E3: Heart Failure

Question 1

Systolic Failure (LVEF <40%)

Answer 1

HF w/REDUCED ejection fraction (HFrEF)

Question 2

Fluid backed up in lungs, pulmonary edema, SOB, fatigue

Often due to systemic HTN

Answer 2

Left sided heart failure

Question 3

↓cardiac muscle cell contractility

Answer 3

HF w/REDUCED ejection fraction (HFrEF)

Question 4

Symptoms:
Dyspnea
Orthopnea
SOB
Exercise intolerance
Tachycardia
Fatigue
Cyanosis: loss of O2

Answer 4

Left sided heart failure

Question 5

Volume overload

Answer 5

HF w/REDUCED ejection fraction (HFrEF)

Question 6

↓ muscle mass

Answer 6

Thinned muscle
HF w/REDUCED ejection fraction (HFrEF)

Question 7

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)

Answer 7

Right heart sided failure

Question 8

Excess end diastolic volume

Answer 8

HF w/REDUCED ejection fraction (HFrEF)

Question 9

Symptoms:
Nocturia
Volume overload: bloating
Edema
Ascites
Jugular venous distention
Hepatojugular reflex/HJR
Fatigue
Cyanosis

Answer 9

Right heart sided failure

Question 10

Diastolic failure

Answer 10

HF w/PRESERVED Left ventricular ejection fraction (HFpEF)

Question 11

Left sided HF biggest cause

Answer 11

Right heart sided failure

Question 12

Hypertrophic (THICKENED heart muscle)

Answer 12

HF w/PRESERVED Left ventricular ejection fraction (HFpEF)

Question 13

Medications that may precipitate or exacerbate HF

Answer 13

1. Negative inotropic agents
   2.Cardiotoxic agents: Carbamazepine-Tegretol
   3.Agents that cause Na+ and H2O Retention

Question 14

HF is end result of decades of ___ _________

Answer 14

CV disease

Question 15

↓ in ventricular compliance will result in ↓ ventricular filling

Ventricle is unable to accept an adequate volume of blood from the venous system

Answer 15

HF w/PRESERVED Left ventricular ejection fraction (HFpEF)

Question 16

Negative inotropic agents that may precipitate or exacerbate HF

Answer 16

Beta-blockers: propranolol-Inderal, metoprolol-Toprol, carvedilol-Coreg

CCB: verapamil-Calan, diltiazem-Cardizem

Question 17

Cardiotoxic agents that may precipitate or exacerbate HF

Answer 17

Carbamazepine-Tegretol

Question 18

agents that cause Na+ and H2O Retention that may precipitate or exacerbate HF

Answer 18

NSAIDS
COX2 Inhibitors
Glucocorticoids
Salicylates
Na+ containing drugs (carbenicillin disodium)
Dipeptidyl peptidase-4 inhibitors (saxagliptin-Onglyza, sitagliptin-Januvia)

Question 19

↓ end diastolic volume

Answer 19

HF w/PRESERVED Left ventricular ejection fraction (HFpEF)

Question 20

Examples of CV disease that cause HF

Answer 20

Coronary artery disease/ischemic heart disease: MOST COMMON CAUSE (67%)

Pressure overload: HTN

Question 21

Ventricular hypertrophy, pressure overload, restricted ventricular filling, ↑ ventricular stiffness

Answer 21

HF w/PRESERVED Left ventricular ejection fraction (HFpEF)

Question 22

Natriuretic Peptides (3)

Answer 22

Atrial natriuretic peptide (ANP)
B-type natriuretic peptide (BNP)
NT-proBNP

Question 23

Actions of natriuretic peptides in the body

Answer 23

Natriuresis

Diuresis

Vasodilation of blood vessels

Question 24

ACCF/AHA HF Classifications

Answer 24

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

Question 25

NYHA Functional Classification

Answer 25

1. Patients w/cardiac disease but without limitation of physical activity
2. Patients w/cardiac disease that results in slight limitation. Ordinary physical activity = fatigue, palpitation, dyspnea, angina
3. 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
4. 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

Question 26

Comparison of ACC/AHA and NYHA Classifications

Answer 26

Class A = N/A

Class B = Class 1

Class C = Class 1, 2, 3

Class D = Class 4