Chronic Heart Failure

Question 1

Basic Definition of heart failure?

Answer 1

Dysfunction of myocardium causing decreased CO and decreased peripheral perfusion

Question 2

What is HFrEF?

Answer 2

Heart Failure with reduced EF (ejection fraction)

Question 3

What is HFpEF?

Answer 3

Heart Failure with preserved EF

Question 4

What is the primary mechanism of HFrEF?

Answer 4

Systolic Dysfunction

Impaired contraction or inotropy (systole) w/reduced EF
L/R sided ventricular impairment
Reduced CO-CHF

Question 5

What is the primary mechanism of HFpEF?

Answer 5

Diastolic Dysfunction

Impaired relaxation or filling (diastole), Normal EF
Left Ventricular stiffing
Reduced CO-CHF

Question 6

Name 2 Primary Causes of HF?

Answer 6

HTN (30% men, 37% women)

HTN + IHD (Ischemic heart disease), increase both male/female to 40%

Question 7

What are risk factors indicating EARLY treatment of HTN to decrease chances for HF

Answer 7

HTN, IHD (atherosclerosis), valvular heart disease

ACEi/ARB decrease remodeling of the heart

BB decrease remodeling of the heart and decrease sudden death

Question 8

Clinical Presentation of Left Sided Heart Failure? (7)

Answer 8

SOB
Dyspnea on exertion (DOE
Orthopnea
Rales
Fatigue
\+/- tachycardia
\+/_ Increase BNP

Question 9

What is the risk of untreated Left sided Heart Failure?

Answer 9

Right Sided Heart Failure

Question 10

Clinical Presentation of Right Sided Heart Failure?

Answer 10

Weight gain
Bilateral lower extremity swelling/edema
Abd Distension
JVD
Hepatojugular reflex

Question 11

What BNP value important in diagnosing Heart Failure?

Answer 11

Troponins–reflect heart stretch/cell death

Question 12

Classification fo HF (Functional)? (4)

Answer 12

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

Question 13

Stages of HF? (4)

Answer 13

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

Question 14

Treatment for Stage A HF? (4)

high risk for HF, no structural changes

Answer 14

RX: ACEi or ARB,
Stop smoking
Stop ETOH,
TX hyperlipidemia

Question 15

Treatment for Stage B HF? (5)

presence of structural disorder but no symptoms of HF

Answer 15

RX: ACEi or ARB, 
BB
Stop smoking
Stop ETOH, 
TX hyperlipidemia

Question 16

Treatment for Stage ? HF? (7-8)

past/current symptoms of HF + structural changes

Answer 16

RX: ACEi
BB
Stop smoking
Stop ETOH, 
TX hyperlipidemia
diuretics
sodium restriction
? (not in notes)

Question 17

Treatment for Stage D HF

Answer 17

end-stage disease needing cardiac support or hospice

Question 18

What is Peripheral Artery Disease (PAD)?

Answer 18

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

Question 19

What is claudication r/t PAD?

Answer 19

Pain with exertion

Question 20

Risk factors for PAD?

5 primary, 1 secondary

Answer 20

Smoking
DM
HTN
Hyperlipidemia
FX
Post-Menopausal

12-25% have Carotid Artery Stenosis (2-4 fold risk of CAD)

Question 21

S/S of PAD? (3)

Answer 21

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)

Question 22

How to assess for PAD? (5)

Answer 22

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)

Question 23

What is the correct procedure for assessing Ankle Brachial Index (ABI)

Answer 23

Technique: pt supine for 10min, measure SBP in brachial, dorsal pedis, and posterior tibial arteries