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Cardiovascular Diseases > CHF > Flashcards

CHF Flashcards

1
Q

What are the 5 types of CHF?

A

HFrEF, HFpEF, LHF, RHF, and global HF

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2
Q

What is HFrEF also known as?
-What’s it’s affect on stroke volume?
- What is the criteria for it?

A

Systolic Heart failure
Reduced stroke volume
LVEF < or = to 35-40%

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3
Q

What is HFpEF also known as?
- What’s it’s effect on stroke volume, end diastolic volume, and EF?
- what’s it’s criteria?

A

Diastolic HF
Reduced SV, normal/reduced diastolic volume, and preserved EF
LVEF > or = to 40-50%

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4
Q

What are the general causes of systolic and diastolic dysfunction?

A

CAD, MI, HTN, diabetes, renal disease, and infiltrative diseases (hemochromatosis and amyloidosis)

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5
Q

What are some specific causes of systolic dysfunction?

A

Dilated Cardiomyopathy, arrhythmias, and myocarditis

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6
Q

What are some specific causes of diastolic dysfunction?

A

Restrictive cardiomyopathy, Hypertrophic Cardiomyopathy, pericardial Tamponade, constrictive pericarditis

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7
Q

How many stages of CHF are there?

A

4 stages

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8
Q

What is stage A CHF?
-Corresponding NYHA class

A

High risk of developing HF, no structural changes or symptoms
- No corresponding class

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9
Q

What is Stage B CHF?
-NYHA class

A

Structural damage to heart, no sign or symptoms
- NYHA 1 class

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10
Q

What is stage C CHF
- NYHA class

A

Structural damage to heart, sign and symptoms of HF
- NYHA 1-4

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11
Q

What is stage D HF?
-NYHA class

A

Terminal stage HF
- NYHA 4 class

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12
Q

How many NYHA classes are there?

A

4

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13
Q

What is class 1 NYHA criteria?

A

No limitations of physical activity, no symptoms of CHF

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14
Q

What is class 2 NYHA criteria?

A

Slight limitations of moderate or prolonged physical activity, comfortable at rest

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15
Q

What is class 3 NYHA criteria?

A

Marked limitations of physical activity, comfortable only at rest

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16
Q

What is class 4 NYHA criteria?

A

Confined to bed, symptoms at rest

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17
Q

What diagnostic tests are done for all patients if suspicion of CHF?

A

Routine Lab studies, cardiac biomarkers, ECG, CXR, and Echo

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18
Q

If CHF is confirmed from diagnostic tests, what should you investigate?

A

Underlying causes and modifiable risk factors

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19
Q

Apart of routine lab studies, a CBC is to screen for?

A

Anemia and infection

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20
Q

Routine lab studies:

What three things are looked at during a BMP?
- what would creatinine determine?
- If creatinine is High, what could this indicate?

A

Creatinine, sodium, and glucose
- What drugs to prescribe
- indicated CKD or cardiorenal syndrome

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21
Q

Routine Lab Studied:

Liver chemistries are looked at for what reasons?

A

To see if there’s any elevations, particularly of the cholestatic enzymes

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22
Q

Routine Lab Studies:

Increased C reactive protein can indicate?

A

Acute infection or inflammation

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23
Q

Routine lab studies:

Fasting Lipid Studies has one common factor found for CHF individuals, what is it?

A

Elevated cholesterol

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24
Q

Routine lab studies:

Lowered TSH is a sign of?

A

Hyperthyroidism

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25
Q

Routine Lab Studies:

What cardiac biomarkers are looked at?

A

Natriuretic peptides and troponin

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26
Q

Which Natriuretic Peptides are primarily used to determine HF?
-what other one can be used?

A

BNP or NT-proBNP
- midregional proatrial natriuretic peptide

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27
Q

BNP levels of HF:
-What levels are unlikely of HF? (In pg/mL)
-Wha levels are like of HF? (In pg/mL)

A

<100 = unlikely
>500 = likely

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28
Q

NT-proBNP levels of HF:
- HF unlikely (in pg/mL)
- HF likely (in pg/mL)

A

<300 = unlikely
>1000 = likely

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29
Q

What are the clinical features of CHF?

A

Nocturia, fatigue, tachycardia or various arrhythmias, S3/S4 gallop, and pulsus alternans

30
Q

What are some clinical features of LHF?

A

Pulmonary congestion: dyspnea, orthopnea, pulmonary edema, paroxysmal nocturnal dyspnea, and cardiac asthma

31
Q

What are some physical examination findings of LHF?

A

Bilateral basilar rales, laterally displaced apical heart beat, coolness and pallor of lower extremities

32
Q

What are some clinical features of RHF?

A

Peripheral pitting edema, abdominal pain and jaundice

33
Q

What are some physical examination findings of RHF?

A

JVD, kussmaul sign, hepatosplenomegaly, hepatojugular reflux

34
Q

What is kussmaul sign?

What is hepatojugular reflux?

A
  1. JVD on inspiration
  2. JVD after pressure applied on the liver
35
Q

What is hepatojugular reflux?

A

JVD after physically applying pressure on the liver

36
Q

What’re some lifestyle modifications used for treatment of CHF?

A

Smoking cessation, alcohol cessation, recreational drug cessation, exercise, and weight loss

37
Q

What are some salt restrictions put in place for those with class A&B CHF?
- C&D?

A

< or = to 1.5g/d in A&B
< or = to 3 g/d in C&D

38
Q

What should be avoided while on aldosterone agonists?

A

Potassium rich foods

39
Q

If your patient has stage D HF and they’re exhibiting signs of edema and hyponatremia, what fluid restriction limit would you put them on?

A

1.5-2 L/d

40
Q

Treatment:

How would you treat these underlying comorbidities in HF?
- HTN
- Dyslipidemia
- Diabetes

A
  • HTN: treat with target BP <130
    -DLM: Start statins to keep lipids in normal range
    -DBT: Screen for hyperglycemia, consider starting SGLT-2 inhibitor (sodium glucose transporter inhibitor)
41
Q

What drugs should be avoided in CHF?

A

Class 1 and 3 anti-arrhythmic drugs, CCB’s (except amlodipine), NSAIDS, thiazolidinediones, inhalation anesthetics

42
Q

What two drugs should not be used in conjunction with each other in CHF?
-what can it cause?

A

Nondihydropyrimidine CCB’s and beta blockers
-Third degree HB

43
Q

Treatment:

What is the initial therapy of stage A HF?
- are meds recommended?

A

Treat underlying disease.
- No.

44
Q

Treatment:

What is initial treatment of class B HF?
-Any avoidances?

A

ACEI’s in all with HFrEF
ARB’s in those who can’t tolerate ACEI’s
B-Blockers once pt is stable on ACEI’s (Avoid in pt with decomp. HF until stable)

45
Q

Treatment:
What ACEI’s would you put the patient on?
-Dose?
-Monitor for?

A

Enalapril: 2.5mg PO x2/d, titrate up to 10-20mg x2/d

Ramipril: 1.25-2.5mg PO 1/d, titrate up to 10mg 1/d

Lisinopril: 2.5-5mg PO 1/d, titrate up to 20-40mg 1/d

Monitor: BP, renal Fx, and potassium

46
Q

Treatment:
What ARBS are recommended?
- Dose?
-Monitor for?

A

Condesartan: 4-8 mg PO 1/d, titrate up to 32mg

Losartan: 25-50mg PO 1/d, titrate up to 150mg

Valsartan: 20-40mg PO 2/d, titrate up to 160mg

Monitor: Same as ACEI’s

47
Q

Treatment:
What are B-Blocker recommendations?
-Dose?
-Monitor for?

A

Bisoprolol: 1.25mg PO 1/d, titrate up to 10mg

Carvedilol: 3.125mg PO 2/d, titrate up to 25mg in pt in pt <85kg, 50mg in >85kg

Metoprolol: 12.5-25mg PO 1/d, titrate up to 200mg

Monitor: Titrate slowly to target dose, consider reducing ACEI if hypotension occurs

48
Q

What is the initial treatment of Stage C HF?

A

Aldosterone agonists, loop/Thiazide diuretics, Isosorbide dinitrate and hydralazine, angiotensin receptor-neprilysin inhibitors (ARNI’s) and SGLT-2 inhibitors

49
Q

Treatment:
What are the recommended aldosterone agonists?
-Doses?
-Monitor for?

A

Spironolactone: 12.5-25mg PO x1/d or x2/d

Eplerenone: 25-50mg PO 1/d

Monitor regularly for hyperkalemia

50
Q

Treatment:
What are the recommended Loop diuretics?
-Doses?

A

Torsemide: 10-200mg PO 1/d

Furosemide: 20-300mg x1 or x2/d

Bumetanide: .5-5mg PO x1 or x2/d

51
Q

Treatment:
What thiazide loop diuretics are recommended?
-Doses?

A

Chlorthalidone: 12.5-100mg PO 1/d

Hydrochlorothiazide: 25-100mg PO x1 or x2/d

Metolazone: 2.5-20mg PO 1/d

52
Q

Treatment:

What should you monitor for in loop diuretics? (thiazides are loop diuretics too)

A

Titrate the dose according to weight and volume status, regularly check electrolytes.

53
Q

Treatment:

What fixed dose of Isosorbide and Hydralazine is recommended?

A

ISDN: 20-40mg
And
Hydralazine: 37.5-75mg

PO 3/d, titrate as needed.

54
Q

Treatment:
What ARNI’s are recommended?
-Dose?
-Initiation?
Monitor for?

A

Sacubitril: 24-97mg
And
Valsartan: 26-103mg

PO 2/d

Initiation: Stop ACEI’s and administer ARNI no earlier than 36hrs from last ACEI dose

Monitor for hypotension, dizziness, cough and hyperkalemia

55
Q

Treatment:
For those in Stage D HF, what two drugs can improve symptoms and reduce hospitalizations?

A

Diuretics and digoxin

56
Q

What is this sound? link

A

S3 gallop

57
Q

What is this sound? link

A

S4 gallop

58
Q

What factors are associated with a worsened prognosis?

A

Elevated BNP, diabetes, anemia, S3 Heart sound, hypotension and hyponatremia

59
Q

What is the physiology of cardiorenal syndrome?

A

Renal function progressively declines as a result of sever cardiac dysfunction

60
Q

How many types are there of cardiorenal syndrome?
-most common type?

A

Five types
-Type 1

61
Q

What is Type 1 Cardiorenal syndrome?
-How does it happen?

A

Acute cardiorenal syndrome
- HF leading to acute kidney injury

62
Q

What is Type 2 CRS?
-How caused?

A

Chronic cardiorenal syndrome
- Chronic HF leading to CKD

63
Q

What is Type 3 CRS?
-Caused by?

A

Acute Renocardiac syndrome
- Acute kidney injury leading to acute HF

64
Q

What is Type 4 CRS?
-Caused by?

A

Chronic renocardiac syndrome
-CKD leading to CHF

65
Q

What is type 5 CRS?
-Caused by?

A

Secondary CRS
-Systemic disease leading to kidney and heart failure

66
Q

Diagnostics of CRS?

A

Decreased GFR, increased creatinine that can’t be explained by underlying kidney disease

67
Q

Treatment of CRS?

A

Heart failure and Renal failure management

68
Q

ACS and/or acute HF causing acute kidney injury is an example of what type CRS?

A

Type 1

69
Q

Chronic HF resulting in a new onset or progression of CKD is an example of what type of CRS?

A

Type 2

70
Q

HF resulting from acute kidney injury due to volume overload is an example of what type of CRS?

A

Type 3

71
Q

LVH resulting from CKD-associated cardiomyopathy is an example of what type CRS?

A

Type 4

72
Q

Cirrhosis and amyloidosis is an example of what type CRS?

A

Type 5 OR secondary CRS

Cardiovascular Diseases (36 decks)

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