CHF Flashcards
Pump failure that fails to meet the metabolic demands of the body. May be structural or functional cardiac disorder
HF definition - usually hypovolemic
Contractile state, preload, afterload, HR govern
CO
LV EF is low and there is eccentric remodeling
Systolic HF
HFrEF
LV systolic function is preserved. High filling pressure. Concentric remodeling.
HFpEF
ventricular stiffness
Causes of HFrEF
1) Cardiac Ischemia
2) Severe HTN
AS, valvular regurg
Causes of HFpEF
HCM, RCM, Tamponade, constrictive pericaditis,
LVEF levels are
50-70% normal
Borderline = 40-50%
Low< 40%
LV failure causes
Arrhythmias (A-fib), valvular disease, CM, high output states (anemia, Hyperthyroidism)
RV failure causes
PE, OSA, Infective endocarditis, Pulm HTN
Biventricular Failure
LV failure, CM, Arrhythmias, Anemia, Paget, Beri Beri
Acute HF causes
Myocardial infarct, ventricular septum wall rupture, PE, Tamponade.
ACC/AHA stages
A: high risk HF w/o structual HF or sxs (HTN)
B: Structural Heart disease w/o Sxs (LV dysfunc)
C: Structural heart disease w/ HF sxs
D: Refractory HF
NYHA classes
I) Asympt
II) sxs with moderate exertion
III) Sxs w/ min exertion
IV) sxs at rest
LV failure SXS
Dysnpea, fatigue, weight gain, JVP, PND
RV failure SXS
Edema, JVD, S3 gallop, Hepatomegaly, Ascites, Anasarca
what labs do you order to diag HF?
CBC (anemia)
CMP (HypoK - arryhthmia, HyperK - RAAS, Hyponatremia - RAAS, BUN, Creatinine)
ABG: hypoxia and respiratoru alki in early HF
- low low 02 and metabolic acid in late HF
How do you measure BNP
<100 - exclude HF
100-400 - borderline
>400 Consistent with HF
What diagnositic imaging test do you order for HF?
EKG: ACS, dysrrythmias, low-voltage, cardiomegaly, kerley B (pulm edema), bat wings (alveolar edema)
Echo: etiology of HF (AS, Hypertrophy, tamponade, and EF)
How do you rule out CAD and valvular disease, and measure the pressure directly?
Cardiac catheterization
What are the overall tx goals of HF?
improve quality of life, cardiac function, prevent death and hospitalization.
Stage A HF treatment?
treat the underlying cause (anemia, infection, thyrotoxicosis)
what are some non-pharm tx of HF
Lifestyle changes, reduce carbs (or increase if cardiac cachexia), restrict salt, use support stockings.
What is the initial drug tx inHF
Diuretics and ACE
What medication do you avoid in HF
Beta blockers and CCM
What meds decreases preload, sxs relief, but you need to monitor hypo/hyperkalemia?
Diuretics (thiazides, loops)
How does furosimide tx HF
venodilation, diaresis, decrease preload.
What drug do you give a HF patient if they are in NYHA class 3 or 4 and LVEF<35% OR LVEF < 40% with AMI
Potassium sparing or Spironolactone
How does spironolactone help pts with HF
prevents cardiac remodeling, fibrosis, and Na retention
What med reduces both preload and afterload & used if HFrEF < 40%
ACE/ARB
What med do you only give if the patient has stable HF caused by LV dysfunction
Beta blockers
What are some precautions with beta blockers
hypoglycemia, astham, airway problems, bradycardia, hypotension
What med has not improved survival from HF but provides SXS relief?
Digoxin, only used if patient has sxs after taking and ACE/ARB, and Beta-blocker
When can you give hydralazine?
reduce PVR (afterload) especially in black patients
What is the stnd recommended therapy in black patients
Beta blockers, ACE/ARB, hydralazine if pt is in NYHA 2,3,4
What drug venodilates and reduces preload in patients with HF and ischemic heart disease?
Nitrates
what drug dilates both arteries and veins, and increase CO by reducing ventricular filling pressure
Nitropress
compare ICD and Pacemaker
ICD: monitor HR and give a shock to correct arryhthmia. if Pt is in NYHA class 2/3 and has EF<35% OR MI and EF <30% Pacemaker: NYHA class 3/4 and EF <35%
When do you urgently hospitalize a patient with HF
Congestion, hypoperfussion, dyspnea not responding to diuretics, Anasarca, hepatic distension, ascites. new A-fib
Immediatly hospitaliza a patient if they are…
No Hx of hypoxia w/ 02 sat < 90%. BP< 75, Pulm edema or respiratory distress, confusion due to hypoperfusion.
