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Cardio > Congestive Heart Failure I - Exam 2 > Flashcards

Congestive Heart Failure I - Exam 2 Flashcards

1
Q

What is heart failure? What is important to note? What are the s/s related to?

A

ACCF/AHA/HFSA define HF as a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood

is it a SYNDROME not a disease, need to figure out the underlying cause

s/s related to reduced CO and volume overload

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2
Q

______ is MCC of HF

A

Ischemic heart disease

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3
Q

**What are the risk factors for heart failure?

A

Hypertension

CVD

Diabetes

Obesity

Exposure to cardiotoxic agents

Genetic variants for cardiomyopathy

Family history of cardiomyopathy

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4
Q

HF classifications are based on _____ and _____. Give the 3 options for classifications

A

timing and function

acute vs chronic
high output vs low output
reduced vs preserved EF

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5
Q

What is the difference between acute and chronic heart failure?

A

acute: last few days to weeks

chronic: symptoms present for months

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6
Q

Shortness of breath, paroxysmal nocturnal dyspnea (PND), orthopnea, and RUQ pain

acute or chronic s/s?

A

acute

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7
Q

Fatigue, anorexia, abdominal distention and edema

acute or chronic s/s?

A

chronic

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8
Q

What is the difference between high and low output heart failure?

A

High: heart is unable to meet the demands of the peripheral needs although it is working normally

think the body is the problem

Low: insufficient forward output

think heart is the problem

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9
Q

What is the difference between reduced and preserved EF? What is it called if the pt falls in the middle?

A

reduced: EF ≤40% HFrEF

preserved: EF ≥ 50% HFpEF

borderline EF is betwwen 41-49% EF

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10
Q

How do you determine treatment for a pt with borderline EF?

A

borderline is 41-49% and treatment is based on symptoms

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11
Q

What are the 4 different classifications with regards to EF? Draw the chart from lecture

A
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12
Q

What are the s/s of LEFT sided HF? What are the s/s of RIGHT sided HF?

A

First symptoms are from the LUNGS
-> Orthopnea, DOE

First symptoms are from the BODY ->
JVD, hepatic congestion, ascites, anorexia, LE edema

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13
Q

What is the MC cause of RIGHT sided HF?

A

Most common cause is left sided HF

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14
Q

**________ uses functional limitation classes to determine severity by assessing ______. Can it change?

A

New York Heart Association (NYHA)

effort needed to elicit symptoms in a HF patient

classification can change at any time

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15
Q

**What are the 4 different NYHA classification of severity?

A
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16
Q

_____ describes the evolution of HF. Helps to define the appropriate ______ and determine ______. Can it change?

A

American College of Cardiology Foundation (ACCF) // American Heart Association (AHA)

therapeutic approach and determine prognosis

CANNOT CHANGE

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17
Q

** What are the 4 different classifications for HF as defined by the ACC/AHA?

A

A and B have no symptoms

C and D have symptoms

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18
Q

What is afterload? What is preload?

A

afterload: the amount of pressure the heart needs to exert to pump blood out of the ventricles during a heartbeat

preload: the force that stretches the heart’s muscle before it contracts and a factor in bearings that improves running accuracy:

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19
Q

What are the neurohumoral adaptations for heart failure?

A

Maintain systemic pressure by vasoconstriction

Restores cardiac output by increasing myocardial contractility and heart rate

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20
Q

What are the 3 major determinants of the LV stroke volume?

A

Preload – venous return and end-diastolic volume

Contractility – the force generated at any given end-diastolic volume

Afterload – aortic impedance, vascular resistance, wall stress

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21
Q

The pressure-volume relationship with systolic dysfunction leads to a reduction in ______. Which leads to a reduction in _____ and _____. What does this promote?

A

reduction in myocardial contractility

reduction in SV and CO

Promotes salt and water retention, leading to expansion of blood volume, therefore raising end-diastolic pressure and volume

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22
Q

What type of HF?

A

systolic HF

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23
Q

What type of HF?

A

diastolic HF

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24
Q

What type of HF?

A

none! it is normal

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25
Q

_____ is one of the first responses to low cardiac output. What is the result? What happens to contractility and HR?

A

Activation of the SNS

Results in increased release and decreased reuptake of norepinephrine

Increases ventricular contractility and heart rate

26
Q

activation of the SNS also leads to ______ and _______ which increases ______. In the kidney is leads to _________ and worsening _______

A

vasoconstriction and enhanced venous tone

increases peload

Also stimulates proximal tubular sodium reabsorption, contributing to sodium retention in HF → worsening fluid overload

27
Q

What is the RAAS system stimulated by? What happens next?

A

Stimulated by decreased glomerular filtration and increased beta-1 adrenergic activity

increases sodium reabsorption and induces vasoconstriction

28
Q

RAAS can act directly on _____ to promote pathologic remodeling via hypertrophy, apoptosis, necrosis leading to an increase in ________

A

myocytes

increase in AT2 receptors

29
Q

Low cardiac output leads to activation of ______ and ______ which release _____ and stimulate _______

A

activation of carotid sinus and aortic arch baroreceptors → release of ADH and stimulation of thirst

30
Q

ADH release leads to an increase in _________ and promotes _____ leading to _____

A

]increase in systemic vascular resistance

Promotes water retention → fluid overload!

31
Q

ANP is released from the _____ in response to ______. When does it rise in HF?

A

atria

in response to volume expansion

ANP rises early in HF

32
Q

BNP is released from the _______ in response to ________. When it is present? What does it reduce?

A

ventricles

high ventricular filling pressure

BNP is present in chronic and advanced HF

Reduces systemic vascular resistance and central venous pressure, while increasing natriuresis, which reduces afterload

33
Q

What are the 2 natriuretic peptides? Which one has a longer half-life and is the preferred test?

A

ANP and BNP

BNP is preferred and is used to guide therapy

34
Q

Consequences of Compensation include elevation in diastolic pressures that are then transmitted to the _____ and ______ and _____ venous circulation

A

atria

pulmonary

systemic venous circulations

35
Q

as a consequence of compensation, the increased afterload can _____ cardiac function and _________.

A

depress cardiac function

enhance detorioration

36
Q

_______ and _______can worsen coronary ischemia. ______ and ______ promote myocyte loss, resulting in cardiac remodeling

A

Catecholamine-stimulated contractility

increased heart rate

Catecholamines

angiotensin II

37
Q

What are the cardinal symptoms of heart failure?

A

Dyspnea
Fatigue
Fluid retention: lower extremity edema

38
Q

What is one way to tell if the edema present is due to HF?

A

Elevated jugular venous pressure will be present if edema is due to HF

39
Q

What is the proper way to assess LE edema?

A

ALWAYS start at the feet, then work your way proximally to see how far the edema extends

need to check sacral and scrotal areas and need to check over a bone

40
Q

**What is the edema rating scale? Specifically need to know time frame

A
41
Q

Pulsus alternans is pathognomonic for _____

A

severe LV failure

42
Q

What does a laterally displaced apical impulse indicate? May feel _____ with pulmonary HTN

A

indicates LV enlargement

parasternal lift of RV

43
Q

______ is associated with systolic HF

______ more common to find in diastolic HF

A

S3 gallop

S4 gallop

44
Q

What is the goal of diagnostic studies in HF?

A

is not only to confirm that symptoms are due to HF but then to determine the CAUSE of the HF

45
Q

What are tests you want to order when working a pt up for HF? What are you looking for in each?

A

EKG -> arrhythmia that might be cause

CXR -> pulm edema or cardiomegaly

46
Q

What are Kerley B lines? Where are they most commonly seen?

A

(thickened interlobular septa) are thin, 1-2 cm lines, virtually always at the lungs BASE and at the lung PERIPHERY lying perpendicular to the pleural surface to which they contact

47
Q

What lab studies do you want to order in CHF?

A

BNP
Tropinin I and T
Magnesium

(plus all the normal ones)

48
Q

_____ is the best lab for HF evaluation. Why is it really good? What is it used for?

A

BNP and NT-proBNP

really good at excluding HF because it has a very high negative predictive value

so if BNP is normal, swelling is from something else!!

Useful in supporting diagnosis and establishing severity

49
Q

What are the normal ranges for BNP? NT-proBNP? What is the difference between the two?

A

Normal value for BNP is < 100 pg/mL (NT-proBNP <300)

Only difference is their half life - NT-proBNP is longer

50
Q

a BNP of _____ and NT proBNP of _____ = Low probability of HF

A
51
Q

a BNP of _____ and NT proBNP of _____ = intermediate probability of HF

A
52
Q

a BNP of _____ and NT proBNP of _____ = high probability of HF

A
53
Q

What are the limitations of BNP and NT-proBNP?

A

Pt may present with more than one cause for dyspnea, ex. PNA and HF

Pts with severe chronic HF may have persistently elevated levels of BNP

54
Q

There are ____ causes of elevated BNP. Name a few

A

MANY!!

ACS, LVH, valvular disease, Afib, S/P Cardioversion
Increased age, Severe anemia, Renal failure
PNA, Pulm HTN
Sepsis, Severe burns

55
Q

What does a significant elevation of troponin I or T indicate?

A

Significant elevations and upward trend typically indicates an ischemic source for the HF

but can be elevated without an ischemic cause

56
Q

What are 2 non-ischemic related causes of elevated troponin?

A

ongoing myocardial injury or necrosis

associated with increased mortality rate

57
Q

All HF pts need a ________. Why?

A

Echocardiography!!! ECHO!!

looks at ventricular size and function and can detect regional wall motion abnormalities

58
Q

_____ is especially helpful in detecting _______. If that is normal, ____ needs to be considered

A

Stress testing

CAD

coronary angiography

59
Q

**______ is the gold standard for diagnosing heart failure. What is being measured? **What number does it have to be to confirm diagnosis?

A

Right heart catheterization

identification of an elevated pulmonary capillary wedge pressure (PCWP) at rest or exercise on an invasive hemodynamic exercise test in a patient with symptoms of HF

**If a patient has symptoms consistent with HF and PCWP ≥15 mmHg at rest or ≥25 mmHg during exercise, a diagnosis of HF is confirmed, regardless of LVEF

60
Q

What is the Pulmonary capillary wedge pressure (PCPW)?

A

is a measurement of the pressure in the pulmonary arterial system that estimates the pressure in the left atrium of the heart

61
Q

What are the 5 classes of recommendations with regards to HF treatment options?

A
62
Q
A

Cardio (20 decks)

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