Congestive Heart Failure Flashcards
What is cardiac heart failure
Clinical syndrome of heart’s inability to meet body’s circulatory demands under normal physiological conditions
How is the frank starling relationship related to heart failure
When preload low, little difference between normal and failing heart. When preload high such as exertion, then you see symptoms in failing heart because less contractillity, so increased preload by the same amount does not produce same stroke volume
What is the pathophysiology of heart failure
Decreased cardiac output, allowing activation of renin-angiotensin system and sympathetic system to do systemic vasoconstriction and volume retention to increase CO temporarily, but LVEDV increased which casues LVEDP to increase, causing pulmonary congestion
What is the difference between systolic dysfunction and diastolic dysfunction
Systolic dysfunction - impaired contractility (EF down), occurs after MI or hypertension-causing cardiomyopathy
Diastolic dysfunction - impaired ventricle filling, caused most commonly by HTN causing myocardial hypertrophy and restrictive cardiomyopathies
What are the general symptoms of LEFT SIDED heart failure
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, nocturnal cough that is nonproductive, diaphoresis and cool extremities when extreme
What are signs of left sided heart failure
Displaced PMI (not in MI), S3 (very specific), S4, crackles at lung bases, pleural effusion causing dullness to percussion and decreased tactile fremitus,
What are signs of right sided heart failure
Peripheral pitting edema (can also be caused by venous insufficiency)
Nocturia - due to increased venous return with elevation of legs
JVD, hepatomegaly, ascites, right ventricular heave
What is the initial diagnostic test of choice for CHF
Echo - Determines whether it is systolic or diastolic dysfunction, and cause of it, and tells EF
Although not the initial test of choice, what does CXR show for heart failure
Cardiomegaly, kerley B lines indicating dilation of pulmonary lymphatic vessels, and interstitial markings with pleural effusions
If echo is not conclusive, what is the second test to use
Radionuclide ventriculography
What test should you use to exclude CAD as the underlying cause of CHF
Cardiac catherization
What is the purpose of BNP for heart failure
Released from ventricles
BNP > 150 corresponds to CHF, can differentiate dyspnea caused by CHF vs. COPD
NT-proBNP better, if less than 300 then CHF excluded
What three medications should a person presenting with systolic CHF be given initially
ACE inhibitor and diuretic and B-blocker
What are general medications given for systolic CHF
- ) Diuretics - provides symptomatic relief only (furosemide best)
- ) Spironolactone - only for advanced disease, eplerenone is alternative, prolongs survival, do not give in renal failure and monitor protassium/renal function
- ) ACE inhibitor - for systolic, reduce mortality, prolong survival, and reduce symptoms, have to give this
- ) B-blockers - carvidelol best, metoprolol second, actually decreases mortality after post-MI, but only given to stable patients with mild to moderate disease
- ) Digitalis - Short term symptomatic relief, last line, only if EF is less than 40% too, does not reduce mortality
- ) Hydralazine + nitrates - if they can’t tolerate ACE inhibitor, also reduces mortality
What is the most common cause of death in CHF
Sudden death from ventricular arrhythmias
