CHF Flashcards
What test is most helpful to determine CHF?
Echo
What is BNP an indicator of?
It tells you if the heart is stretched; heart releases it when its in volume overload
What is heart failure?
it is a clinical SYNDROME (from structural or functional cardiac disorder) where ventricular supply is less than demand
Signs and symptoms of CHF are manifested by what 4 things
dyspnea, fatigue, fluid retention, and decreased exercise tolerance
How much of cardiac output is due to atrial kick?
20%
Explain the frank-sterling law in terms of heart failure
As the ventricle stretches, it has more forceful contractions; if the stretch exceeds frank starling limit it would actually negatively impact heart functioning (too much stretch is bad)
What is preload?
pressure in ventricles at the end of diastole
What is afterload?
the resistance the heart must work against to eject blood during systole (related to arterial systolic pressure and vascular resistance)
How do Beta blockers impact your cardiac output?
they decrease your heart rate and initially dec CO but body will compensate by increasing SV & getting CO back to normal
What are the two opposing forces responsible for fluid transfer to interstitium(edema)
hydrostatic capillary pressure and plasma oncotic pressure
What causes shortness of breath during heart failure? How does this happen
pulmonary edema: capacity of lymphatic drainage is exceeded & liquid gathers in the interstitial spaces around bronchioles and lung
Is hypertension a systolic or diastolic dysfunction? Why
diastolic; HTN causes stiffness of the ventricle and reduces filling ability
What are the two main types of heart failure? What is the cutoff of ejection fraction for these two?
HF with preserved ejection fraction
HF with reduced ejection fraction
Less than 40%EF = HFrEF
More than 40% EF = HFpEF (SV is still reduced)
Dilated Cardiomyopathy is is a type of _____ dysfunction. what type of heart failure can this lead to?
systolic
HF with reduced EF
Hypertrophic cardiomyopathy is a type of _____ dysfunction. What type of heart failure can this lead to
diastolic
HF with preserved EF
What is responsible for 2/3 of heart failure cases?
coronary artery disease
What body mechanism is crucial for understanding the pathophysiology of HF?
activation of RAAS (kidneys stimulate it bc they sense decreased perfusion, since perfusion is being directed towards other body parts)-ACE/ARBs to block effects
what does Left ventricle hypertrophy lead to in terms of CHF
leads to MV regurg which increases volume overload = CHF
What is the first sign of HF on the physical exam?
JVD (shows up even before edema)
CHF is a _______ diagnosis
clinical
What is a sign of HF that sometimes shows up on a CXR?
Cardiomegaly (cardiothoracic ratio greater than 50%)
What is Stage A of HF and how do you treat it
at risk without symptoms or abnormalities
Tx: control risk factors (HTN, CAD, Smoking, ETOH)
What is goal of Tx for stages B, C, and D of HF? What 3 main classes of drugs do you use?
decrease fluid overload and congestive symptoms
loop diuretics
ACEIs to minimize angiotensin II (ARBs for pt who cant take ACEI)
BBs
Why are BBs so important for HF treatment?
improve systolic function by increase diastolic filling & improves contractility
**shown to dec morbidity, hospitalizations, sudden death & reverses heart remodeling (3-4 months)
What are four contraindications of using BB for HF?
diabetes asthma, bradydysrhythmias, heart block
What three BBs have been shown effective for CHF?
Coreg (carvedilol), metoprolol succinate/Toprol XL, and Bisoprolol/Zebeta
What type of dose should a BB for CHF be started at?
low dose and gradually increased
What drug is now considered a last ditch effort for CHF?
Digoxin (so many toxicities)
What is the benefit and risk for using mineralocorticoid receptor antagonist/aldosterone antagonist for CHF tx? What type of HF is it usually used for?
(Potassium sparing diuretics)
it has an additive benefit for reducing mortality
risk for hyperkalemia
HF with preserved EF
What type of drug do you give after an MI to prevent HF?
statin
What other type of drug do you add to pharmacological tx for African American pts?
Nitroglycerin
What type of therapy are you considering for a pt in Class D HF?
Cardiac replacement and devices
