Exam 3 - HF pt 2 (Cook) Flashcards
What is heart failure?
Complex syndrome where the heart is unable to pump blood effectively to meet the body’s needs
What is congestive heart failure?
Type of HF where fluids build up in tissues
What is acute heart failure?
Sudden worsening of HF symptoms
What is left ventricular ejection fraction (LVEF)?
% of blood ejected from LV with each heartbeat
What is HFrEF?
HF with LVEF ≤ 40%
Also called systolic HF
What is HFpEF?
HF with LVEF ≥ 50%
Also called diastolic HF
What type of HF has an EF ranging from 40-50%?
Borderline or mid-range HF
What is HF with improved EF?
EF used to be ≤ 40% but has increased to > 40%
What is mean arterial pressure (MAP)?
Average pressure in arteries during a single cardiac cycle
What role does a pharmacist play in HF management?
Monitoring patients
Optimizing medication regimens
Educating patients about their condition
What are the symptoms of HF?
Fatigue
Shortness of breath
Exertional intolerance
Weight gain
Orthopnea
Nocturnal dyspnea
What are the signs of HF?
Pulmonary rales/crackles
S3 gallop
Peripheral edema
Jugular venous distention
Hepatojugular reflux
What lab tests are needed to detect HF?
BMP, CBC, BNP, NT-proBNP
What imaging is needed to detect HF?
ECG, echocardiogram, chest radiography
What form of imaging is MOST important for detection of HF?
Echocardiogram
What is BNP?
Brain natriuretic peptide — hormone released by heart in response to stress
What BNP levels are indicative of HF?
Increased
What BNP level would raise concern for HF?
> 100 pg/mL
What is NT-proBNP?
N-terminal pro-brain natriuretic peptide — precursor to BNP
What NT-proBNP levels are indicative of HF?
Elevated
What NT-proBNP level would raise concern for HF?
> 300 pg/mL
What does a BMP assess?
Electrolytes, kidney function, glucose levels
What may we see on a BMP in HF?
SCr may increase, hyponatremia (normal and expected)
What does a CBC assess?
RBC, WBC, and platelet counts
What may we see on an ECG in HF?
Normal - variable abnormalities, LV hypertrophy
What does an ECG assess?
Heart rhythm, electrical activity, signs of hypertrophy
What may we see on a chest x-ray in HF?
Pulmonary edema
Pleural effusions
Cardiac enlargement
What can we look at on an echo in potential HF?
LV size
Ejection fraction
Wall motion abnormalities
Why would a HF patient present with hyponatremia?
Dilutional effect, but this is expected and normal
What is hyponatremia?
Low sodium levels in blood
What is the mechanism of hyponatremia?
HF causes hyponatremia due to fluid retention and decreased renal perfusion
What are the stages of HF?
A, B, C, D
What is stage A HF?
At risk patients with no evidence of cardiac structural disease
Who falls into the category of stage A HF?
Most people
What are some examples of stage A HF?
Hypertension
Coronary artery disease
Diabetes mellitus
Metabolic syndrome
What is stage B HF?
Structural cardiac disease with no symptoms
What are some examples of stage B HF?
EF ≤ 40%, previous myocardial infarction, LV hypertrophy
What is stage C HF?
Structural cardiac disease that does have symptoms
What are some examples of stage C HF?
EF ≤ 40%, dyspnea
Reduced exercise tolerance
Fatigue
What is stage D HF?
Refractory HF
What is an example of stage D HF?
Persistently symptomatic at rest, despite appropriate therapy
What are the classes of HF?
I, II, III, IV
When is HF considered class I?
No limitations of physical activity
What are examples of class I HF?
No interruption to work, exercise, or daily activities
When is HF considered class II?
Slight limitations of physical activity
What are examples of class II HF?
Some dyspnea, fatigue, or other symptoms caused by exercise, normal work, household activities
When is HF considered class III?
Marked limitations of physical activity
What are examples of class III HF?
Symptoms present during instrumental activities, or even basic activities of daily living
When is HF considered class IV?
Inability to carry on any physical activity
What are examples of class IV HF?
Symptoms present at rest
