Exam 2: HF Flashcards
Definition of HF
failure of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissues
Most common cause of HFrEF
CAD (Ischemic Dilated CM)
Other causes: HTN, valvular Dz, cardiomyopathies
Definition of HFrEF
HF symptoms with EF < 40%
Impairment in Cardiac Function: HFrEF
Systolic dysfunction: decreased contractility
HFpEF Definition
HF symptoms with EF > 50%
Impairment in Cardiac Function
diastolic dysfunction: impairment in ventricular relaxation/filling
Cause of HFpEF
HTN is most common cause
Determinants of LV Performance (Stroke Volume)
Preload: venous return, LVEDV
Myocardial Contractility: force generated at any given LVEDV
Afterload: Aortic impedance and wall stress
Medications that Reduce Preload (move left on FS Curve)
diuretics
nitrates
Medications that increase cardiac output (move up on FS Curve)
ACE inhibitors
positive inotrope
Factors precipitation or worsening HF
lack of compliance
Drug Induced HF
drugs that reduce contractility (inotropes)
drugs that cause direct cardiac toxicities
drugs that cause fluid overload
Natriuetic Peptides Labs
BNP > 35 pg/mL
NT-proBNP >125 pg/mL
NYHA Class 1
patients with cardiace disease but without limitations of physical activity
asymptomatic disease
NYHA Class II
patients with cardiac disease resulting in slight limitations of physical activity
NYHA Class III
patients with cardiac disease resulting in limitations of physical activity
NYHA Class IV
patients with cardiac disease resulting in inability to carry on any physical activity without discomfort
AHA Stage A
high risk of developing HF but no identified structural or functional abnormalities of the heart and have never shown signs or symptoms of HF
AHA Stage B
Structural heart disease that is strongly associated with HF but no signs or symptoms of HF
Class I
AHA Stage C
current or prior symptoms of HF associated with underlying structural heart disease
class II and III
AHA Stage D
advanced structural heart disease and marked symptoms of HF at rest despite max medical therapy and who require specialized interventions
General Measures: Exercise
dynamic exercise to increase HR 60-80% of maximum for 20-60 minutes 3-5 times/week
General Measures: Sodium
intake should be restricted to 2-3 grams/day as possible
General Measures: Alcohol
patients with EtOH induced HF should totally abstain
No more than 2 or 1 drink per day
General Measures: Misc
weight monitoring
general education
smoking cessation
immunizations
electrolytes
thyroid disease mgnt
herbal products
Drug Therapy Strategies: Diuretics/SGLT2i
reduce intravascular volume
Drug Therapy Strategies: positive inotropes
increase myocardial contractility
Drug Therapy Strategies: ACEi, vasodilators, SGLT2i
decrease ventricular afterload
Drug Therapy Strategies: ARNis, BB, ACEi/ARBs, MRAs, SGLT2i
neurohormonal blockade
GDMT for Stage A
if ASCVD present: ACEi/ARB
GDMT for Stage B
if previous MI or asymptomatic rEF: ACEi/ARB or BB
GDMT for Stage C
ARNI/ACE/ARB (ARNI preferred)
GDMT BB
Aldosterone Antagonist
SGLT2i
loop for symtpomatic only
Place of Therapy: ISDN/Hydralazine
Class I Evidence A: if black and persistently symptomatic on GDMT
Class IIa Evidence B: if ARNI/ACE/ARB intolerant
Place of Therapy: Digoxin
Class IIa Evidence B: if persistently symptomatic on GDMT
Place in Therapy: Ivabrandine
NYHA Class II-III symptoms in NSR and HR≥ 70 bpm on maximally tolerated BB
Diuretics: Place in Therapy
All HF patients with signs/symptoms of fluid retention should be managed with diuretics
reduce hospitalizations but do not have effect on mortality or natural progression of HF
