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