Exam 5: heart failure Flashcards
What is Heart Failure (HF)?
HF is a complex syndrome leading to impaired ventricular filling or blood ejection
systemic hypoperfusion
HF may be caused by structural abnormalities of the pericardium, myocardium, endocardium, heart valves, or great vessels.
What are common symptoms of Heart Failure?
Fatigue, dyspnea, weakness, edema, and weight gain.
What characterizes HF with reduced ejection fraction (HFrEF)?
HF with EF ≤ 40%.
What characterizes HF with preserved ejection fraction (HFpEF)?
HF with EF ≥ 50%.
maintaining normal EF
What is ‘borderline HFpEF’?
Symptomatic HF with an EF between 40-49%
boarderline EF
Diastolic dysfunction is present in both HFrEF and HFpEF or in one?
in both
What is the main marker for determining HF risk factors, treatment, and outcomes?
Ejection fraction, measured on echocardiogram.
What proportion of HF patients have a normal ejection fraction?
Approximately 1/2 of HF patients have normal (>50%) ejection fraction.
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, and anemia
Pts with HFrEF are more likely to have what type of risk factors?
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, and PVD
What conditions are associated with the increasing proportion of HFpEF?
- Hypertension (HTN)
- Diabetes Mellitus (DM)
- Atrial fibrillation (A-fib)
- Obesity
- Metabolic syndrome
- Chronic obstructive pulmonary disease (COPD)
- Renal insufficiency
- Anemia.
Which gender is more likely to be affected by HFpEF?
Women.
Which gender is more likely to be affected by HFrEF?
Men.
What is the primary determinant of HFpEF?
Left ventricular diastolic dysfunction (LVDD).
What is the primary determinant for HFrEF?
Left ventricular systolic dysfunction (LVSD).
What factors determine the left ventricle’s ability to fill?
- Pulmonary venous blood flow
- Left atrial (LA) function (atrial kick)
- Mitral valve dynamics
- Pericardial restraint
- Elastic properties of the left ventricle.
What does a steeper rise of the end-diastolic pressure-volume curve indicate?
Delayed left ventricular relaxation and increased myocardial stiffness.
What common symptoms are associated with HFpEF?
Paroxysmal nocturnal dyspnea, pulmonary edema, dependent edema.
Exercise intolerance occurs with what type of heart failure?
w/HFpEF
What common symptoms are more prevalent in HFrEF?
S3 gallop.
Cardiac catheterization defines elevated ____ systolic and diastolic stiffness using pressure-volume analysis
left ventrical
What is the ACC/AHA diagnostic criteria for HFpEF? (3)
HF symptoms, EF > 50%, and evidence of LVDD.
Mean pulmonary capillary wedge pressure >____mmHg at rest or ____mmHg during exercise indicates HFpEF and is a predictor of mortality
15; 25
What signs on chest xrays may indicate HF?
An early sign of LV failure & pulmonary venous HTN is distention of the pulmonary veins in the upper lung lobes
Perivascular edema appears as a hilar haze with ill-defined margins
Kerley lines produce a honeycomb pattern, which reflect interlobular edema
Alveolar edema produces densities in the lung fields, typically in a butterfly pattern
Pleural effusion and pericardial effusion may be present
Radiographic evidence of pulmonary edema may lag behind the clinical evidence by up to ___ hours
12
acute heart failure patients may have clear lungs
