Heart Failure Flashcards
Clinical signs and symptoms of HF
dyspnea, fatigue, edema and rales
HF where ejection fraction is >50%
HFpEF
*preserved EF
HF where ejection fraction is <40%
HFrEF
*reduced EF
Sudden onset of HF symptoms
ADHF
*acute decompensated HF
Altered RV structure/function in the context of chronic lung disease
Cor pulmonale
HFrEF pathophysiology
Myocardial injury lead to decreased CO, which activates SNS and RAAS, leading to increased HR, blood pressure (vasoconstriction) and blood volume
- causes eccentric LV hypertrophy, systolic dysfunction, reduced LV EF
- HFpEF less well understood
Shared risk factors for HFrEF and HFpEF
Age DM2 Smoking HTN Atherosclerosis Obesity Metabolic syndrome
The following risk factors are specific for which type of HF?
Male LVH BBB Previous MI Smoking
HFrEF
*dilated hypertrophic LV
The following risk factors are specific for which type of HF?
Female
Old
HTN
Afib
HFpEF
*concentric hypertrophic LV
Clinical presentation for Left heart failure
- Symptoms of congestion (pulmonary)
- Symptoms of hypoperfusion (cyanosis, fatigue, exercise intolerance)
*also be sure to ID risk factors for HF
Diagnostic features of HF on physical exam
- Vital signs
- Assessment of congestion (wet/dry) and perfusion (warm/cold)
- S3 on auscultation
- Displaced MPI on auscultation
Diagnostic imaging for HF
ECG (assess rhythm, ischemia, conduction)
CXR (pulm congestion, heart enlargement)
Echo (assess LVEF, chamber remodeling, valves, pericardial disease, etc.)
Diagnostic labs for HF
Check K (hypokalemia in HF due to RAAS) Check BNP (sensitive, normal BNP rules out HF)
Staging/ Functional Classifications of HF
Which scale describes progressive, demonstrating increasing mortality?
ACCF/AHA
*staging HF associated with mortality
Staging/ Functional Classifications of HF
Which scale provides a snapshot of a pts functional classification in HF?
NYHA
*functional classifications based on ADLs
In the treatment/management of HFrEF, what drugs help with symptom relief?
Diuretics
*alleviate congestion
In the treatment/management of HFrEF, what drugs help prevent remodeling?
ACEi, B-blockers
*MR antagonist added if LVEF not improved with ACEi and B-blockers
What is the only evidence-based medication treatment for HFpEF?
Diuretics
In the treatment/management of ADHF, what can be used to treat hypoperfusion (cold)?
cold = hypoperfused wet = congested
Fluid challenge and/or inotropic agents
*goal is to improve perfusion!
In the treatment/management of ADHF, what can be used to treat congestion (wet)?
cold = hypoperfused wet = congested
Vasodilators, diuretics, dialysis
*goal is to relieve congestion
Pathophysiology of cor pulmonale
Pulmonary HTN = increased RV afterload, leads to alterations in RV structure and function
Clinical presentation for cor pulmonale
Systemic congestion (LE edema, increased abdominal girth (ascites)
Elevated JVP
S3 on auscultation
Pulmonary disorder on auscultation (wheezes, rales)
Hepatomegaly, hepatojugular reflux
LE edema and cyanosis
Diagnostic imaging for cor pulmonale
ECG: signs of pulm HTN (right axis deviation, RV hypertrophy)
CXR: enlargement of pulmonary vessels
Treatment and management of cor pulmonale
Maintain O2 >90% Optimize volume status: Diuretics, Na restriction IV inotropes Restrict activity while symptomatic Palliative care
