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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
Q

What are signs/symptoms of CHF?

A 
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
Q

What are s ymptoms of Right ventricular failure?

A 
Abdominal pain
Anorexia
Nausea
bloating
Constipation
(build up in VEINS)
27
Q

What are signs of RV failure?

A

Peripheral edema
JVD, HJF
Hepatomegaly
Ascites

28
Q

What are symptoms of Left ventricular HF?

A

DOE, orthopnea, PND, tachypnea, cough, hemoptysis

build up in LUNGS

29
Q

What are signs of LVHF?

A

Rales, S3 gallop
Pulmonary edema
Pleural effusion
Cheyne-Stokes respiration

30
Q

What are the MAJOR signs/symptoms of pulmonary congestion?

A 
DOE
Orthopnea
Paroxysmal nocturnal dyspnea
Rales
Pulmonary edema
31
Q

What are the major signs/symptoms of systemic venous congestion?

A

Peripheral edema
Jugular venous distension
Hepatojugular reflex
Hepatomegaly, ascites

32
Q

What lab assessments should be performed for patients with heart failure?

A

Hematology/biochemistry (CBC, electrolytes, BUN, Cr, thyroid)
ECG
CXR
BNP or NT-proBNP

33
Q

What is used to measure LVEF?

A

ECG
Nuclear testing**
Cardiac catheterization**
MRI/CT

34
Q

What are the NYHA Function classes?

A

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
Q

What are the AHA stages?

A

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
Q

What NYHA FC goes with AHA Stage A?

A

None

37
Q

What NYHA FC goes with AHA Stage B?

A

NYHA I

38
Q

What NYHA FC goes with AHA Stage C?

A

NYHA II, III

39
Q

What NYHA FC goes with AHA Stage D?

A

NYHA IV

40
Q

What is the exercise goal for patients with stable HF?

A

HR 60-80% of maximum for 20-60 minutes 3-5 times a week

41
Q

What is sodium restriction for HF?

A

2-3g/day

42
Q

What is alcohol restriction for patients with HF?

A

Abstain completely if alcohol-induced

2 drinks/day for men, 1 drink/day for women

43
Q

When should HF patients be fluid-restricted?

A

Severe hyponatremia (<135) not controlled with diuretics

44
Q

How much fluid in fluid restriction?

A

<2L/day

45
Q

What drug class reduces intravascular volume?

A

Diuretics

46
Q

What drug classes increase myocardial contractility?

A

Positive inotropes

47
Q

What drug classes decrease ventricular afterload?

A

ACEIs, vasodilators

48
Q

What drug classes are neurohormonal blockade?

A

Beta-blockers, ACEIs, ARBs, spironolactone

Therapeutics III (12 decks)

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