Heart Failure 1 & 2 Flashcards
In Asia, majority of people with heart failure are those considered:
A) older and senile
B) young and dependent
C) young and productive
D) young and sickly
C is correct. Due to prevalence of risk factors such as hypertension (51.9%), coronary artery disease (50.2%), and diabetes mellitus (40.4%)
Note: prevalence of HF in the Philippines is 1.6%
Which one is not a major HF etiology in the Philippines: A) anemia B) HTN C) rheumatic heart disease D) CAD E) cardiomyopathy F) congenital heart disease
Answer: A
Which is more common in the Philippines: Chagas disease or rheumatic fever (both infections)?
Rheumatic fever! Both can cause HF. Other factors/conditions that can cause HF are high BP, heart problems, lung problems, other medical conditions, and lifestyle.
Most common etiology (60-70%) that leads to depressed ejection fraction?
coronary artery disease (can lead to myocardial infarction & ischemia)
Framingham Criteria for HF (2 major, or 1 major + 2 minor). Identify which is a major criteria and which is a minor criteria. (Bonus: identify if found in Hx or PE)
1) dyspnea on exertion
2) pleural effusion
3) rales
4) hepatomegaly
5) neck-vein distention
6) orthopnea
7) S3 gallop
1) minor, Hx
2) minor, PE
3) major, PE
4) . minor, PE
5) major, PE
6) major, Hx
7) major, PE
Note: considered “minor” since it can be common in other conditions as well
What are the cardinal symptoms of HF?
breathlessness & fatigue (seen in Hx along with fluid retention
Note: found in PE - congested lungs, gallop rhythm, distended neck veins, fluid retention or edema
Important mechanism of cardiac dyspnea (arrange in order)
I. accumulation of interstitial or intra-alveolar fluid
II. stimulates rapid, shallow breathing
III. activated juxtacapillary J receptors
IV. pulmonary congestion
IV, I, III, II
Classification of HF based on EF: Identify under which classification the criteria belongs
1) LVEF >50%
2) No elevated natriuretic peptides
3) Better prognosis than HFrEF
4) LVEF 40-49% with diastolic dysfunction
1) HFpEF
2) HFrEF
3) HFpEF
4) HFmrEF
Stages & Classification
1) The stage where you can no longer go back to the previous one: ___
2) Recent dyspnea at rest in this sub-class: ___
1) Stage C
2) Class IIIb - sign of decompensation
Identify if systolic or diastolic HF
1) S4 gallop
2) HFrEF
3) large, dilated heart
4) tx not well-established
5) broad age group and more common in men
6) Reduced EF (=<40%)
1) D (S: S3)
2) S (D: HFpEF)
3) S (D: small LV cavity, concentric LVH
4) D (S: well-established Tx)
5) S
6) S (D: EF >40%)
Note: systolic HF can’t PUMP hard enough
diastolic HF can’t FILL enough
Presentations of acute HF: cardiogenic shock, acute decompensation of chronic HF, and ____
acute cardiogenic pulmonary edema
Note some diagnostic modalities: electrocardiogram, chest radiograph, 2D echocardiogram, nuclear imaging, hemodynamic studies, contrast left ventriculography, biomarkers
ECG: what does deep S in V1 and tall R in V5/V6 indicate?
Left ventricular hypertrophy
Biomarkers very specific for heart failure:
A) ST2 & BNP
B) BNP & NT-proBNP
C) MR-proANP & NT-proBNP
D) Galectin-3 & high sensitivity troponins
Answer: B - markers of cardiac myocyte strain (along with MR-proANP
ST2, Galectin-3: markers of cardiac myocyte remodeling
high sensitivity troponins: markers of cardiac myocyte injury
Pathophysio of HF
Decreasing ejection fraction is a sign of ____.
remodelling (we don’t want this in the heart!)
Pathophysio: Identify if neurohormonal activation, secondary damage, or endothelial changes
1) Fibrosis
2) ↑ ANP/BNP
3) ↑ RAS activity
4) ↑ Hypertrophy
5) Vasoconstriction
6) ↑ Apoptosis
7) ↑ Cytokines
1) SD
2) NA
3) NA
4) SD
5) EC
6) SD
7) NA
SD: LV remodelling, ↓ contractility, NOS/ROS, changes in electrophysiology
NA: ↑ SNS activity, ↑ endothelin
EC: NOS/ROS, structural changes, cytokines
LV remodelling: Identify which leads to/is a characteristic of concentric or eccentric hypertrophy
1) parallel sarcomeres
2) ↑ diastolic wall stress
3) pressure overload
4) volume overload
5) ↑ systolic wall stress
1) CH
2) EH
3) CH
4) EH
5) CH
Left-sided vs right-sided: Which is which?
1) paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure, blood-tinged sputum, cough, orthopnea, exertional dyspnea, cyanosis: ___
2) fatigue, ↑ peripheral venous pressure, distended jugular veins, ascites, anorexia & complaints of GI distress, cyanosis, dependent edema: ___
1) left-sided failure (hint: emphasis on lung involvement)
2) right-sided failure (hint: emphasis on venous involvement)
Note:
Left-sided: usually systolic, d/t ischemic heart disease, long-standing HTN, dilated cardiomyopathy
Right-sided: often caused by left-sided HF, d/t R-to-L shunt, cor pulmonale
Identify the stage of the indicated treatments
1) Heart transplantation, advanced care measures, left ventricular assist device
2) Diuretics, RAS blockers, Beta blockers, aldosterone antagonists, SGLT2 inhibitors, hydralazine/isosorbide dinitrate (for select pts)
3) RAS blockers for HTN, statins for Hypercholesterolemia
4) ACEi, RAS blockers, Beta blockers, perform ICD or revascularization in select pts
1) Stage D
2) Stage C - HFrEF (HFpEF has no approved therapies)
3) Stage A - treat risk factors
4) Stage B - prevent progression to heart failure
Stage B - ACEi -> BACE
Stage C - HFrEF -> H for hydralazine, r for RAS blockers
HF Tx: 3 treatments using devices & surgery
revascularization (pacemakers, implantable cardioverter defibrillators, catheter interventions, surgery), ultrafiltration, hemodialysis
Identify which device is being described (LVAD - left ventricular assist device, ICD - implantable cardioverter defibrillator, or CRT - cardiac resynchronization therapy?)
1) For pt with asynchronous contractions (wide QRS)
2) Improves ejection fraction by synchronizing LV & RV
3) assists LV in pumping blood into the systemic circulation
4) similar to a pacemaker
5) very expensive
6) can detect ventricular tachycardia and fibrillation then automatically fires and returns patient to sinus rhythm
1) CRT
2) CRT
3) LVAD
4) ICD
5) LVAD
6) ICD
Normal ejection fraction is ___
50-70% (accdg. to Osmosis vid)
Note: 40-50% is borderline
<40% - systolic HF
Ejection fraction: stroke volume/total volume
Heart failure cells: ___
hemosiderin-laden macrophages
