Exam 1: Heart Failure Flashcards
What is heart failure?
Complex clinical syndrome that can results from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood
What is left heart systolic dysfunction ?
Impaired cardiac contractile function
What is left heart diastolic dysfunction?
Abnormal cardiac relaxation
What is HFrEF? Systolic or diastolic?
Heart failure with reduced ejection fraction, systolic
What is HFpEF? Systolic or diastolic?
Heart failure with preserved ejection fraction, diastolic
How does HFrEF present?
Systolic dysfunction, reduced left ventricular EF (< 40%) and increased LV volumes
-Eccentric remodeling
What are the causes of HFrEF?
Impaired contractility (CAD and cardiomyopathy) and high afterload (HTN)
How does HFpEF present?
Diastolic dysfunction, normal LVEF, normal to decreased LV end diastolic volume (increased pressure)
-Concentric remodeling
What determines LV diastolic pressure?
The volume of blood in ventricle and distensibility or compliance of the ventricle.
When LV diastolic pressure increases, what else increases?
Pulmonary venous pressures, which may cause pulmonary arterial pressure which increases afterload on the right ventricle (may lead to RHF)
When compared to HFrEF, patients with HFpEF tend to be…?
Older, have HTN, overweight, and women
What is the most common cause of right heart failure?
Left heart failure
What is the most common underlying cause of heart failure?
CAD
What are the most common symptoms seen with heart failure?
Dyspnea, fatigue, dependent edema, and weight gain
Does right or left heart failure have decreased cardiac output and pulmonary congestion?
Left heart failure
Does right or left heart failure have congestion of peripheral tissues?
Right heart failure
What kind of heart failure is most likely causing the following symptoms: Peripheral edema, RUQ pain, JVD, and ascites.
Right heart failure
What CXR findings are suggestive o HF?
Cardiomegaly, cephalization of Pulmonary vessels, kerley B lines, and pleural effusions
What labs should you order when your patient has heart failure?
Cardiac enzymes, CBC, CMP, and BNP
When is ordering a BNP useful?
Diagnosing HF, risk stratification, and guiding the treatment of patients with HF
What kind of patients should you order a BNP for?
Patients presenting with dyspnea to support a diagnosis of HF, or in patients with chronic HF on admission to the hospital to establish prognosis in acutely decompensated HF
What is recommended initial therapy for HFrEF?
ACE inhibitor and diuretic
When prescribing diuretics, what medication and dosage should you start with?
20-40mg furosemide
When should you use ARBs?
When ACE inhibitors are not tolerated
If a patient has a normal EKG, what kind of heart failure is unlikely?
Systolic dysfunction
What should you do when placing your patient on diuretics?
Monitor renal function and electrolytes (hypokalemia)
What should you do when placing your patient on an ACE inhibitor?
Monitor blood pressure, renal function, electrolytes (hyperkalemia)
When are MRAs indicated?
Patients with at rest dyspnea within the past 6 months
When is hydralazine indicated?
Patients who cannot take ACE, ARB, or ARNI
-Add on therapy for African American patients
When is Ivabradine used?
patients with chronic HFrEF, LV ejection fraction of less than 35% in NSR, resting HR is greater than 70 on max dose beta blocker, or use of beta blocker is contraindicated
When you having a patient on digoxin, what should their serum levels be?
Between 0.5 and 0.8
What are the most common causes of death in patients with heart failure?
Progressive pump failure and malignant arrhythmias
What is acute decompensated heart failure?
A complication of HF, elevated left sided filling pressures and dyspnea with or without pulmonary edema
What most often causes cardiogenic pulmonary edema?
Acute decompensated heart failure
What is often seen on CXR in patient with cardiogenic pulmonary edema?
Kerley B lines, edema, and cardiomegaly.
You see a patient with dyspnea and a productive cough itch pink and frothy sputum. What should you be concerned about?
Cardiogenic pulmonary edema
How does heart failure progress?
Damage to the myocardium (either abrupt, gradual, or hereditary) and then progressive disease (contributes to cardiac remodeling and there is neurohormonal imbalance cause by overactivation of the renin angiotensin aldosterone system)
What kind of remodeling does HFrEF have?
Eccentric
What kind of remodeling does HFpEF have?
Concentric
What can happen when there is increased afterload to the right heart?
Pulmonary embolism and chronic pulmonary disease
What is the BNP value when you can rule out CHF?
100 or less
What is the BNP value when you an rule in CHF?
500 or above
What is the NT-proBNP value where you can rule out CHF in patients <50?
50-75?
75?
300 for all
What is the NT-proBNP value where you can rule in CHF in patients <50?
50-75?
75?
450
900
1800
What are the goals of therapy in HF?
- Reduce preload to diminish congestive symptoms
- reduce afterload to improve cardiac function
What is the main side effect of beta blockers?
Bradycardia
What should you monitor when placing your patient on an MRA?
Electrolytes, fluid, balance, and renal function (may result in hyperkalemia )
What is digoxin and what are these types of medications used for?
An inotropic agent, which are used to improve symptoms and decreased hospitalization rates in symptomatic heart failure.
-Also used in patient with concomitant atrial fibrillation
How is ADHF managed?
- O2
- Diuretics
- Nitro
