Heart 6b Hf Flashcards
Aha stages of heart failure
Stage a
Patients at high risk for hd ( htn, diabetes, metabolic syndrome) but eithout structural heart disease
Aha stages of heart failure stage 2
Patients with structural heart disease but who have never show signs of hf
Aha stages of heart failure stage c
Pateints with prior signs of hf associated with knkwn, underlying structural heart disease
Aha stages of heart failure stage d
Patients with refractory hf ( severe signs) eho require specialised interventions
Diagnosis of chf
Good physical assessment, appropriate diagnostic test are vital to confirm diagnosis
Assessment of chf
Patient history Physicsl examination Ecg Chest x-ray Echocardiogram Blood test Coronary angiogram Endomyocardial biopsy
Clinical course ir chf
Healthy heart
Predisposing risk factors
Acute cardiac event
Cardiac remodeling
Symptomatic chf Clinically unstable Stable Clinically stable Stable End stage Death
Management of non-pharmacological
Nutrition Fluid management - alcohol - caffeine Physical activity and rehabilitation - when to rest Daily weight Smoking Models of care - mdt heart failure disease management programs and tele-monitoring - nurse les titrations
Pharmacological therapy chf
Diuretic Renin-angiotensin aldosterone system inhibitors Vasodilators B adrenergic blockers Hcn channel blocker Positive inotropes Morphine Aantiarrhythmics Anticoagulant
Diuretic
Decrease fluid volme
Decrease pulmonary venous pressure
Relieve signs of hf
Decrease preload
Renin- angiotensin aldosterone system inhibitors
Dilate venulea Improve renal blood dlow Decrease fluid volume Relieves signs of hf Promote reverse remodelling Decrease morbidity and mortality
Vasodilator
Reduce cardiac afterload Dilate the arterioles of the kidney, increasing perfusion and fluid loss Decreased by Decreased preload Relive symptoms of hf
B adrenergic blockers
Promote reverse remodeling
Decrease afterload
Inhibit sns
Decrease morbidity and mortality
Hcn channel blockers
Lowers heart rate
Positive inotropes
Increase co
Increase hr
Produce mild vasodilation
Increase stroke volume and co
Morphine
Decrease anxiety
Decrease preload and afterload
Antiarrhythmics
Prevent or treat arrhythmias
Anticoagulant
Prevent thromboembolism
Management of chf
Pacemaker Icd Lvads Tah Biventricular pacing
Surgery chf
Cardiac revascularisation
Lv aneurysmectomy
Surgical ventricular reconstruction
Cardiac transplantation
Cardiac transplantation
Orthotopic or heterotopic ( denervated heart transplanted into recipient from decreased donor)
Survival post 10-20
Palliative care
Poor prognosis in chf means professionals should talk to patients and their families about advanced care planning and symptom management
Intergration of palliative care into md heart team is effective in reducing the symptom burden and distrsss experienced by caregivers and paitents with end-stage disease
Patients are considered suitable for palliative care when all therapeutic options have explored
Involvement of palliative care should be considered early in the trajectory towards end-stage heart failure
Relative contraindications to cardiac transplant
Higher than 65 Active infection Severe diabetes mellitus Morbid obesity Unhealed peptic ulceration Irreversible organ dysfunction current substances abuse ( alcohol, tobacco)
Indications for cardiac transplantation
Definite
Persistent clss 4 symptoms
volume oxygen consumed more than 10
Recurrent uncontrolled ventricular arrhythmia
Indications for cardiac transplantation
Probable
Nyha class 3 Recurrent unstable angina with poor lv function
