Heart Failure Flashcards
what are the cardinal clinical symptoms of heart failure?
dyspnea and fatigue
what are the cardinal clinical signs of heart failure?
edema and rales
what defines heart failure with preserved ejection fraction (HFpEF)?
LVEF >50%
what defines heart failure with reduced ejection fraction?
LVEF less than 40%
decreased cardiac output leads to activation of what?
activation of SNS and activation of RAAS
who is at risk for HFrEF?
male, LVH, bundle branch block, previous MI, smoking
who is at risk for HFpEF?
older age, female, hypertension, a fib
what type of symptoms are seen in a patient with heart failure?
symptoms of congestion and symptoms of hypoperfusion
what are 3 cardiac findings that could be seen in a patient with HF?
an S3 heart sound, enlarged/displaced PMI, and a right ventricular heave
when might BNP be elevated with normal volume status?
in patients with advanced age, renal insufficiency, anemia, COPD, pulmonary HTN
what imaging modality is used to rule out an intracardiac thrombus or infectious source of HF?
TEE
what is an important component in the determination of candidacy for mechanical circulatory support and cardiac transplantation?
cardiopulmonary exercise testing
what is the gold standard imaging modality for diagnosing HF?
echocardiography: 2D TTE
what does a 2D TTE show in a patient with HFrEF?
reduced LVEF, atrial and ventricular chamber dilation or hypertrophy, valvular dysfunction,
what are the two different types of staging/functional classification systems for HF? and what is the main difference between the two?
ACC/AHA and NYHA; ACC/AHA is progressive and increasing mortality. NYHA is a snapshot in time, you can go back and forth
generally speaking, how do you improve the symptoms of HF?
diuretics
generally speaking, how do you prevent heart remodeling in heart failure?
therapy with ACEi and beta blocker; you can also add an MR antagonist
how do you treat HFpEF?
only with diuretics- no other medications have proven to be beneficial; TREAT COMORBIDITIES
how do you treat an acutely decompensated HF patient?
you diurese them if they are congested. You improve perfusion if they are hypoperfused
what does right sided heart failure develop in response to?
chronic pulmonary HTN resulting from parenchymal lung disorders, primary pulmonary vascular diseases, or conditions leading to alveolar hypoxia (COPD and chronic bronchitis)
how might a patient present with cor pulmonale?
systemic congestion- elevatedJVP, LE edema
what might an EKG show on a patient with cor pulmonale?
signs of pulmonary HTN: right axis deviation, RV hypertrophy
is a 2D TTE helpful in cases of cor pulmonale?
not as much as left sided heart failure: it can be difficult to evaluate due to the severe lung disease
