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Therapeutics III > CHF - Sowinski > Flashcards

CHF - Sowinski Flashcards

1
Q

T/F: Patients with most types of cancer die sooner than patients with HF

A

FALSE - average time to death with HF is LESS than cancer (except lung cancer)

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2
Q

HFrEF is aka what?

A

Systolic dysfunction

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3
Q

Systolic dysfunction is characterized by ______

A

Decreased contractility

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4
Q

Diastolic dysfunction is aka what?

A

HFpEF

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5
Q

Diastolic dysfunction is caused by impairment of what?

A

Ventricular relaxing/filling

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6
Q

What is the EF cut-off for HFrEF?

A

<35-40%

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7
Q

What is EF <35-40% without symptoms called?

A

Asymptomatic reduced EF

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8
Q

What are the causes of systolic dysfunction?

A

-Ischemia
-Nonischemia
HTN, thyroid, obesity, stress, cardiotoxins, myocarditis, idiopathic, tachycardia, peripartum

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9
Q

What are the most common cause of diastolic dysfunction?

A

HTN

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10
Q

How do you calculate EF?

A

(EDV-ESV)/(EDV) * 100

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11
Q

What is EDV?

A

End diastolic volume

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12
Q

What is ESV?

A

End systolic volume

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13
Q

Compensatory response: Increased preload

Benefits? Increased _____ via ________ Mechanism

A

Stroke volume via Frank-Starling mechanism

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14
Q

Compensatory response: Increased preload

Detriments? ________ and increased ______

A

pulmonary/systemic congestion and edema; increased MVO2

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15
Q

Compensatory response: Vasoconstriction

Benefits? Maintain ____ during reduced CO; and ______

A

maintain BP; shunt blood from nonessential tissues to heart

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16
Q

Compensatory response: Vasoconstriction

Detriments? Increased ____; increased ____; decreased ______

A

Increased MVO2; increased afterload; decreased SV (further activates compensatory responses)

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17
Q

Compensatory response: Tachycardia and increased contractility
Benefits? Maintain ____

A

CO

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18
Q

Compensatory response: Tachycardia and increased contractility
Detriments? Increased ____; shortened ____; decreased ________; ventricular _______; increased risk of _______ death

A 
Increased MVO2
Shortened diastolic filling time
Decreased responsiveness of b-receptor
Ventricular arrhythmias
Increased risk of myocardial cell death
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19
Q

Compensatory response: Ventricular hypertrophy and remodeling
Benefits? Maintain _____; reduce _____; decrease _____

A

Maintain CO
Reduce myocardial wall stress
Decrease MVO2

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20
Q

Compensatory response: Ventricular hypertrophy and remodeling
Detriments? _____ and _____ dysfunction; risk of _____ death and ____; risk of _____, _____

A

Diastolic and systolic dysfunction
Risk of myocardial cell death and ischemia
Risk of arrhythmias
Fibrosis

21
Q

Major factor precipitating/worsening HF?

A

Lack of compliance!

22
Q

What are the 3 mechanisms for drug-induced heart failure?

A

Decreased contractility
Direct cardiac toxins
Na and water retention

23
Q

What drugs cause HF via decreased contractility?

A

Antiarrhthmics (disopyramide, flecainide)
Beta-blockers (atenolol, propranolol, metoprolol)
CCBs (Verapamil, diltiazem)

24
Q

What drugs cause HF via sodium and water retention?

A
  • Glucocorticoids, Androgens, Estrogens
  • NSAIDs, COX-2 Inhibitors
  • Rosiglitazone, pioglitazone
  • Sodium-containing drugs
25
What are signs/symptoms of CHF?
``` SOB Chronc lack of energy Swelling of feet/legs Difficulty sleeping at night (b/c of breathing) Swollen abdomen Cough with frothy sputum Increased urination at night Confusion/memory impairment ```
26
What are s ymptoms of Right ventricular failure?
``` Abdominal pain Anorexia Nausea bloating Constipation (build up in VEINS) ```
27
What are signs of RV failure?
Peripheral edema JVD, HJF Hepatomegaly Ascites
28
What are symptoms of Left ventricular HF?
DOE, orthopnea, PND, tachypnea, cough, hemoptysis | build up in LUNGS
29
What are signs of LVHF?
Rales, S3 gallop Pulmonary edema Pleural effusion Cheyne-Stokes respiration
30
What are the MAJOR signs/symptoms of pulmonary congestion?
``` DOE Orthopnea Paroxysmal nocturnal dyspnea Rales Pulmonary edema ```
31
What are the major signs/symptoms of systemic venous congestion?
Peripheral edema Jugular venous distension Hepatojugular reflex Hepatomegaly, ascites
32
What lab assessments should be performed for patients with heart failure?
Hematology/biochemistry (CBC, electrolytes, BUN, Cr, thyroid) ECG CXR BNP or NT-proBNP
33
What is used to measure LVEF?
ECG Nuclear testing** Cardiac catheterization** MRI/CT
34
What are the NYHA Function classes?
I: No limitations of physical activity II: Slight limitations of physical activity III: Limitations of physical activity IV: Inability to carry on any physical activity without discomfort
35
What are the AHA stages?
A: High risk, no structural or functional abnormalities B: Structural abnormalities, no symptoms C: Symptoms of HF associated w/structural heart disease D: Advanced HD--marked symptoms of HF at rest
36
What NYHA FC goes with AHA Stage A?
None
37
What NYHA FC goes with AHA Stage B?
NYHA I
38
What NYHA FC goes with AHA Stage C?
NYHA II, III
39
What NYHA FC goes with AHA Stage D?
NYHA IV
40
What is the exercise goal for patients with stable HF?
HR 60-80% of maximum for 20-60 minutes 3-5 times a week
41
What is sodium restriction for HF?
2-3g/day
42
What is alcohol restriction for patients with HF?
Abstain completely if alcohol-induced | 2 drinks/day for men, 1 drink/day for women
43
When should HF patients be fluid-restricted?
Severe hyponatremia (<135) not controlled with diuretics
44
How much fluid in fluid restriction?
<2L/day
45
What drug class reduces intravascular volume?
Diuretics
46
What drug classes increase myocardial contractility?
Positive inotropes
47
What drug classes decrease ventricular afterload?
ACEIs, vasodilators
48
What drug classes are neurohormonal blockade?
Beta-blockers, ACEIs, ARBs, spironolactone

Therapeutics III (12 decks)

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