CHF class Flashcards by J Pint

2 basic mechanisms of heart failure

systolic and diastolic dysfunction

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RAAS Neuronal changes cause salt and water retention short term and long term effect

short: preload increase
long: pulmonary congestion, anasarca

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RAAS Neuronal changes cause:

Vasoconstriction short term and long term effect

short: maintains bp for perfusion

pump dysfuntion due to increased afterload

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Ejection fraction greater than 40% may be seen in

diastolic failure

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Patient with alcholism may be at risk for which sided heart failure

both sides

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Cardiomyopathy is defined as

disease of heart muscle, with mechanical or electrical dysfunction, with ventricular changes; frequently genetic

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Dilated Cardiomyopathy

most common, idiopathic, dilation and impaired contraction of ventricles leading to hypertrophy, can be reversed

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SAM

SYSTOLIC ANTERIOR MOTION anterior mitral valve

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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

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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

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Amyloidosis occurs from: treatment includes

extracellular deposits of fibrils composed of proteins

Treat HF and underlying cause (TTR treatable)

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Amyloidosis treatment includes

treating hf and underlying disease

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heterogeneous disorders, patchy scar formation around infiltrating, noncaseating granulomas

Sarcoidosis

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Common presentation of Cardiac sarcoid

AV block

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Stress induced CMP also know as broken heart syndrome

Takotsubo

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Hallmark of aortic stenosis

chest pain, shortnes of breath, syncope

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Aortic stenosis murmur heard during which phase of filling

systolic

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Women in 40 comes with chest pain sob and syncope you suspect aortic stenossi what cause do you suspect

rheumatic

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Man in 70 comes in aortic stenosis suspect cause

Bicuspid valve

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Man in 80 come is aortic stenosis suspect cause

calcific /degenerativ

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Most common cause of Mitral regurgitation

degenerative

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Mitral regurgitation pathophysiology

Volume overload increases LVEDP;
compensatory dilatation of LA&amp;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

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New york Heart Association functional Class 1

no limits

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New york Heart Association functional Class 2

slight limitation, no symptoms at rest

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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

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

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