Exam 1 - HF Flashcards
Define Preload. What determines it?
Loading condition of heart at end of diastole, right before systold. Mainly determined by venous return to heart.
Define Afterload. What determines it?
Force heart must generate to eject blood from filled heart. Determined by ventricular wall tension and peripheral vascular resistance.
Define Contractility
Ability of heart to contract
What is an Inotropic Influence?
Increases heart contractility
What is a Positive Inotropic Action? Examples?
Stimulates heart to increase contraction.
Ex: Ditigalis (aka Digoxin), sympathetic stimulation
What is a Negative Inotropic Action? Examples?
Something which decreases hearts contractility. Akinesis (lack of movement) of part of heart wall.
What is Left Ventricular Ejection Fraction?
Percent of blood leaving the heart each time it contracts.
LEVF aka EF
What is normal EF?
55-65%
What can an EF more than 65% signify?
Dehydration or massive blood loss
What does the Frank-Starling Curve mean?
More pull a contracting agent the stronger the recoil
Define Heart Failure
Structural or functional cardiac disorder, or both. (Functional caused by structural.)
–Impaired ventricle filling or impaired ventricle ejection.
Describe Low Output HF? (Hint: what’s impaired, causes)
Impaired pumping ability. D/T HTN and CAD.
Most common type of HF.
Describe High Output HF? (hint: pump and causes)
Excessive need for high output but still inadequate for body’s needs. 3 causes:
- Beri-Beri=Thiamine deficiency causing vasodilation and increased blood volume
- Anemia
- Thyrotoxicosis
Describe Right Sided HF? (hint: etiology, pathophys)
D/t Left Sided HF (most common), Pulm Dz, or Pulmonic Valve Stenosis.
-Blood backup into systemic venous system (legs, hepatic veins, GI tract), and JVD
What are the two types of Left Sided HF?
Systolic and Diastolic HF
What happens to blood in Left Sided HF? Etiology?
Backs up into lungs (pulm edema), backs up to right side of heart, and systemic venous system.
-D/t MI, CAD w/many small infarcts, caridomyopathy, LVH from long-term HTN
What happens to Afterload and Preload in HF?
Increased Afterload and increased Preload
What happens to heart contractility in HF?
Decreased contractility
What type of arrythmias can causes HF?
Afib w/RVR, other tachyarrythmias
What can cause decompensation in chronic HF?
Increased Na, increased fluid, missed diuretic dose, poor compliance, massive thanksgiving meal, moved to nursing home with high Na food
What it the main Sx in HF?
SOB/DOE (dyspnea on exertion)
What is the main form of HF?
Systolic HF
What is MC of Systolic HF?
Ischemic heart dz from MI
Also HTN causing LVH, valve dz, CAD
What is the murmur heard in Systolic HF?
S3 gallop
What is heard at lung bases in Systolic HF? What seen on LEs?
Lungs bases=Crackles
LEs=putting edema
What happens to EF in Systolic HF?
Decreased HF
S3 gallop murmur heard in which type of HF?
Systolic HF
EKG findings on Systolic HF?
AFib, acute MI, prior MI (pathologic Q-waves), a
CXR findings on Systolic HF?
Bunted costophrenic angles Pulm vein engorgement, Cephalization, Kerley B Lines, cardiomegaly
How to dx Systolic HF? (and all other HFs)
Echo
Which lab result can rule in HF?
BNP. Released due to heart stretch/strain. High BNP can rule in HF.
What happens to the LV chamber and walls in Systolic HF?
Walls become thin. Chamber becomes dialated.
General tx for HF?
Reduce Na+, reduce fluids, tx underlying dz. ACEi, loop diuretics (Furosemide), Beta-blocker.
What med should all HF patients be getting? What does it do to loads and output?
ACE-I. Decreases Afterload and increases CO.
When do give Beta-Blocker in HF?
When PT is relative stable and not in acute distress.
Etiologies of Diastolic HF?
HTN, RCMP
EF in Diastolic HF?
Preserved or increased
Murmur in Diastolic HF?
S4 gallop=Atrial contraction into stiff ventricle.
S4 gallop murmur heard when?
In Diastolic HF.
Ventricle walls and chamber size in Diastolic HF?
Thick ventricular walls. Small LV
Tx for Diastolic HF?
ACEi, BB, CCB (Dilt)
If African American what medication combo improves outcomes?
Hydralazine + Isosorbide Dinitrate
If HF patient hospitalized what medication class to use?
Positive Inotrope to increase contractility.
Do Positive Inotropes improve mortality in HF?
No, just prevent hospitalization.
What do ACE-Is do for HF?
Decrease Afterload, increased CO
What do Beta-Blockers do for HF?
Increase EF, improve remodeling, decrease scar tissue formation
Which class diuretics to use in HF?
Loop Diuretics (Furosemide/Lasix)
What do use an adjunct to Loop Diuretics esp if K is low?
Potassium Sparring Diuretics (Spironolactone)
If PT w/HF hospitalized and has severe edema what is goal for fluid reduction?
1L-1.5L/day
What is Acute-on-Chronic HF?
PTs with CHF for many years who have been undertreated and undermanaged but bodies have compensated in a number of ways including angiogenesis or lung changes.
What is absent in Acute-on-Chronic HF? What to check?
Signs and symptoms are mostly normal. Check BNP!
How to tx Acute Decompensated HF?
- Hospitalize and use IV Loop Diuretics (Furosemide) w/goal of -1L to -1.5L/day.
- Fluid restriction to 1.5L.
- Rate control with BB or CCB if have rapid Afib
- Monitor K, Mg, and kidney function
How to treat Severe Hemodynamic Compromise in HF? (If severely hypoxic or severe resp distress.)
- Intubate, admit to CCU
- Give Positive Inotrope=Dobutamine, Milrinone
- Give Vasocontrictors=Dopamine, Epi, Phenylepherine, Vasopressors
- Mechanical and surgical support=Intraaortic balloom pump, LV assist device
