CHF class Flashcards
2 basic mechanisms of heart failure
systolic and diastolic dysfunction
RAAS Neuronal changes cause salt and water retention short term and long term effect
short: preload increase
long: pulmonary congestion, anasarca
RAAS Neuronal changes cause:
Vasoconstriction short term and long term effect
short: maintains bp for perfusion
pump dysfuntion due to increased afterload
Ejection fraction greater than 40% may be seen in
diastolic failure
Patient with alcholism may be at risk for which sided heart failure
both sides
Cardiomyopathy is defined as
disease of heart muscle, with mechanical or electrical dysfunction, with ventricular changes; frequently genetic
Dilated Cardiomyopathy
most common, idiopathic, dilation and impaired contraction of ventricles leading to hypertrophy, can be reversed
SAM
SYSTOLIC ANTERIOR MOTION anterior mitral valve
Hypertrophic Cardiomyopathy usually due to, treated with what calcium channel blockers, confirmed by; common cause of what USA death
LV Hypertrophy
verapamil and diltiazem (negative inotropic)
Confirmed by ECHO (wall >15cm thick)
Sudden cardiac death in young athletes
Restrictive Cardiomyopathy characteristics, how diagnosed, causes
biatrial enlargement, without ventricle changes, ventricle not being filled, diagnose with echo,
causes: infiltrative( amyloidosis, sarcoidosis, hemochromatosis); noninfiltrative: diabetes, idiopathic; Storage: Fabrays; Other
Amyloidosis occurs from: treatment includes
extracellular deposits of fibrils composed of proteins
Treat HF and underlying cause (TTR treatable)
Amyloidosis treatment includes
treating hf and underlying disease
heterogeneous disorders, patchy scar formation around infiltrating, noncaseating granulomas
Sarcoidosis
Common presentation of Cardiac sarcoid
AV block
Stress induced CMP also know as broken heart syndrome
Takotsubo
Hallmark of aortic stenosis
chest pain, shortnes of breath, syncope
Aortic stenosis murmur heard during which phase of filling
systolic
Women in 40 comes with chest pain sob and syncope you suspect aortic stenossi what cause do you suspect
rheumatic
Man in 70 comes in aortic stenosis suspect cause
Bicuspid valve
Man in 80 come is aortic stenosis suspect cause
calcific /degenerativ
Most common cause of Mitral regurgitation
degenerative
Mitral regurgitation pathophysiology
Volume overload increases LVEDP; compensatory dilatation of LA&LV to lower pressures; increased Preload, LVH, and reduced Afterload (low resistance of LA provides unloading of LV) causing large total SV; MR Begets MR; leading to contractile dysfunction with decrease in EF, increase in LVEDP
New york Heart Association functional Class 1
no limits
New york Heart Association functional Class 2
slight limitation, no symptoms at rest
New york Heart Association functional Class 3
symptoms develop with less than ordinary activity no symptoms at rest
New york Heart Association functional Class 4
symptoms occur at rest
Dilation hypertrophy would be characteristic of which HF (acute or chronic
chronic
Diagnostic evaluation of CHF
BNP/ANP
CBC, Chem 7, albumin, HepC, Lft, (liver congetions) , TSH, Troponin, CXR, ECG, ECHO
what is BNP/ANP in HF
BNP/ANP greater than 400pg/ml in patient with dyspnea due to HF
Cardiorenal syndrome labsd
gfr,
congested kidney use what med
lasix to decongest
When should echocardiogram be done, what is assessed
baseline, and 3months, assesses LV function, wall thickness, wall motion, valve dz, pericadial effusion
Cardiac MRI is superior over
echo
left heart cath gold statnder fro
cad
what should be monitored iwth LHC
Kidneys
Swan-ganz catheter gives pressure of
left ventricle
Swan-ganz catheter gives pressure of
left ventricle
Acute cardio treatment problem
decreased intestinal perfusion and mucosal edema
may markedly slow the rate of drug absorption and therefore the
rate of delivery of drug to the kidney.
GDMT
Guideline directed therpay
3 things to look at on heart failure
weight, bloodpressure, heartrate
Mainstay medical therapy for volume management in hf
diuretics loopdiurects
Mainstay medical therapy for volume management in hf
diuretics loopdiurects
mainstay for HF
ACE ARB
Check what after initiation of ACEI
chem 7 (especially K+)
Patient with GFR less than 30 ARNI dose should be
24/26
ARNI starting dose normal
49/51 then change to 97/103
Beta blockers increase, most common used med
heart filling time, left side decrease heart rate, Metoprolol
Betablocker for patient with low heart rate
carvidolol
amiodarone can affect what should be done
thyroid, treat the high thyroids, get thyroids levels check
aldosterone should be started after starting what 2 drugs
ACEI and BB
aldosterone should be started after starting what 2 drugs
ACEI and BB
if patient dosent need to be on blood thinner use
ablation
Aortic stenosis valve replace if severe
have to be on coumadin
j
you chronic drug use need valve
get mechanical
pregnancy warfarin contraindicated put on
heparin
Primary Mitral regurgitation is treated with
surgery valve replacement
IABP commonly use for how long
short term
ICD recommended for people with ef less than
35%
predictors of poor outcomes
• severe LV
dilatation and MR.
LVAD improvent and survival
80% patients with NYHA Class III-IV
improved to Class I-II, 68% survival at 2 years
Transplant contraindications
Systemic illness with a life expectancy < 2 years despite heart transplantation.
• Irreversible pulmonary HTN (may consider heart-lung transplant – there is some variation on criteria at different centers).
• Active substance abuse, Noncompliance to medical therapy.
• Multisystem disease with severe extracardiac organ dysfunction (example amyloidosis).
• Clinically severe symptomatic cerebrovascular disease
Possible considerations
Age > 70 years of age • Obesity (BMI > 35) • Diabetes with poor glycemic control, irreversible renal dysfunction (GFR < 30), neoplasm, certain infections HCV with mild disease) • Inadequate social support
Possible considerations
Age > 70 years of age • Obesity (BMI > 35) • Diabetes with poor glycemic control, irreversible renal dysfunction (GFR < 30), neoplasm, certain infections HCV with mild disease) • Inadequate social support
Who should be involve with crhonic heart failure
palliative care
Teach patients 2
2g sodium, 2L fluid, weight gain 2 lbs take extra lasix
Normal Ejection fraction is
55-60%
what mechanisms does the heart use to compensate for failure
frank-starling, neurohormonal (augmented MAP) and ventricular remodeling
increase in preload causing increase in stretch leading to increase CO of the heart is a description of what mechanism
Frank-Starling Mechanism
what is an example of the neurohormonal model of HF
reaction of Renin-angiotensin aldosterone system (RAAS) and sympathetic nervous system
RAAS Neurohormonal changes cause sympathetic stimulation what are the short and long term effect
short: increases HR and contractility
Long: increase energy expenditure
patient with hyperthyroidism may be at risk for what type heart failure
high output
Patient with sepsis may have what type heart failury
high out put
patient with anemia may have what type heart failure
high output
systolic hf defined by EF of
less than 40%
diastolic hf defined by EF of
greater than 40%
patient with pulmonary disease should be cautioned for what HF
right sided heart failure
