E3: Heart Failure Flashcards
Systolic Failure (LVEF <40%)
HF w/REDUCED ejection fraction (HFrEF)
Fluid backed up in lungs, pulmonary edema, SOB, fatigue
Often due to systemic HTN
Left sided heart failure
↓cardiac muscle cell contractility
HF w/REDUCED ejection fraction (HFrEF)
Symptoms:
Dyspnea
Orthopnea
SOB
Exercise intolerance
Tachycardia
Fatigue
Cyanosis: loss of O2
Left sided heart failure
Volume overload
HF w/REDUCED ejection fraction (HFrEF)
↓ muscle mass
Thinned muscle
HF w/REDUCED ejection fraction (HFrEF)
Fluid backed up in legs and abdomen = ascites
Often due to lung disease (COPD or pulmonary arterial hypertension)
Fluid backs up into right ventricle/atria
Ascites (fluid in abdomen from back up in venous system)
Right heart sided failure
Excess end diastolic volume
HF w/REDUCED ejection fraction (HFrEF)
Symptoms:
Nocturia
Volume overload: bloating
Edema
Ascites
Jugular venous distention
Hepatojugular reflex/HJR
Fatigue
Cyanosis
Right heart sided failure
Diastolic failure
HF w/PRESERVED Left ventricular ejection fraction (HFpEF)
Left sided HF biggest cause
Right heart sided failure
Hypertrophic (THICKENED heart muscle)
HF w/PRESERVED Left ventricular ejection fraction (HFpEF)
Medications that may precipitate or exacerbate HF
- Negative inotropic agents
2.Cardiotoxic agents: Carbamazepine-Tegretol
3.Agents that cause Na+ and H2O Retention
HF is end result of decades of ___ _________
CV disease
↓ in ventricular compliance will result in ↓ ventricular filling
Ventricle is unable to accept an adequate volume of blood from the venous system
HF w/PRESERVED Left ventricular ejection fraction (HFpEF)
Negative inotropic agents that may precipitate or exacerbate HF
Beta-blockers: propranolol-Inderal, metoprolol-Toprol, carvedilol-Coreg
CCB: verapamil-Calan, diltiazem-Cardizem
Cardiotoxic agents that may precipitate or exacerbate HF
Carbamazepine-Tegretol
agents that cause Na+ and H2O Retention that may precipitate or exacerbate HF
NSAIDS
COX2 Inhibitors
Glucocorticoids
Salicylates
Na+ containing drugs (carbenicillin disodium)
Dipeptidyl peptidase-4 inhibitors (saxagliptin-Onglyza, sitagliptin-Januvia)
↓ end diastolic volume
HF w/PRESERVED Left ventricular ejection fraction (HFpEF)
Examples of CV disease that cause HF
Coronary artery disease/ischemic heart disease: MOST COMMON CAUSE (67%)
Pressure overload: HTN
Ventricular hypertrophy, pressure overload, restricted ventricular filling, ↑ ventricular stiffness
HF w/PRESERVED Left ventricular ejection fraction (HFpEF)
Natriuretic Peptides (3)
Atrial natriuretic peptide (ANP)
B-type natriuretic peptide (BNP)
NT-proBNP
Actions of natriuretic peptides in the body
Natriuresis
Diuresis
Vasodilation of blood vessels
ACCF/AHA HF Classifications
Stage A: Patients at high risk for developing HF
Stage B: Patients w/structural heart disease but no HF s/sx
Stage C: Patients w/structural heart disease & current or previous symptoms
Stage D: Refractory HF requiring specialized interventions
NYHA Functional Classification
- Patients w/cardiac disease but without limitation of physical activity
- Patients w/cardiac disease that results in slight limitation. Ordinary physical activity = fatigue, palpitation, dyspnea, angina
- Patients w/cardiac disease that results in marked limitation of physical activity. Although patients are comfortable at rest, less-than ordinary activity will lead to symptoms
- Patients w/cardiac disease that results in an inability to carry on physical activity without discomfort. Symptoms of congestive heart failure are present event at rest. With any physical activity, increased discomfort is experienced
Comparison of ACC/AHA and NYHA Classifications
Class A = N/A
Class B = Class 1
Class C = Class 1, 2, 3
Class D = Class 4
