Clin Med - CHF Flashcards
New York Heart Association Classes
Class I – minimal symptoms
Class II – mild symptoms
Class III – moderate symptoms
Class IV – severe symptoms
*Mortality correlates with severity of symptoms
Left heart failure symptoms
- Dyspnea
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Fatigue
Left heart failure signs
- Rales
- Rhonchi (inspiratory and expiratory)
- Crackles
- Diminished breath sounds in distal airways as compared to apexes of the lungs
- Pulse ox
Right heart failure symptoms
- These symptoms can also go for left-sided heart failure
- Pedal/sacral edema
- Abdominal distension, discomfort (ascites)
- Poor appetite
Right Heart Failure - Signs
- JVD (a and v waves)
- Ascites
- Pedal/sacral edema
CHF percentages
- Systolic – LVEF < 55% (HFREF)
- Diastolic – LVEF > 55% (HFPEF)
Etiology - HFrEF (HF with reduced ejection fraction)
- Coronary Heart Disease #1
- Hypertension
- Diabetes
- Myocarditis
- Tachycardia (SVT, atrial fibrillation)
- Hyperthyroidism
- Valvular disease (Mitral and aortic valves)
Etiology - HFpEF (HF with preserved ejection fraction)
- Age > 75
- Female sex
- Hypertension
- Diabetes
- Coronary artery disease
CHF Diagnosis
- History & physical exam
- CxR
- Echocardiography (tissue doppler)
- BNP
- TSH
- BMP/CMP (BUN, Cr, Na, K, Mg)
Treatment - acute
- IV loop diuretics (furosemide, bumetanide), metolazone (HFPEF and HFREF)
- Inotropes (dobutamine, milrinone) – HFREF only
- Ultrafiltration, hemodialysis
*review Letassy’s lecture
Treatment – chronic (HFREF)
- ACE inhibitors (lisinopril, Ramipril, etc.) or ARBs (losartan, valsartan)
- Beta blockers (carvedilol, metoprolol ER, bisoprolol)
- Aldosterone inhibitors (spironolactone, eplerenone)
- Sacubitril/valsartan
*review Letassy’s lecture
Steps to RAAS
- Renin is produced in the kidneys in response to poor perfusion
- Renin converts angiotensinogen (from liver) to angiotensin I
- Angiotensin I is converted to angiotensin II by ACE (angiotensin converting enzyme)
- Angiotensin II is a potent vasoconstrictor and raises blood pressure
- Angiotensin II stimulates the adrenal glands to produce aldosterone
- Aldosterone increases BP, causes Na retention and promotes fibrosis
Sympathetic Nervous System in CHF
It is hyperactive. If you can’t physically move volume, the body’s response is to speed the heart up to try and move that volume.
What SNS features worsen CHF?
Epinephrine and norepinephrine cause hypertension and myocardial damage (fibrosing and hardening of muscles).
Which drugs help SNS activity in CHF?
Beta blockers
