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Cardio - Newman > Chronic Heart Failure > Flashcards

Chronic Heart Failure Flashcards

1
Q

What is the number one reason people are hospitalized each year?

A

Heart Failure

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2
Q

What are some major contraindications for Transplant?

A
  • Malignancy
  • Money
  • Mental Status
  • Age (over 65 or 70 usually no go)
  • Drug Addicts
  • Non-compliance
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3
Q

What are 3 neurohumoral responses to heart failure?

A
  • Increased RAAS (decreased renal perfusion 2° to low CO)
  • Increased NE release (b/c of hypoxia)
  • Increased ANP (atrial neurogenic peptide)
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4
Q

How do we determine if someone has heart failure?

• how do we determine severity?

A

Heart Failure is Defined by Ejection Fraction

• Classifications are used to determine the severity of the disease by looking how HF impacts daily life of the patient

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5
Q

What defines Classes 1-4 of heart failure?

A

Class I:
• Patient Live a normal Life, no symptoms of HF

Class II:
• Patients may have to stop or slow down during physical activity

Class III:
• Short of breath even getting up and going to the bathroom

Class IV:
• Can hardly breathe, bedridden

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6
Q

When do we most commonly see ECCENTRIC hypertrophy in the heart?

A

• Most common in: Myocardial Infarction (weakened tissue) and Infection

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7
Q

When do we most commonly see CONCENTRIC hypertrophy?

A

• Hypertension and some Valvular Diseases

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8
Q

How do you calculate Ejection Fraction?

• what value do we typically want to see?

A

SV/EDV = EF

• Typically want to see EF of 50% or more

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9
Q

What important aspects of Heart Failure Cannot be predicted by Ejection Fraction?

A
  • Cardiac Output
  • Renal Blood Flow
  • RAAS activation
  • Salt and Water Retention

***EF is a good starting point for Dx but doesn’t tell us much about how the patients condition is affecting their life

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10
Q

What systems are most affected by the massive neurohumoral response to MI?

A
  • Brain
  • Kidney
  • GI tract
  • Skeletal Muscle
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11
Q

What are some GI side effects seen in severe Heart Failure?

A

• Nausea, Vomiting, Abdominal Pain

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12
Q

Why does renin get released?

A

• Poor Renal Perfusion - the kidney thinks you’re bleeding to death

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13
Q

What symptoms of heart failure are directly linked to the effects of renin?

A
  • Difficulty Breathing
  • Pitting Edema
  • Ascites

***all these are effects of water retention

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14
Q

What effects does aldosterone have on the body?

A
  • Increased Na+ reabsorption and K+ excretion
  • Vasocontriction

***Both of these increase fluid volume leading to increases in afterload

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15
Q

Why would you want someone whose heart is failing in bed as much as possible?

A

• When patients are upright there renin levels are increased, however when they lie down they go DOWN

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16
Q

T or F: like renin aldosterone also is decreased in patients who are supine

A

True, this is likely due to less renin since angiontensin II elicits production of ALDOSTERONE

17
Q

How much of the Heart’s output is required to maintain GFR?

A

20%

18
Q

T or F: its believed that Angiotensin is directly toxic to the heart

A

True

19
Q

Why do you want to keep your heart failure patients out of the heat?

A

• Vasodilates Skin leading to decreased renal perfusion

20
Q

What is Spirolactone?

A

• Aldosterone Receptor Antagonist

21
Q

What are some of the measurable effects to keeping patients bedridden who have CHF?

A
  • INCREASED responsiveness to Medical Management
  • Cardiomegaly on CXR was reduce
  • Symptoms of overall CHF were reduced
22
Q

What causes cardiomegaly in heart disease?

A

• INCREASED AFTERLOAD

23
Q

T or F: like angiotensin, aldosterone is direct toxin to the heart.

A

True, BOTH angiotensin and aldosterone are direct toxins to the heart

24
Q

What is the main compensating mechanism in compensated heart failure?
• what causes patients to move from compensated HF to decompensated HF?

A

ANP typically balances out RAAS in compensated heart failure

• People move to decompensated heart failure because they are non-compliant with therapy or GO OUT IN THE HEAT

25
Q

Is INTRAvascular or EXTRAvascular water retention responsible for Jugular Venous Distention?
• what level of fluid retention causes JVD?

A

INTRAvascular Volume increase is responsible

• JVD caused by 3L of retention

26
Q

What is the problem with the body’s compensatory mechanisms for congestive heart failure?

A

• It can never compensate because there is so much extracellular fluid that increased Cardiac Output just leads to more fluid getting pushed into the periphery

27
Q

What level of extracellular volume causes Ansacara?

A

30L of extracellular fluid

28
Q

What are the 4 signs and symptoms to look for in Congestive Heart Failure (CHF)?

A
  1. Low Cardiac Output
  2. Abnormal Retention of Sodium and Water by RAAS
    3/4. Signs and symptoms of pulmonary and systemic congestion
29
Q

What measurable effects do ace inhibitors have on treatment of CHF?

A
  • Reduced Mortality

* Decreased End Diastolic Volume

30
Q

Why do we want to see reduced end diastolic volumes in CHF pts?

A

• Because it means they’ll likely have decreased afterload because less blood is getting pumped into the system

*Remember increased blood in the system isn’t good in pts. with CHF because it just gets pushed into lungs and the periphery

31
Q

What happens to ACE expression in infarcted hearts?

A

• It gets increased drastically

***Remember ACE is typically only found in the lungs

32
Q

In someone with ansacara what is the target for amount of fluid to lose everyday?

  • what should you monitor?
  • why?
A
  • 1000mL is the target fluid loss and NO MORE
  • Monintor Serum Creatinine because RENAL PERFUSION is decreased due to rapid loss in blood volume and the kidney may start to shut down
33
Q

T or F: lying supine helps to decrease the daily sodium balance and make diuretics even more effective.

A

True, this is because lying down helps to decrease RAAS activation which causes sodium retention via Angiotensin II and Aldosterone, this a multiplicative effect on Increased Sodium loss (this is a good thing)

34
Q

What is Spironolactone?

• why is it only prescribed to patients who are very symptomatic?

A
  • Aldosterone Antagonist
  • Only prescribed to patients who are very symptomatic because you RETAIN a lot of POTASSIUM with this drug
  • Diuretics also make you retain Potassium (since Spironolactone is often added to a diuretic you can get really large increases in potassium)
35
Q

What causes Cachexia associated with heart failure?

A
  • TNF-alpha and IL-6

* RAAS activation also increases nitro-/oxidative stress in: Heart, Skeletal Muscle, Skin, Plasma

36
Q

Can we treat cachexia associated with HF?

A

NO, ACE and Aldosterone inhibitors will do nothing

Cardio - Newman (8 decks)

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