Clinical considerations for heart failure

Question 1

Impact Left sided heart failure?

Answer 1

Diastolic (preserved EF)
-impaired relaxation
-pericadial disease
Systolic (reduced EF)
-impaired contractility
-increased afterload
Valvular

Question 2

Impact Right sided heart failure?

Answer 2

Cardiac
Pulmonary
-Pulmonary Parenchymal disease
-Pulmonary Vascular disease

Question 3

Impair contractility?

Answer 3

Myocardial infarction
Transient myocardial ischemia
Dilated cardiomyopathy

Question 4

Increase afterload?

Answer 4

Aortic stenosis

Uncontrolled Hypertension

Question 5

Impair relaxation?

Answer 5

left ventricular hypertrophy
hypertrophic cardiomyopathy
restrictive cardiomyopathy
transient myocardial ischemia

Question 6

Cause Valvular failure?

Answer 6

mitral stenosis
aortic reguritation
Chronic mitral reguritation

Question 7

Cause preicardial disease?

Answer 7

pericardial constriction

pericardial tamponade

Question 8

Cause cardiac disease?

Answer 8

left sided heart failure
pulmonic valve stenosis
right ventricular infarct

Question 9

Cause pulmonary parenchymal disease?

Answer 9

COPD
intersitial lung disease
respiratory distress syndrome
chronic lung infection
bronchiectasis

Question 10

Cause Pulmonary vascular disease?

Answer 10

pulmonary embolism

Primary Pulmonary Hypertension

Question 11

Etiology Heart Failure?

Answer 11

Any insult that causes altered structure or function of the heart
-Coronary artery disease
-Hypertension
Rheumatic heart disease (Africa/Asia)
Chagas disease (south america)

Question 12

Prognosis Heart Failure?

Answer 12

30-40% patients dies within one year of onset

60-70% die within 5 years

Question 13

Adaptive measures to acute injury/ chronic insidious insult?

Answer 13

Short term- bring heart back to normal cardiac output

long term- lead to further heart failure

Question 14

Basic Heart Failure?

Answer 14

myocardial dysfunction which leads to inadequate tissue perfusion

Question 15

Generally Heart failure is what kind of output?

Answer 15

Low output failure
high output is possible, when heart is unable to meet increased metabolic demands despite increased cardiac output (Thyrotoxicosis, severe anemia, sepsis)

Question 16

Angiotensin II and Aldosterone cause?

Answer 16

Increased cytokine production
Inflammatory cell adhesion and chemotaxis
Activation of macrophages at sites of injury and repair
Stimulates growth of fibroblasts and synthesis of collagen fiber

Question 17

Endothelins cause?

Answer 17

Vasoconstriction
Induce vascular smooth muscle proliferation
Myocyte hypertrophy

Question 18

Short term adaptive mechanisms?

Answer 18

Increase CO by increasing heart rate, preload, and contractility
Maintain adequate perfusion to critical organs by volume expansion and selective vasoconstriction
Facilitate repair

Question 19

Long term adaptive mechanisms?

Answer 19

• High catecholamine state can provoke dysrhythmias, increased oxygen demand (increase HR and increase afterload)
• Hypertrophy meant to enhance CO can further exacerbate HF by increasing preload and afterload and/or decrease diastolic filling
• Chronic activation of RAAS can lead to total body volume overload and increased preload
• Myocardium can become infiltrated with fibroblasts, impairing both contractility and diastolic filling

Question 20

Things that cause symptoms and signs of clinical presentation?

Answer 20

decrease oxygen delivery/ gas exchange
Activation of RAAS
Altered cardiac structure
passive hepatic congestion

Question 21

NYHA Functional Class?

Answer 21

Relies on patient report of symptoms and can underestimate the limitation in exercise capacity

Question 22

Functional Classes?

Answer 22

1- not limited
2- slight limit
3- everyday activity
4- can be symptomatic at rest

Question 23

AHA/ACC Objective Stages?

Answer 23

Emphasizes development and progression of disease

Question 24

Objective Stages?

Answer 24

A- only at risk
B- no symptoms
C- symptoms now/ past
D- End stage

Question 25

Risk for Stage A?

Answer 25

HTN, atherosclerotic, DM, obesity, metabolic syndrome, cardiotoxic, family Hx cardiomyopathy

Question 26

Single most useful test in evaluation with suspected heart failure?

Answer 26

2-D echocardiogram

Question 27

Other things to evaluate patient with suspected heart failure?

Answer 27

``` History and physical 12- lead EKG 2 view chest xray Labs BNP ```

Question 28

Labs?

Answer 28

CBC, urinalysis, electrolytes, glucose, lipids, renal and liver function, thyroid function tests, BNP

Question 29

BNP?

Answer 29

brain natriuretic peptide released when ventricle is stretched elevated in both preserved EF and reduced EF, although levels are generally higher in reduced EF

Question 30

However with BNP?

Answer 30

can be elevated in persons over 60 or in women who do not have heart failure Cannot be used in isolation to confirm or exclude the presence of heart failure

Question 31

Chest xray findings in heart failure?

Answer 31

``` Cardiomegaly Batwing appearance Kerley B lines Pleual effusion Cephalization of blood vessels and Pulmonary edema ```

Question 32

Treatment of heart failure?

Answer 32

Modify/eliminate contributing risk factors Non-pharmacologic- dietary salt restriction, fluid restriction, daily weights Pharm