Gen Med: Lecture 8- CHF Flashcards
What is the Frank Starling relationship?
Stroke volume related to ventricular end diastolic volume
What happens if end diastolic volume is too high?
Stroke volume goes down
What 3 factors affect stroke volume?
Contractility
Preload
Afterload
How does stroke volume increase during exercise?
Increased venous return increase preload
In heart failure, how does the Frank Starling relationship shift and what does it cause?
Shift to the right
Causes higher back pressures in lungs and periphery
What effects does the activation of Beta Receptors have?
Increase contractility
Increase HR
What does excess stimulation of the Beta Receptors cause?
Arrhythmias
What compensatory mechanisms are active in heart failure to make up for decreased CO?
Increased sympathetic hormones
Activation of RAA system
Why are the compensatory mechanisms in heart failure dangerous?
Promote myocyte apoptosis leading to hypertrophy, loss of myocytes, and fibrosis
What type of heart failure is considered a systolic dysfunction?
Left ventricular heart failure with reduced ejection fraction
What type of heart failure is considered a diastolic dysfunction?
Left ventricular heart failure with preserved ejection fraction
What causes systolic dysfunction heart failure?
Diminished ability to pump blood requiring increased filling pressures to meet demands of metabolic tissues like muscles
What types of symptoms does systolic dysfunction lead to?
Peripheral edema
Pulmonary edema
SOB
Weakness
Fatigue
Why does left sided heart failure with reduced ejection fraction/systolic dysfuction cause peripheral edema?
Increased RAA
What can left sided heart failure often lead to?
Right sided congestive heart failure
What will be found on a physical exam indicative of Heart failure with reduced ejection fraction/systolic dysfunction?
S3
Rales/crackles on lung exam
Peripheral edema
How would Heart failure with reduced ejection fraction/systolic dysfunction show on a chest x ray?
Pulmonary vascular congestion
Enlarged heart
Pulmonary edema
What may show up on labs in someone with heart failure with reduced ejection fraction/systolic dysfunction?
Hyponatremia
BNP
What shows up on an ECHO in someone with heart failure with reduced ejection fraction/systolic dysfunction?
Reduced ejection fraction
What are the most common causes of heart failure with reduced ejection fraction?
Coronary Heart disease
Dilated cardiomyopathy
Hypertension
Valvular disease
What are the guidelines for using beta blockers to treat congestive heart failure?
Do not use them in acute uncompensated CHF
Initiate use once CHF is compensated
What is the primary goal in the treatment of HFrEF?
Manage hypertension, myocardial ischemia, and diabetes
What is the preferred methods of treatment for hypertension in people with HFrEF?
B-Blockers (Only in compensated CHF)
ACE
ARB
Mineral corticoids
What medications can be used as alternatives to treat hypertension in people with HFrEF if tradition meds don’t work?
Loop diuretics
Hydralazine
Calcium Channel Blockers
What medication is used to treat volume overload in people with HFrEF?
Loop diuretics
How is coronary disease determined?
With heart catheterization
What can an ECHO be used to assess for in people with HRrEF?
Valvular disease
What are some lifestyle modifications for people with HFrEF?
Quit smoking
Control LDL
Restrict Alcohol
Restrict Sodium
What associated conditions should be treated in people with HFrEF?
A-Fib
Ventricular Arrhythmias
Thromboembolism
What medications have been found to improve symptoms in people with HFrEF?
Diuretics
B-Blockers
Arni
ACE
ARBs
Hydralazine/Nitrates
Digoxin
Aldosterone Antagonists
What medications have been found to improve survival in people with HFrEF?
B-Blockers
ACE
Hydralazine/nitrates
Aldosterone antagonists
What diabetic medication has been shown to positively affect people with HFrEF?
SGLT2 Antagonists
How is ejection fraction affected in individuals with HFpEF?
Normal
How does the ventricle differ in individuals with HFpEF?
Stiff and doesn’t relax properly during diastole
What are the effects on the heart in HFpEF caused by the heart not relaxing during diastole?
Increased LV filling pressure
How does an increased LV filling pressure affect other systems?
Increases back pressure to pulmonary vasculature
What symptoms are caused by increased back pressure to pulmonary vasculature?
Dyspnea
Orthopnea
PND
Pulmonary edema
What are the effects on end diastolic volume in people with HFpEF?
Normal
What can be found during a physical exam of someone with HFpEF?
S3
S4
Rales/crackles
Peripheral edema
What can be seen on chest x-ray in people with HFpEF?
pulmonary edema
What labs are often different in people with HFpEF?
Decreased Na
Increased BNP
What can be seen on an ECHO in people with HFpEF?
LV Hypertrophy
LA Enlargement
Normal EF
Elevated end diastolic pressure
Elevated pulmonary artery systolic pressure
What medications should be used to treat HFpEF?
Diuretics
Aldosterone Antagonists
ACE
When should B-Blockers be used in people with HFpEF?
Only if there is associated coronary heart disease
What are symptoms of Right Ventricular Heart Failure?
Hepatic congestion
Ascites
Peripheral edema
What can be found during physical exam in people with right ventricular heart failure?
JVD
Right sided S3
Liver enlargement
Ascites
Peripheral edema
What can be seen on a 12 lead EKG in people with right ventricular heart failure?
Right axis deviation
RVH
Right sided strain pattern
What can be seen on an ECHO in people with right ventricular heart failure?
Pulmonary hypertension
Right ventricular dysfunction
