CHF/ Shock Flashcards
what are the different classifications of HF
acute vs chronic
systolic vs diastolic
right vs left side
forward failure vs backward failure
what are causes of CHF
Uncontrolled HTN
CAD/IHD
VHD
Cardiac arrhythmias
Increased demand in setting of increased metabolism
decreased O2 in blood
cardiomyopathy
pericardial disease (pericarditis, tamponade)
CHD (congenital heart disease)
what is the hemodynamic model/cardiocirculatory model of HF
emphasizes effect of altered load on failing ventricle (treatment focused on vasodilators and inotropic agents)
what is the neurohumoral model of HF
activation of RAAS axis (cardiorenal model -function of salt and water retention)
SNS activation
cardiac hormones
what is ventricular remodeling model of HF
mechanical, neurohormonal, or genetic alteration in ventricle size, shape, function
hypertrophy, loss of myocytes, increased interstitial fibrosis
what is biventricular heart failure
both sides of the heart are affected
symptoms are the same as left sided plus right sided heart failure
what increases risk for HF
CAD
DM
HTN
obesity
VHD
really and other heart/vascular condition
tobacco use
poor diet
lack of exercise
excessive alcohol intake
what are the clinical features of left sided forward heart failure
decreased CO from LV
less O2 rich blood getting to the tissues: fatigue, weakness, dizziness, AMS, signs of hypoxia, cyaosis, oliguria
what are clinical features of left sided backward heart failure
blood backing up into the lungs (pulmonary congestion)
fluid leaking into alveoli, less air exchange, pulmonary edema
cough, crackles, coughing up foamy pink sputum “frothy”
orthopnea
paroxysmal nocturnal dyspnea (PND)
mild to moderate JVD
what is HFrEF
heart failure with REDUCED ejection fraction - systolic failure
weakened LV cannot squeeze as much blood out
what is HFpEF
heart failure with PRESERVED ejection fraction - diastolic failure
stiff LV cannot relax to accommodate blood
what are the clinical features of right sided forward heart failure
less blood being pumped into the lungs for gas exchange, therefore less oxygenated blood to dispense to body
fatigue, weakness
what are the clinical features of right sided backward heart failure
blood is backing up into veins, increasing venous pressure in vena cava and cascading in a retrograde fashion all the way to capillaries, pushing fluid out of veins into organs/tissue
manifests as dependent edema (pitting edema) in legs, abdomen, genitals, sacrum, GI tract, liver
weight gain associated with fluid retention
severe JVD
notcuria
hepatomegaly and splenomegaly
what is framingham criteria
used for diagnosis of CHF
need 2 major OR one major 2 minor
what are the major framingham criteria
SAW PANIC
S3 heart sound (gallop)
Acute pulmonary edema
Weight loss
Paroxysmal noctural dyspnea
Abdominojugular reflux (hepatojugual reflux)
Neck vein distention (JVP)
Increased cardiac shadow on XR
Crackles heard in lung
what are the minor framingham criteria
HEART VINO
Hepatomegaly
Effusion, pleural
Ankle edema, bilat
exeRtional dyspnea
Tachycardia
VItal capacity decreased by 1/3
Nocturnal cough
what are suggestive findings of Right heart failure
lower limb edema
sacral edema
hepatomegaly
increased JVD
regurgitation murmur in the tricuspid area
what are suggestive findings of Left Heart failure
lung crackles
respiratory wheeze
displaced cardiac apex
left-sided heart murmurs
what are shared findings with left and right sided HF
cool peripheries
cyanosis
orthopnea
delayed capillary refill
what are the xray findings with CHF
cardiomegaly
pulmonary congestion: hilar fullness, cephalization, Kerley B lines
pleaural effusions
what is Hilar Fullness
increased congestion/prominence of hilum
what is cephalization
increased prominence of upper lobe vasculature
what is kerley B lines
edema of the interlobular septa
what are the work up assessment tools used for CHF diagnosis
CXR
ECG
echocardiogram
aniogram
BNP
what is the purpose of a BNP
it is a sensitive test - if normal rule out HF
if REALLY elevated - can rule IN HF
helps guide treatment and following patients
what are the treatment options for acute and chronic CHF
diet and lifestyle changes
daily weight monitoring
intensive case management to limit readmissions
regular activity to preserve functional status
surgical options: CABG, repair vs replacement, transplantation
device therapy: ICD, CRT, balloon pump, LV assist device
when is heart transplantation the treatment of choice
< 60yo
severe, refractory HF
no other life-threatening conditions
AND
highly adherent to management conditions
what are the goals of CHF treatment
improve symptoms management and quality of life
decreased hospitalizations
decreased overall mortality associated with this agent
what are pharmaceutical options for HF treatment
Diuretics
RAAS
beta blockers
what is used if a patient has a contraindication for RAAS medications with HR
hydralazine PLUS nitrate
what medicatiosn are used for HFrEF patients
ACEi
BB
ARBs
aldosterone antagonists
ARNI
If channel bloker
what medication do you need to take when using loop diuretics
must take potassium
what is cardiogenic pulmonary edema
fluid accumulation in interstitial space of lungs (via increased hydrostatic pressure, increased capillary permeability, low oncotic pressure)
what are non cardiogenic causes of pulmonary edema
pulmonary infection
toxic inhalation
chest trauma
damage to alveoli, increased capillary permeability due to inflammation
what is cardiogenic shock
heart cannot pump enough blood (and O2) to brain and other vital organs
most often caused by MI, HF, chest trauma, PE
what are the signs and symptoms of cardiogenic shock
Low BP, weak or irregular pulse
dyspnea, cold extremities, clammy, dizziness, confusion, LOC, decreased urination, LE edema
what are the different types of treatment for cardiogenic shock
medications
interventions: PCI, CABG
Medical devices: ECMO, IABP, PCADs
supportive care
what medications are used to treat cardiogenic shock
antiarrhythmics
blood thinners in presence of clot blocking coronary arteries
inotropes, vasopressors - to increased blood pressure and blood flow
what are the interventions for cardiogenic shock
CABG
PCI aka angioplasty - possible stenting
what are the medical device options for treatment of cardiogenic shock
ECMO - extracorporeal membrane oxygenation device
IABP - intra-aortic balloon pump - can be used with ECMO
PCADs - percutaneous circulatory assist devices - can support while heart recovers or while waiting for heart transplant
what are supportive treatment options for cardiogenic shock
dialysis - if kidneys are damaged
IV fluids
mechanical breathing support (ventilator)
supplemented O2
what are the causes of cardiogenic pumonary edema
Left sided heart failure
or
severe HTN
what populations are at a higher risk for cardiogenic shock
Asian american pacific islanders, age, women, CAD, HF, HTN, DM, obesity, hx of CABG, PTX(penumothorax), sepsis
