Exam 4 Heart Failure Part 1 Flashcards
Heart failure is an emerging worldwide epidemic with more than ____ million pts in the US will be treated for the condition by 2030
8 million
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HF is defined as a complex syndrome that results from any structural or functional impairment of ____ or _____.
ventricular filling or blood ejection
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HF leads to:
- tissue-hypoperfusion
- causingfatigue
- dyspnea
- weakness
- edema
- weight gain
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HF may be caused by structural abnormalities of the ….?
- pericardium
- myocardium
- endocardium
- heart valves
- or great vessels
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HF with reduced EF (HFrEF, aka ____HF) is classified as HF w/ EF ___
- systolic HF
- ≤40%
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HF with preserved EF (HFpEF, aka ____ HF) is diagnosed as HF w/ EF____
- diastolic HF
- ≥50%
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HF symptoms and an EF btw 40-49%
Borderline HFpEF
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____ dysfunction is present in both HFrEF andHFpEF
Diastolic
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what are distinguishing features between HFrEF and HFpEF?
- LV dilation patterns
- remodeling
- also have different responses to medicaltreatment
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____ remains a useful tool, as it is easily measured onechocardiogramand serves asthe main marker for determining HF risk factors, treatment, and outcomes
Ejection fraction
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̴1/2 HF pts have normal (____%) ejection fraction
- > 50%
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The proportion of pts with HFpEF is increasing d/t its relationship w/conditions such as :
- HTN
- DM
- A-fib
- obesity
- metabolic syndrome
- COPD
- renal insufficiency
- anemia
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Pts with HFrEF are more likely to have modifiable risk factors (smoking, hyperlipidemia) as well as a higher incidence of :
- myocardial ischemia & infarction
- previous coronary intervention
- CABG
- PVD
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- ____% HF cases are HFpEF
- ____% are HFrEF
- ____% are borderline HFpEF (EF 40-49%)
- 52% HF cases are HFpEF
- 33% are HFrEF
- 16% are borderline HFpEF (EF 40-49%)
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- ____ are more likely to be affected by HFpEF
- ____ more likely to be affected by HFrEF
- Women are more likely to be affected by HFpEF
- Men more likely to be affected by HFrEF
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LV diastolic dysfunction (LVDD) is the primary determinant of ____, whereas contractile dysfunctionis the primary determinant for ____.
- HFpEF
- HFrEF
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The LV’s ability to fill is determined by:
- pulmonary venous blood flow
- LA function
- mitral valve dynamics
- pericardial restraint
- the active & passive elastic properties of LV
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LV diastolic function is normal when these factors combine to provide a LVEDV (preload) that provides sufficient ____ for cellular metabolism without elevating ____ and ____.
- cardiac output
- pulmonary venous pressures and LA pressures
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LVDD
The majority ofLVDD measurements depend on:
- HR
- loading conditions
- andmyocardial contractility
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In HFpEF, higher LV filling pressures are required to achieve normal ____
end-diastole volume
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A steeper rise of the end-diastolic pressure-volume curve is indicative of ____ LV relaxation and ____ myocardial stiffness. This leads to:
- delayed
- increased
Leads to:
* reduced LV compliance and precipitates LA hypertension
* LA systolic &diastolic dysfunction
* pulmonary venous congestion
* exercise intolerance
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- what does the left LV pressure volume loop show?
- what does the right LV pressure volume loop show?
- Left: decreased contractility is indicated by a decrease in the slope of the end-systolic pressure-volume relation(HFrEF)
- Right: decreased in LV compliance is indicated by an increase in the end-diastolic pressure-volume relation slope (HFpEF)
- These diagrams emphasize that heart failure may result from LV systolic or diastolic dysfunction independently
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what are common causes of left ventricular diastolic dysfunction?
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Delays in relaxation are a form of “____” c/b failure of the actin-myosin disassociation, which occurs due to ____ or ____.
- active stiffening
- occurs d/t: inadequate perfusion or dysfunctional intracellular Ca++ homeostasis
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LV relaxation d/o afterload, which is typically elevated in ____ pts
hypertensive
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____ exacerbates the failure of LV relaxation
Tachycardia
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- Profound exercise intolerance is seen w/HFpEF despite having only a modestly depressed ____
- In addition, prolonged compression of the coronary arteries restricts diastolic coronary blood flow, which contributes to ____ and a further reduction in exercise tolerance
- LV systolic function
- subendocardial ischemia
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Most common symptoms of HF?
- fatigue
- tachypnea
- dyspnea
- paroxysmal nocturnal dyspnea
- orthopnea
- S3 gallop
- JVD
- peripheral edema
- exercise intolerance
- reduced tissue perfusion
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what symptoms are more common with HFpEF?
- paroxysmal nocturnal dyspnea
- pulmonary edema
- dependent edema
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what sypmtom is more common with HFrEF
S3 gallop
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When EF is reduced, the presence of HF symptoms establishes the diagnosis of ____(following standard guidelines)
HFrEF
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In contrast to ____ , the initial diagnosis of____is often more difficult,especially when the pt has little/no symptoms at rest
- HFrEF
- HFpEF
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Cardiac catheterization defines ____ and ____ usingpressure-volume analysis or provocative testing (s/a exercise & rapid IV volumeexpansion)
elevated LV systolic and diastolic stiffness
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Direct measurement of RV filling pressures offers further information about the severity of____
HFpEF
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Mean pulmonary capillary wedge pressure >____mmHg at rest or ____mmHg duringexercise provides strong evidence ofHFpEFand is a predictor of mortality
- > 15 mmhg
- 25 mmhg
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CXR may detect what?
- pulmonary dz
- cardiomegaly
- pulmonary venous congestion
- interstitial or alveolar pulmonary edema
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CXR
An early radiographic sign of LV failure & pulmonary venous HTN is distention of ?
the pulmonary veins in the upper lobes of the lungs
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____, produce a honeycomb pattern, reflect interlobular edema & may be present in HF
Kerley lines
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ACC/AHA criteria vs ESC crietria of HF?
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The New York Heart Association (NYHA) and the ACC/AHA created classification systems for HF. The NYHA system focuses primarily on ____ whereas the ACC/AHA focus on ____.
- NYHA: the degree of physical limitation
- ACC/AHA: the presence & severity of HF
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Classification of HF
- Since progression of HF is linked to reduced 5-year survival, it is important to note that these stages are ____
- Pts are oftenclassified using a combination of ____?
- progressive
- both scoring systems(NYHA and ACC/AHA)
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what is the treatment algorithm for HFpEF?
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LVAD is used for?
- temporary ventricular assistance while heart is recovering its function
- Pts awaiting cardiac transplant
- Pts are on inotropes or balloon pump (IABP) with potentially reversible medical conditions
- Pts with advanced HF who aren’t transplant candidates
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