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Clin Med - Cardio Exam #2 > CHF > Flashcards

CHF Flashcards

1
Q

What is the definition of Congestive Heart Failure?

A

Cardiac pumping capacity that is inadequate to meet the body metabolic needs.

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2
Q

What are some stats as to who gets Congestive Heart Failure?

A

It affects about 10% of men and 8% of women over 60y/o
The number of incidence is on the rise esp. over 65 y/o
5 year mortality after diagnosis is 50 percent

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3
Q

What are the 2 most common causes of Congestive Heart Failure?

A

CAD and HTN

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4
Q

Outside of the most common causes what are some other etiologies of Congestive Heart Failure?

A

Cardiomyopathies, valvular disease, cardiotoxins, arrhythmias and renal disease

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5
Q

Why may NSAIDS or thiazolidinedions cause Congestive Heart Failure?

A

They promote salt detention

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6
Q

Why may CCBs cause Congestive Heart Failure?

A

Due to their negative tropic effects on the heart. caused by the fact that they impede the transmembrane cellular calcium transport and activation of RAAS and Sympathetic NS

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7
Q

What happens to a person who has left sided Congestive Heart Failure?

A

It’s systolic left sided heart failure (left ventricle remodeling secondary d/t MI, HTN or obstruction outflow process

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8
Q

What might you find in the physical exam of a patient with left sided Congestive Heart Failure?

A

1) Fatigue
2) Crackles and Rales
3) DOE
4) Orthopnea and Paroxysmal nocturnal dyspnea
5) Cheyne-stokes respirations
6) Diminished pulses, JVD, cyanosis, S3 gallop, murmurs and tachy

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9
Q

What happens to a person who has right sided Congestive Heart Failure?

A

There is a disruption in distal felling or contractility of RV secondary to MI.

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10
Q

What might you find in the physical exam of a patient with right sided Congestive Heart Failure?

A

1) Peripheral pitting edema
2) GI tract congestion (decreased appetite, ascites, hepatomegaly
3) JVD (more than left), RV hypertrophy

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11
Q

What kind of work up would you want to do for someone with Congestive Heart Failure?

A

Labs - CBC, CMP, Lipid panel, TSH, and B-natriuretic peptide (BNP) (BNP most specific d/t its response to strain
EKG - for hypertrophy/arrhythmia/tachy
ECHO - Essential for treatment diagnosis and management)

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12
Q

What are the BNP readings that would indicate if you may/may not have Acutely Decompensated Heart Failure (ADHF)

A

BNP less than 100 - ADHF unlikely
BNP btwn 100-500 - Baseline for LV dysfunction (ask if patient has cor pulmonale or acute pulmonary embolism( if yes, ADHF possible, if no ADHF likely
BNP more than 500 - ADHF likely

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13
Q

What would be some findings on a Chest X-ray for someone with Congestive Heart Failure?

A

1) Alveolar edema (bat’s wing)
2) Kerley B lines (interstitial edema)
3) Darker ouside parts, whiter inside parts
4) Pleural effusion
5) Cardiomegaly
6) Prominent upper lobe vessels

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14
Q

What are the 4 ACC/AHA stages of Congestive Heart Failure?

A

Stage 1 - High risk for CHF with no structural disorders of heart
Stage 2 - Structural disorders of heart, no CHF symptoms
Stage 3 - Past or current CHF symptoms that are associated with underlying heart disease
Stage 4 - End stage disease, requires special treatment strategies.

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15
Q

What are the NYHA stages of Congestive Heart Failure?

A

Stage 1 - No limitation on physical activity
Stage 2 - Minor limitations, comfortable at rest
Stage 3 - Marked limitations, comfortable at rest
Stage 3a - (no dyspnea at rest)
Stage 3b - (recent dyspnea at rest)
Stage 4 - Inability to carry on any physical activity w/o discomfort. Symptoms present even at rest

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16
Q

What would be the first thing you want to do to treat a patient with Congestive Heart Failure?

A

First treat the reversible causes (HTN, DM, CAD, arrhythmias and structural problems

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17
Q

What is the most effective agent for chronic symptom relief for a person with Congestive Heart Failure?

A

Diuretics

18
Q

What are 3 diuretics that you may want to use for a patient with Congestive Heart Failure? What would you used them for?

A

Thiazide - for mild HF (HCTZ and chlorthiadole)
Loop - used for more moderate to severe HF (furosemide, bumetanide, torsemide_
Potassium sparing

19
Q

Outside of diuretics what are other drugs that you may want to use to treat a patient with Congestive Heart Failure?

A

1) ACE -
2) ARB -
3) Beta Blocker
4) Digitalis
5) Vasodilators

20
Q

What are some side effects of ACEs.

A

cough, Hypotention (esp. after 1st dose), renal dysfunction, hyper-K+, dizziness

21
Q

What are some side effects of ARBs

A

N/V/D and myalgias

22
Q

When do you used Beta Blockers?

A

If the patient’s symptoms are stable

23
Q

What do Beta Blockers do?

A

Counteract elevations of catecholamines and symp NS

24
Q

What are some side effects of Beta Blockers?

A

Hypotension, bradycardia, fluid retention

25
Q

When would you use Digitalis

A

Recommended for patients with A-fib or failure to improve on other meds.

26
Q

What are some warnings of Digitalis?

A

It produces HF exacerbations but also has increased mortality d/t arrhythmias and MI. Also can be toxic, especially for those with kidney problems.

27
Q

When would you use vasodilators?

A

Generally reserved for those who have an inability to tolerate other meds or a failure to control systems. They improve SOB but have no improvement over limiting advanced HF

28
Q

What are nitrates (NTG) used?

A

Most useful in acute exacerbations

29
Q

What are side effects of Nitroglyerine

A

Hypotension H/A, long term tolerance, tachy

30
Q

When may you use Anticoagulation or amiodarone?

A

If A-fib is present

31
Q

When would you use a Difibrillator (ICD) for a patient with Chronic Heart Failure?

A

Heart failure with cardiomyopathy and an EF under 35%

32
Q

When would you use Biventricular Pacing for a patient with Chronic Heart Failure?

A

Heart failure with an EF under 35% and LBBB

33
Q

T/F Na+ restriction is important for a patient with Chronic Heart Failure?

A

True

34
Q

T/F Exercise should not be done by a person with Chronic Heart Failure?

A

False, no benefit or harm. It improves lifestyle

35
Q

What are some causes of Acute Decompensated Failure?

A

Acute MI, arrhythmia, infection, medicine/diet noncompliance, sepsis, DIC, or transfusion reactions.

36
Q

What would you find upon a physical exam of someone with Acute Decompensated Failure?

A

Hypoxia, anxiety and distress, diaphoresis, cyanosis, frothy cough, edema and rales (from bases to apices)

37
Q

What would you find in labs for someone with Acute Decompensated Failure?

A

Elevated BNP, troponins and creatine

38
Q

What would you find on an EKG for someone with Acute Decompensated Failure?

A

Acute MI, arrhythmia, low voltage (pericardial effusion)

39
Q

What would you find on a CXR for someone with Acute Decompensated Failure?

A

Increased interstitial markings, butterfly pattern, cardiomegaly

40
Q

What would you find on a bedside ultrasound for someone with Acute Decompensated Failure?

A

Possible b-lines and wall motion abnormalities

Clin Med - Cardio Exam #2 (12 decks)

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