Heart Articles Flashcards
Hear failure is?
Common clinical syndrome characterized by :
- dypsnea,
- fatigue
- signs of volume overload
Volume overload
- peripheral edema
- pulmonary rales
Diastolic heart failure w preserved left ventricle function accounts for how much HF?
40-50%
PE findings for heart failure?
Displaced cardiac apex 3rd heart sound Radiology findings - venous congestion - interstitial edema
Heart failure definition
Structural or functional cardiac d/o that impaires the ability of the ventricle to fill w or eject blood
Risk factors for progression from asymptomatic to symptomatic LV systolic disfunction?
HTN
Valve disease
DM
DM and Heart Failure?
DM = one of the strongest risk factors for HF in women w CAD
Framingham criteria value?
Systolic heart failure can be effectively r/o when framingham criteria are not met
SYSTOLIC HEART FAILURE
Framingham criteria?
2 major or 1 maj 2 minor
MAJOR
- paroxysmal nocturnal dyspnea/orthopnea
- neck vein distention
- rales
- cardiomegaly
- acute pulmonary edema
- S3 gallop
- hepatojugular reflux
Minor criteria
- ankle edema
- night cough
- dypsnea on exertion
- pleural effusion
- tachycardia rate >120 bpm
Common causes of heart failure
More common
- Coronary Artery Disease
- HTN
- Idiopathic cardiomyopathy
- Valvular disease
Less common
- arrhythmia
- collagen vascular disease (SLE, DM)
- hypertrophic cardiomyopathy
- myocarditis
- pericarditis
- postpartum cardiomyopathy
- restrictive cardiomyopathies
- toxic cardiomyopathy (ETOH, cocaine)
Most important consideration when categorizing heart failure?
If Left ventrical ejection fracture is preserved or reduced (<50%)
Classic diastolic HF pt?
Woman Older HTN Afib LVH
No HX of CAD
Therapies for systolic vs diastolic HF?
Systolic - well validated therapies
Diastolic - no good EBM
Simplest and most widely used method to gauge heart failure symptom severity?
New york heart association functional classification of HF
New york heart association functional classification of HF
classes
I: no limitations of activity, no HF sx
II: mild limiation, HF sx w significant exertion
III: marked limitation, HF sx w mild exertion, comfortable at rest
IV: discomfort w any activity; HF sx at rest
Blood test for eval of HF?
BNP Calcium and Magnesium CBC Liver function Serum electrolytes TSH UA
These will help r/o common causes of sx
This test is a strong predictor of mortality at 2-3 months post cardiovascular event
BNP
- if greater than 200 pg/mL
N-terminal pro BNP
- greater than 5,180 pg/mL
Value of framingham study?
Not so good at diagnosing HF but really good at r/o HF
How do you confirm HF diagnosis?
Echocardiography
Heart failure w angina?
coronary angiography - unless contraindication to revascularization
Improve sx and survival in pts w angina and reduced EF
How are acute MI’s categorized?
STEMI or NSTEMI
Classifications of acute MI?
- Coronary artherothrombosis
- Supply-demand mismatch
- Sudden death (no biomarker or ECG)
4a. PCI related
4b. thrombosis of stent - CABGE related
Usual cause of acute MI?
Rupture or erosion of plaque
Thrombosis relationship to STEMI vs NSTEMI?
STEMI - total occluding thrombus
NSTEMI - partial occlusion or occlusion w collateral circulation
Unstable angina - same as NSTEMI
What do MI’s need w/in 10 min?
ECG
Troponin levels
How long do you need to r/o MI w troponin?
1-2 hrs of serial troponin
Causes of troponin rise?
- MI
- Other cardiac
- Renal failure
- Respiratory failure
- Stroke
- intracranial hemorrhage
- Septic shock
- Chronic heart disease
O2 recommendation for pts with acute MI?
Only when SPO2 <90
Sublingual nitroglycerine is used for?
Relief of ischemic discomfort
Meds for myocardial supply-demand mismatch?
O2 Analgesics (morphine 1-5mg) Nitrates (NO2 0.3-0.4 mg q 5 min) B-blocker CCB - for persisten ischema
Meds for coronary thrombus?
Antiplatelet therapy
- ASA
- P2Y inhibitor
Anticoagulant
Meds for unstable atheroma or disease progression?
Statin therapy
ACEI
Primary therapy for STEMI?
PCI (if w/in 90-120 min)
- sx w/in 12 hrs
Fibrinolytics
PCI for STEMI uses what for therapy?
Stent
- Bare metal
- Drug eluding (preferred)
NSTEMI and fibrinolytic therapy?
May be harmful in pts w/o ST elevation
Antithrombotic therapy?
ASA - 162-325mg
- then 81-325 q day
P2Y inhibitor (high risk pts)
- clopidogrel
- prasugrel
- ticagrelor
Preferred P2Y for fibrinolytics?
Clopidogrel
Anticoagulation agents?
Heparin
Enoxaparin
Bivalirudin
Fondaparinux
Words used by pts to describe palpitations?
Flip-flopping in chest
Rapid fluttering in chest
Pounding in neck
Palpitations that have an abrupt onset and termination are often?
SVT
V-tach
Ways for pts to terminate their own palpitations?
Carotid-sinus massage Vagal maneuvers (valsalva)
Midsystolic click?
Mitral-valve prolapse
Harsh holosystolic murmur along LSB increasing w valsalva?
Hypertrophic obstructive cardiomyopathy
Palpitations are determined to be high risk or low risk for arrhythmia. How is this determined?
High risk
- organic heart disease
- myocaridal abnormality
- previous MI (scar)
- idiopatic dilated cardiomyopathy
- valvular regur
- stenotic lesion
- hypertrophic cardiymopathies
- fam/personal hx
Low risk
- no potential substrate for arrhythmias
Ambulatory Heart monitoring devices
Holter - 24hr continuous recording
Continuous-loop even recorder
- saves previous 2 min when pt pushes button
Preferred heart monitor for palpitations? Why?
Continuous loop recorder
- worn for longer so more likely to catch the events
Typically worn for 2 weeks but can be up to 1 month
Indications for treadmill exercise testing?
Sx during/following exercise
can be:
- SVT
- A- fib
- Idiopathic VTac
- premature depol
Indications for electrophysiologic testing:
Documented rapid pulse w/o ECG findings
- any tachyarrhythmia
Palpitations preceeding syncopal episode
- v-tach
- SVT
How are sustained supra-ventricular or ventricular arrhythmias causing palpitations managed?
Pharmacologic
Invasive electrophysiologic management
- radio-frequency ablation
Premature contractions and non-sustained vtach in structurally normal heart?
Benign diagnosis - non life threatening
The majority of outpatient palpitations are?
Benign - extensive investigation not warranted
