Clincal Asessment Of HF Patients Flashcards
Type of dyspnea occuring in recumbency at the left side?
Trepopnea
ACC/AHA staging of HF
A
B
C
D
A - high risk but no structural problem/ HF symptoms
B - structural heart disease, but no symptom
C - structural heart disease plus previous or current symptom
D - Refractory HF requiring specialised interventions
PE findings in HF patients indicative of a more severe disease?
Narrow pulse pressure or thready pulse
Pulsus alternans
Cool/mottled extremities
Anasarca
Most sensitive history or PE finding that would lead you to suspect heart failure?
Least sensitive?
Most sensitive - orthopnea (requiring >/= to 2 pillows)
Least sensitive - JVP <8
Most specific PE finding for HF?
Hepatomegaly - more than 4 fingerbreadths beyond coastal margin
True or false
“No physical finding is pathognomonic for HFpEF or HFrEF”
True
Shoulder pad sign is a physical finding often found in?
Amyloidosis
Valvular disorder found in HF patients located at the left parasternal border and presents with prominent v waves
Tricuspid regurg
Superimposition of the third and fourth heart sound
Summation gallop
This heart sound corresponds to ventricular stiffening
4th heart sound
The most definitive method to assess the patients volume status by PE
JVP
Elevation indicates left sided filling pressure
70% sensitive 79% specific
How many percent of unitlateral effusion occur on the left side of HF patients
10%
Of the clinical signs suggesting reduced Cardiac output. Which among the them is the most useful?
Poor mentation
Reduced UO
Mottled skin
Cool extremities
Cool extremities is most useful
Most common congestion/perfusion combination found in decompensated HF
Wet and warm
Congestion/perfusion combination in cardiogenic shock
Wet and cold
Classic chest radiogrphic findings of patients with pulmonary edema
Butterfly pattern
Horizontal linear opacities extending to the pleural space caused by accumulation of fluid in the interstitial space?
Kerley B lines
This finding on radiograph indicates venous hypertension?
Peribronchial cuffing
Conditions with increased JVP but normal LVEDP
Severe TR
Isolated RV failure
Severe pulmonary Hpn
Stages of pulmonary congestion
1 venous hypertension - PCWP >13
2 interstitial edema - PCWP > 18
3 alveolar edema - PCWP >25
LOW QRS voltatge on ECG suggests?
Infiltrative disease
Pericaridial effusion
Leading cause of ADHF?
Acute coronary ischemia
This electrolyte abnormality is associated with worsening HF or poor prognosis
Hyponatremia
This diagnostic modality is a class I indication for HF
BNP and NT - pro BNP
ANP released by atrium
BNP released by “B”entircles
Biomarkers BNP and NT-BNP are elevated more on HFrEF than HFpEF
True
Cut off value to exclude AHF based on
BNP
NTBNP
BNP <30-50
NTBNP <300
Cut off to diagnose AHF
BNP
NTBNP
BNP >/= to 100
NTBNP >/= to 900
NTPBNP cut off based on age
<50
50-75
>75
<50 - 450
50-75- 900
>75 - 1800
target BNP decrease in percent?
30% decrease
Half life on BNP
Half life of PBNP
BNP - 20 minutes
NTPBNP - 90
An interleukin marker for myocardial fibrosis?
ST2
Galectin 3 - released by macrophages
Imaging modalities and info gathered
Best for:
Anatomy
Function
Tissue metabolism
AOTA
Anatomy - CT-scacn
Function - echo
Tissue metabolism Nuclear scan PET
AOTA MRI
Indicative of infiltrative disease?
Concentric LVH with no HPN, with biatrial enlargement
Hallmark finding of ischemic cardio myopathy on imaging?
Note of subendocardial enhancement since this area is most prone to ischemia
