Chronic Heart Failure Flashcards
Basic Definition of heart failure?
Dysfunction of myocardium causing decreased CO and decreased peripheral perfusion
What is HFrEF?
Heart Failure with reduced EF (ejection fraction)
What is HFpEF?
Heart Failure with preserved EF
What is the primary mechanism of HFrEF?
Systolic Dysfunction
Impaired contraction or inotropy (systole) w/reduced EF
L/R sided ventricular impairment
Reduced CO-CHF
What is the primary mechanism of HFpEF?
Diastolic Dysfunction
Impaired relaxation or filling (diastole), Normal EF
Left Ventricular stiffing
Reduced CO-CHF
Name 2 Primary Causes of HF?
HTN (30% men, 37% women)
HTN + IHD (Ischemic heart disease), increase both male/female to 40%
What are risk factors indicating EARLY treatment of HTN to decrease chances for HF
HTN, IHD (atherosclerosis), valvular heart disease
ACEi/ARB decrease remodeling of the heart
BB decrease remodeling of the heart and decrease sudden death
Clinical Presentation of Left Sided Heart Failure? (7)
SOB Dyspnea on exertion (DOE Orthopnea Rales Fatigue \+/- tachycardia \+/_ Increase BNP
What is the risk of untreated Left sided Heart Failure?
Right Sided Heart Failure
Clinical Presentation of Right Sided Heart Failure?
Weight gain Bilateral lower extremity swelling/edema Abd Distension JVD Hepatojugular reflex
What BNP value important in diagnosing Heart Failure?
Troponins–reflect heart stretch/cell death
Classification fo HF (Functional)? (4)
Class I: no limits on activities (could just be HTN)
Class II: ADLs result in fatigue, palpitations, dyspnea, or angina
Class III: less than normal activity results in symptoms
Class IV: unable to carry out any activity w/o symptoms
Stages of HF? (4)
Stage A: high risk for HF, no structural changes
Stage B: presence of structural disorder but no symptoms of HF
Stage C: past/current symptoms of HF + structural changes
Stage D: end-stage disease needing cardiac support or hospice
Treatment for Stage A HF? (4)
high risk for HF, no structural changes
RX: ACEi or ARB,
Stop smoking
Stop ETOH,
TX hyperlipidemia
Treatment for Stage B HF? (5)
presence of structural disorder but no symptoms of HF
RX: ACEi or ARB, BB Stop smoking Stop ETOH, TX hyperlipidemia
Treatment for Stage ? HF? (7-8)
past/current symptoms of HF + structural changes
RX: ACEi BB Stop smoking Stop ETOH, TX hyperlipidemia diuretics sodium restriction ? (not in notes)
Treatment for Stage D HF
end-stage disease needing cardiac support or hospice
What is Peripheral Artery Disease (PAD)?
Disease caused by atherosclerosis and thromboembolic processes that alter normal structure and function of the aorta, visceral arterial branches, and arteries for the lower extremiites
What is claudication r/t PAD?
Pain with exertion
Risk factors for PAD?
5 primary, 1 secondary
Smoking DM HTN Hyperlipidemia FX Post-Menopausal
12-25% have Carotid Artery Stenosis (2-4 fold risk of CAD)
S/S of PAD? (3)
Pain, aching, numbness, fatigue with walking in lower extremities
Post-prandial abd pain reproducible by eating and is associated with weight loss
ED (r/t reduced blood flow)
How to assess for PAD? (5)
Check BP in both arms, note asymmetry Auscultate the abd and flanks for brits Palpate the abd for aortic pulsation Note poorly healing or non-healing wounds (venous statis ulcers, infection) Ankle Brachial Index (ABI)
What is the correct procedure for assessing Ankle Brachial Index (ABI)
Technique: pt supine for 10min, measure SBP in brachial, dorsal pedis, and posterior tibial arteries
