Heart Failure Flashcards
HF with a reduced EF is defined as systolic failure with an EF less than or equal to
40%
Caused by a variety of pathophysiologic processes in which the heart is unable to pump or fill with an adequate amount of blood to meet the metabolic demands of tissues
Heart Failure
HF with a preserved EF with an EF of greater than or equal to
50%
Impaired ventricular filling related to impairment of ventricular relaxation
Diastolic heart failure
HF with midrange eF with an eF between 41 and 49%
HFmrEF
More than ___ people in the US have heart failure
6.5 million
What are predisposing factors for HF?
LV dysfunction from CAD, MI, HTN, DM2, metabolic syndrome, physical inactivity, obesity, excessive alcohol intake, and smoking
CAD is the most common cause of
chronic HF
What are disease states or other factors that can cause HF?
Infections such as pericarditis or systemic bacterial infections, hyperthyroidism, thyrotoxicosis, and pheochromocytoma, thiamine deficiency, protein deficiency, preeclampsia, cardiomyopathy, myocarditis, myasthenia graves, autoimmune diseases, valvular heart disease, rheumatic heart disease, infiltrative disease, sleep apnea, substance abuse, cardio toxicity, idiopathic
What happens in heart failure to make up for the heart not pumping effectively?
Cardiac wall thickens with increased muscle mass - Hypertrophy
Chambers enlarge to compensate for increased blood volume - Dilatation
Heart rate increases
Increase in SVR which increases after load
Sodium and water retention
What are physical exam findings for LV impairment?
Rales
Crackles, wheezing
Dyspnea
Bilateral infiltrates
S3, S4
Afib
Evidence of pulmonary edema
What are physical exam findings for RV impairment?
JVD
Peripheral edema
Hepatomegaly
Ascites
S3, S4
What are subjective physical exam findings?
Fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, tachycardia, edema, nocturia, chest pain, weight gain, anorexia, cardiac cachexia
What labs are checked for HF?
ABGs to assess for metabolic and respiratory acidosis, BNP, BMP, magnesium, lipid profile, LFTs, TSH, CXR, ECG, echocardiogram, nuclear stress test
What management is used for HF?
Regular exercise 30 minutes 5 days of the week
Smoking cessation
Healthy weight
Discourage alcohol consumption
Agressive BP control
ACEi for all patients with HFrEF who do not have renal insufficiency
ARBs recommended for those who can’t take ACEi
BB is recommended for all patients with HFrEF
Diuretic therapy if patient begins to show evidence of fluid retention
Treat dyslipidemia
Stress management
What nonpharmacologic management is used for patients with chronic heart disease?
Sodium restriction 3g
Carbohydrate and caloric restraint teaching
Fluid restriction: less than 1.5-2L is recommended for stage D with hyponatremia
Daily multivitamin use is recommended especially for those on restricted diets or diuretic therapy
Annual flu vaccine and pneumococcal vaccine as appropriate
Beta blockers should be used with caution in patients with DM who have
recurrent hypoglycemia, asthma, or resting limb ischemia
BB are not recommended in patients who have asthma with
active bronchospasms
In patients with or without CAD, prophylactic
ICD placement should be considered if LVEF < 30% or LVEF 31-35% for patients with mild to moderate HF
Concomitant ICD placement should be considered in patients undergoing implantation of
biventricular pacing device
What is the basic management considerations for patients with HFpEF?
Aggressive BP control, low sodium diet/sodium restriction
Diuretic therapy
BB recommended in patients who have had prior MI, HTN, or Afib
CPAP for OSA
What must be monitored inpatient?
Daily weight
I&Os
Daily electrolyte assessment
Monitor for edema, ascites, rales, JVD
Monitor for orthopnea, PND, nocturnal cough, dyspnea, fatigue
