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Clinical Medicine 2 > Exam 1: Heart Failure > Flashcards

Exam 1: Heart Failure Flashcards

1
Q

What is heart failure?

A

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

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2
Q

What is left heart systolic dysfunction ?

A

Impaired cardiac contractile function

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3
Q

What is left heart diastolic dysfunction?

A

Abnormal cardiac relaxation

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4
Q

What is HFrEF? Systolic or diastolic?

A

Heart failure with reduced ejection fraction, systolic

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5
Q

What is HFpEF? Systolic or diastolic?

A

Heart failure with preserved ejection fraction, diastolic

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6
Q

How does HFrEF present?

A

Systolic dysfunction, reduced left ventricular EF (< 40%) and increased LV volumes
-Eccentric remodeling

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7
Q

What are the causes of HFrEF?

A

Impaired contractility (CAD and cardiomyopathy) and high afterload (HTN)

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8
Q

How does HFpEF present?

A

Diastolic dysfunction, normal LVEF, normal to decreased LV end diastolic volume (increased pressure)
-Concentric remodeling

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9
Q

What determines LV diastolic pressure?

A

The volume of blood in ventricle and distensibility or compliance of the ventricle.

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10
Q

When LV diastolic pressure increases, what else increases?

A

Pulmonary venous pressures, which may cause pulmonary arterial pressure which increases afterload on the right ventricle (may lead to RHF)

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11
Q

When compared to HFrEF, patients with HFpEF tend to be…?

A

Older, have HTN, overweight, and women

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12
Q

What is the most common cause of right heart failure?

A

Left heart failure

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13
Q

What is the most common underlying cause of heart failure?

A

CAD

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14
Q

What are the most common symptoms seen with heart failure?

A

Dyspnea, fatigue, dependent edema, and weight gain

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15
Q

Does right or left heart failure have decreased cardiac output and pulmonary congestion?

A

Left heart failure

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16
Q

Does right or left heart failure have congestion of peripheral tissues?

A

Right heart failure

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17
Q

What kind of heart failure is most likely causing the following symptoms: Peripheral edema, RUQ pain, JVD, and ascites.

A

Right heart failure

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18
Q

What CXR findings are suggestive o HF?

A

Cardiomegaly, cephalization of Pulmonary vessels, kerley B lines, and pleural effusions

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19
Q

What labs should you order when your patient has heart failure?

A

Cardiac enzymes, CBC, CMP, and BNP

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20
Q

When is ordering a BNP useful?

A

Diagnosing HF, risk stratification, and guiding the treatment of patients with HF

21
Q

What kind of patients should you order a BNP for?

A

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

22
Q

What is recommended initial therapy for HFrEF?

A

ACE inhibitor and diuretic

23
Q

When prescribing diuretics, what medication and dosage should you start with?

A

20-40mg furosemide

24
Q

When should you use ARBs?

A

When ACE inhibitors are not tolerated

25
Q

If a patient has a normal EKG, what kind of heart failure is unlikely?

A

Systolic dysfunction

26
Q

What should you do when placing your patient on diuretics?

A

Monitor renal function and electrolytes (hypokalemia)

27
Q

What should you do when placing your patient on an ACE inhibitor?

A

Monitor blood pressure, renal function, electrolytes (hyperkalemia)

28
Q

When are MRAs indicated?

A

Patients with at rest dyspnea within the past 6 months

29
Q

When is hydralazine indicated?

A

Patients who cannot take ACE, ARB, or ARNI

-Add on therapy for African American patients

30
Q

When is Ivabradine used?

A

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

31
Q

When you having a patient on digoxin, what should their serum levels be?

A

Between 0.5 and 0.8

32
Q

What are the most common causes of death in patients with heart failure?

A

Progressive pump failure and malignant arrhythmias

33
Q

What is acute decompensated heart failure?

A

A complication of HF, elevated left sided filling pressures and dyspnea with or without pulmonary edema

34
Q

What most often causes cardiogenic pulmonary edema?

A

Acute decompensated heart failure

35
Q

What is often seen on CXR in patient with cardiogenic pulmonary edema?

A

Kerley B lines, edema, and cardiomegaly.

36
Q

You see a patient with dyspnea and a productive cough itch pink and frothy sputum. What should you be concerned about?

A

Cardiogenic pulmonary edema

37
Q

How does heart failure progress?

A

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)

38
Q

What kind of remodeling does HFrEF have?

A

Eccentric

39
Q

What kind of remodeling does HFpEF have?

A

Concentric

40
Q

What can happen when there is increased afterload to the right heart?

A

Pulmonary embolism and chronic pulmonary disease

41
Q

What is the BNP value when you can rule out CHF?

A

100 or less

42
Q

What is the BNP value when you an rule in CHF?

A

500 or above

43
Q

What is the NT-proBNP value where you can rule out CHF in patients <50?

50-75?

75?

A

300 for all

44
Q

What is the NT-proBNP value where you can rule in CHF in patients <50?

50-75?

75?

A

450

900

1800

45
Q

What are the goals of therapy in HF?

A
  • Reduce preload to diminish congestive symptoms

- reduce afterload to improve cardiac function

46
Q

What is the main side effect of beta blockers?

A

Bradycardia

47
Q

What should you monitor when placing your patient on an MRA?

A

Electrolytes, fluid, balance, and renal function (may result in hyperkalemia )

48
Q

What is digoxin and what are these types of medications used for?

A

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

49
Q

How is ADHF managed?

A
  • O2
  • Diuretics
  • Nitro

Clinical Medicine 2 (22 decks)

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