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Cardiology Medicine > Heart Failure > Flashcards

Heart Failure Flashcards

1. Discuss the etiology and pathophysiological mechanisms involved with right and left sided heart failure 2. Compare the different causes and symptoms systolic and diastolic heart failure also called heart failure with preserved ejection fraction (HF-PEF). 3. Contrast the differences in presentation between right and left sided heart failure 4. Contrast the physical findings associated with right sided an left sided heart failure (Bates- Physical Exam text may be useful for this) 5. Summari

1
Q

A clinical syndrome characterized by systemic perfusion inadequate to meet the body’s metabolic demands as a result of impaired pump function.

A

Heart Failure

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2
Q

True or False: A definitive lab test can determine/diagnose heart failure.

A

False

It is multifactorial

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3
Q

What is the final goal of treatment?

A

Improve Symptoms
Improve Survival
Shrink the Heart Down to Size
Keep them out of the Hospital

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4
Q

Seven Major Classes of Biomarkers Contributing to Heart Failure Profile

A
  1. Myocardial Stretch
  2. Myocyte Injury
  3. Matrix Remodeling
  4. Inflammation
  5. Renal Dysfunction
  6. Neurohumoral Activation
  7. Oxidative Stress
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5
Q

Etiology of Heart Failure

A
  1. Ischemic Cardiomyopathy (50-75%)
  2. Non-Ischemic CM
    - Unknown (20-30%)
    - HTN (13%)
    - Valvular Dz (10-12%)
    - Others: ETOH, Cocaine, OSA, Nutritional Deficiency, Viral Myocarditis, HIV, Tachycardia, Hemochromatosis, Sarcoid, SLE, etc.
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6
Q

When does Postpartum Heart Dz develop?

A

1 month before delivery
or
5 months after delivery

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7
Q

What are the two overarching forms of Heart Failure?

A
  1. Low Output

2. High Output

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8
Q

Which form of Heart Failure is most common?

A

Low Output

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9
Q

Definition of Low Cardiac Output

A
  1. Resulting from HTN, Ischemic Heart Dz, Valvular Dx, and CM
  2. Exam reveals impaired peripheral circulation: Cold, pale, cyanotic extremities with a narrow pulse pressure
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10
Q

Definition of High Cardiac Output

A
  1. Characteristic of thyrotoxicosis, AV fistula, anemia, pregnancy, and Paget’s Dz of Bone
  2. Exam reveals warm extremities with normal or widened pulse pressure
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11
Q

Long QRS on EKG would indicate:

A

Right and Left ventricles not contracting at the same time

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12
Q

Bad prognostic indicators of Heart Failure (5)

A
  1. Prolonged QRS
  2. Low Na+
  3. low lymphocytes
  4. hypotension
  5. poor renal fxn
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13
Q

What causes excess absorption of Na+ in Heart Failure patients?

A

Decreased perfusion to the kidneys will make it think you are dehydrated, so you will want to keep salt and therefore water.

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14
Q

What Diagnostic Tests would you order for suspected HF?

A
  1. EKG
  2. 2-D Echo
  3. Labs (Electrolytes, CBC, Liver Enzymes, TSH, Na, Crea, BUN, Troponin)
  4. CXR
  5. Cardiac Catherization
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15
Q

Seattle Heart Failure Model

A

Want to check Percent of Lymphocytes because they will be lower if there is wasting of the body due to poor nutrition.

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16
Q

occurs when the heart is incapable of meeting the metabolic demands of the body tissue

A

heart failure

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17
Q

In systolic heart failure that occurred as a result of ischemic heart disease, would the patient’s EF be normal or less than normal?

A

Systolic heart failure is “pump failure”.

EF < 55%

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18
Q

Is it common to have left AND right heart failure simultaneously?

A

YES! “Most people who have had HF from ischemia (#1 cause) will have both right and left systolic heart failure.”

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19
Q

If you have right systolic HF, and normal LV function, what are the potential causes?

A

Cause must be somewhere BETWEEN the RV and LV. So is could be the 1) pulm valve 2) lungs (pulm htn) 3) mitral valve stenosis

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20
Q

What are the common symptoms of right sided systolic heart failure?

A

JVD, peripheral edema, fatigue (fluid back up in the body)

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21
Q

What are the common symptoms of left sided heart failure?

A

congestion in the lungs (crackles, cough, dyspnea). Increased pressure in lungs quickly leads to right sided failure as well

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22
Q

Systolic Heart failure is caused by a problem with what?

A

The ventricles. “Pump problem”

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23
Q

Diastolic heart failure is caused by what problem?

A

A stiff heart! This is a filling problem.

24
Q

What are the main causes of diastolic (filling) heart failure?

A

diabetes, htn

25
Q

Which side of the heart is typically more effected by diastolic heart failure?

A

TRICKSTER: typically effects both sides at the same time, and effect is equal on either side

26
Q

When both sides of the heart fail in diastolic heart failure, which sided failure produces the most troubling side effects?

A

The left sided failure is typically more symptomatic (lung congestion)

27
Q

In diastolic heart failure, is the EF low or normal?

A

Normal. (Less blood getting into ventricles in the first place, so The heart still pumps out 60% of the blood in the ventricles, but its 60% of a much smaller number)

28
Q

What are some signs/symptoms that your HF patient might not be getting adequate perfusion?

A

1) Narrow pulse pressure
2) cool extremities
3) decreased mental status (confused, sleepy)
4) low sodium
5) elevated creatinine (low renal fxn)
6) hypotension

29
Q

What are some signs/symptoms that your HF patient might be experiencing fluid overload?

A

1) orthopnea
2) JVD or increased JVP
3) peripheral edema
4) ascites
5) rales/crackles
6) an S3 heart sound (gallop)

30
Q

“Good perfusion” = WARM and “fluid overload” = WET. If your patient is warm and wet, what should you do?

A

decrease the afterload (vasodilate) and diurese.

31
Q

“Good perfusion” = WARM and “fluid overload” = WET. If your patient is cold and wet, what should you do?

A

Increase perfusion by using inopropic agents

32
Q

“Good perfusion” = WARM and “fluid overload” = WET. If your patient is cold and dry, what should you do?

A

discontinue diuretics and give fluids

33
Q

“Good perfusion” = WARM and “fluid overload” = WET. If your patient is warm and dry, what should you do?

A

sing and dance. you’ve found the promised land.

34
Q

How far has a patient’s HF progressed by the time they become symptomatic?

A

They already have increased pulmonary pressure and there has been remodeling of the heart before any symptoms are detected

35
Q

What medications are ideally given to all HF patients following their first onset of symptoms? (3)

A

1) Diuretics for symptom control
2) ACE inhibitors to block the RAAS which will be active following the diuretics
3) BB to reverse cardiac remodeling

36
Q

If your HF patient is already on a diuretic, an ACEI, and a BB, but they are still having symptoms, what is the best medication to adjust (of the above 3)?

A

Increase the BB (continuing to shrink the heart has the best improvement in mortality)

37
Q

What are the most common MAJOR diagnostic criteria for dxing HF?

A

PND, DOE, JVD, rales, CM, pulm edema/htn, S3

38
Q

What are the most common MINOR diagnostic criteria for dxing HF?

A

ankle edema, night cough, hepatomegaly, pleural effusion, decreased vital capacity, tachycardia (>120), 4.5kg wt loss within 5 days of treatment

39
Q

How many of the major/minor s/s must be met to make a HF diagnosis?

A

Either 2 major OR 1 major and 2 minor

40
Q

What happens to the brain natriuretic peptide (BNP) as fluid overload increases?

A

It rises

41
Q

What produces the BNP?

A

the ventricles of the heart

42
Q

When does the heart secrete BNP?

A

when it is stretched by excess fluid or high pressures

43
Q

What does BNP do in the body once secreted?

A

1) dilates vessels to reduce afterload and

2) wastes Na+ and H2O to reduce fluid volume

44
Q

What does the heart do to protect itself from excess fluid volume generated as a result of the RAAS?

A

Secretes BNP

45
Q

What is the term for the alteration of right heart structure and/or function which is caused by a lung problem?

A

Cor pulmonale

46
Q

Essentially what is happening in cor pulmonale?

A

pulmonary htn creates strain on the right ventricle and leads to RV hypertrophy

47
Q

What are some underlying conditions that lead to cor pulmonale?

A

COPD, PE, OSA, CF

48
Q

What is the best treatment for cor pulmonale?

A

treat underlying lung dz!

49
Q

What percent of the general population has been diagnosed with heart failure?

A

2%

50
Q

What percent of the elderly population has heart failure?

A

20%

51
Q

Does advanced HF affect cognition?

A

Yes! Remember Dick Chaney?

52
Q

What type of care is consistently neglected in HF patients?

A

Palliative care!

53
Q

What are some things to consider when talking about palliative care in HF patients?

A

DNR, disabling pacers, comfort care

54
Q

Fromm said know this

What are the poor prognostic indicators that suggest life expectancy < 6 months?

A

1) Sodium (<20%
8) frequent hospitalizations
9) cachexia (poor nutricion)
10) Lymphopenia

55
Q

What types of HF symptoms are you targeting with palliative care?

A

pain, dyspnea, edema, lightheadedness, wasting fatigue, nausea, depression/anxiety

Cardiology Medicine (13 decks)

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