dysnea
fatigue
Signs of heart failure
Edema
Rales
EF <40%
Systolic failure
Heart failure with reduced ejection fraction
HF >50%
Diastolic failure
Heart failure with preserved ejection fraction
Depressed ejection fraction >40-50%
CAD- MI Chronic pressure overload-HPN Chronic volume overload Chronic lung disease Chagas disease
Preserved Ejection <40%
Hypertrophic cardiomyopathies HPN Aging Restrictive cardiomyopathy- sarcoidosis, amyloidosis Hemochromatosis Fibrosis
High output states
Thyrotoxicosis
Beriberi
Systemic arteriovenous shunting
Chronic anemia
Decreased ventricular contraction, CAD, dilated cardiomyopathy, Low EF
Systolic dysfunction
Noncompliant ventricle, Concentric LVH
Diastolic dysfunction
Most common cause of myocarditis?
Coxsackie B virus
Post MI pericarditis
Dressler’s syndrome
Most common cause of restrictive cardiomyopathy?
Amyloidosis
2D Echo finding of amyloidosis
Sparkling granular appearance
No limitation of physical activity
Ordinary activity does not cause fatigue
NYHA CLASS I
Slight limitation of physical activity
Ordinary activity results in fatigue
NYHA CLASS II
Marked limitation
Less than ordinary activity causes fatigue
NYHA CLASS III
Inability to carry out physical activity
Symptomatic at rest
NYHA CLASS IV
HF with Preserved Ejection Fraction
Control congestion Improve exercise tolerance Stabilize HR and BP - CANDESARTAN (CHARM trial) -DIGOXIN and NEBIVOLOL trial: ineffective
Cornerstone therapy for HFREF
RAAS blockers
Beta blockers
Beneficial to HF are limited to these 3 Beta-blockers
Carvedilol
Bisoprolol
Metoprolol succinate
For HFREF, initial strategy
ACEI + BB
If ACEI intolerant
ARB + BB
If symptomatic NYHA II-IV?
ARB + BB + ALDOSTERONE ANTAGONIST ( SPIRONOLACTONE AND EPLERENONE)
4 drug therapy should be avoided
True
For HFREF
Hydralazine + Nitrates Ivabradine Valsartan + sacubitril Diuretics Aspirin
Control heart rate, acts on funny channels
Ivabradine (Coralan)
Hyperpolarization activated cyclic nucleotide gated channel blockers
Lower heart rate without affecting contractility
Ivabradine
Endopeptidase inhibitor
Sacubitril
Angiotensin receptor neprilysin inhibitor (ARNI)
Sacubitril
