Heart Failure Flashcards
Heart Failure
Syndrome that results from structural/functional impairment of ventricular filling or ejection of blood
What are the cardinal symptoms of Heart Failure?
Dyspnea, fatigue, edema and rales
What are the cardinal symptoms of Heart Failure?
Dyspnea, fatigue, edema and rales
HFpEF
Heart failure with preserved ejection fraction
HFrEF
Heart failure with reduced ejection fraction
= LVEF < 40%
Refractory (unmanageable) heart failure that requires specialized interventions
Advanced Heart Failure
Cor Pulmonale
Chronic Lung Disease that results in altered Right Ventricle structure/function
What are some risk factors for Heart Failure?
Age, obesity, smoking, hypertension and atherosclerosis
What are specific risk factors for HFrEF?
Male
LVH, BBB, Previous MI
Males are at greater risk for what type of heart failure?
HFrEF
What are specific risk factors for HFpEF?
Females
Atrial fibrillation
Females are at a greater risk for what type of heart failure?
HFpEF
Describe the pathogenesis of Heart Failure
- Injury to myocardium or disease state that leads to decreased contraction of ventricles
- (+) of SNS and RAAS
= Increased HR, contraction, blood pressure and volume
What is an example of a disease state that leads to decreased contraction of ventricles and thus propagating Heart Failure Pathogenesis?
CAD
- > MI
- > Dilated cardiomyopathy
The clinical presentation of Heart Failure is difficult to identify at early stages. What are 2 basic categories of signs?
Congestion
Hypoperfusion
Congestion symptoms of Heart Failure?
Dyspnea
Orthopnea and Paroxysmal Nocturnal Dyspnea
Weight fluctuations
Edema
Hypoperfusion symptoms of Heart Failure?
Exercise and cold intolerance
Fatigue
Decreased mentation
What may be heart on auscultation of the heart with Heart Failure?
S3 gallop
How is BNP useful with diagnosing Heart Failure?
If it is within NORMAL limits it rules OUT heart failure
What are some labs to order for Heart Failure Diagnosis?
EKG
CXR (not good for detecting lung congestion)
TTE Echocardiography – chamber dilation and/or hypertrophy
ACC/AHA staging classifications of Heart Failure
Progressive with increasing mortality
– A –> D
NYHA staging classifications of Heart Failure?
Only a snapshot at the time
– I –> IV
Overall treatment goals of Heart Failure?
Improve symptoms, quality and duration of life
– Prevent hospital admission
To treat HFrEF, what improves the patients symptoms?
Diuretics
To treat HFrEF, what prevents remodeling?
ACEi and beta-blocker
– Can add MR antagonist
If the patient is eligible, what is the best treatment option?
Cardiac transplant and rehab (exercise)
To treat HFpEF, what is the recommended treatment?
Diuretics ONLY and then treat comorbidities
Common comorbitidies with Heart Failure?
Hypertension
Hyperlipidemia
Common complications of Heart Failure?
Anxiety, sadness, sleep issues, fatigue
Pain and cognitive issues
How does Cor Pulmonale arise?
Lung diseases –> pulmonary HTN
- -> Increased RV afterload
- -> altered RV structure/function
If Cor Pulmonale arises acutely, will there be RVH?
No
ex. Pulmonary embolism
If Cor Pulmonale arises chronically and over time, will there be RVH?
Yes
Symptoms of Cor Pulmonale?
DYSPNEA (due to lung disease)
LE swelling and ascites
Symptoms of Cor Pulmonale?
DYSPNEA (due to lung disease)
LE swelling and ascites
What may a CXR show with cor pulmonale?
Enlarged pulmonary arteries
If a TTE Echocardiography is limited due to a patient’s lung disease with cor pulmonale, what tests should be done?
MRI and right heart catheterization
Treatment of Cor Pulmonale?
Oxygen delivery and volume status maintained
Hemodynamic support
Manage other conditions/palliative care
Prevention of Heart Failure?
- Treat conditions that leads to heart failure
2. Prevent development of further cardiac remodeling and symptoms
Main thing that causes Right sided heart failure?
Pulmonary HTN from lung diseases
= Increased RV afterload
Clinical presentation of Heart Failure?
Congestion - dyspnea
Hypoperfusion - exercise intolerance, fatigue
