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Physical Assessment > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

HF is defined as _

A

Complex syndrome that results from any structural or functional impairment of ventricular filling or ejection

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2
Q

HF can lead to _

A

Tissue hypoperfusion

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3
Q

What five signs and symptoms can be seen with tissue hypoperfusion from HF?

A

Fatigue
Dyspnea
Weakness
Edema
Weight gain

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4
Q

HFrEF is defined as

A

Systolic HF
EF < 40%

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5
Q

HFpEF is defined as

A

Diastolic HF
EF >50%

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6
Q

Borderline HFpEF is defined as

A

HF symptoms with EF 40-49%

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7
Q

Is diastolic dysfunction present in HFrEF and HFpEF?

A

Yes

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8
Q

What are two distinguishing features between HFrEF and HFpEF?

A

LV dilation patterns
Remodeling

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9
Q

What is the main diagnostic tool for determining HF risk factors, treatment, and outcomes?

A

Echocardiogram

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10
Q

What is primarily being measured on an Echocardiogram?

A

Ejection Fraction

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11
Q

What amount of HF patients have a normal EF?

A

> 50%

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12
Q

T/F
Patients with HFrEF are more likely to have higher incidences of myocardial ischemia, infarction, previous coronary intervention, CABG, and PVD.

A

True

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13
Q

What percentage of HF cases are HFpEF?

A

52%

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14
Q

What percentage of HF cases are HFrEF?

A

33%

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15
Q

Are men or women more likely to experience HFpEF?

A

Women

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16
Q

Are men or women more likely to experience HFrEF?

A

Men

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17
Q

What is the primary determinant of HFpEF?

A

LV diastolic dysfunction

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18
Q

What is the primary determinant of HFrEF?

A

Contractile dysfunction

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19
Q

The LV’s ability to fill is determined by what 5 factors?

A

Pulm venous flow
LA function
MV dynamics
Pericardial restraint
Active/Passive elasticity of the LV

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20
Q

T/F
Higher LV filling pressures are required to achieve normal end-diastolic volume in HFpEF patients

A

True

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21
Q

T/F
a steep rise of EDPV is indicative of delayed LV relaxation and increased myocardial stiffness

A

True

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22
Q

Increased myocardial stiffness leads to what 6 problems?

A

Reduced LV compliance
LA HTN
LA systolic dysfunction
LA diastolic dysfunction
Pulmonary venous congestion
Exercise intolerance

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23
Q

What are some causes of LVDD?

A
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24
Q

What are the 10 signs/symptoms of HF?

A

Fatigue
Tachypnea
Dyspnea
Paroxysmal nocturnal dyspnea
Orthopnea
S3 gallop
JVD
Peripheral edema
Exercise intolerance
Reduced tissue perfusion

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25
Q

What symptoms are more common with HFpEF?

A

Paroxysmal nocturnal dyspnea
Pulmonary edema
Dependent edema

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26
Q

What symptom is more common with HFrEF?

A

S3 gallop

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27
Q

Which HF is harder to diagnose initially?
HFrEF or HFpEF?

A

HFpEF

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28
Q

What test do we use to establish cardiac pressures?

A

Cardiac catheterization

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29
Q

Mean pulmonary capillary wedge pressure >__ at rest or __ during exercise are strong indicators of __ and __

A

> 15 mmHg
25 mmHg
HFpEF
Mortality

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30
Q

Chest x-ray can detect what 5 things related to HF?

A

Pulmonary disease
Cardiomegaly
Pulmonary venous congestion
Interstitial edema
Alveolar edema

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31
Q

What are Kerley lines?

A

Honeycomb pattern which reflects interlobular edema present in HF patients

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32
Q

What does alveolar edema look like on CXR?

A

Homogenous densities in a butterfly pattern

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33
Q

T/F
Radiographic evidence of pulmonary edema lags behind clinical presentation by up to 12 hours

A

True

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34
Q

What are the ACC/AHA diagnostic criteria for HFpEF?

A

HF symptoms
LV EF >50%
Evidence of LV diastolic dysfunction

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35
Q

T/F
The ACC/AHA diagnostic criteria is more specific when compared to the ESC criteria

A

False

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36
Q

What are the two important biomarkers for HF?

A

Brain natriuretic peptide (BNP)
N-terminal pro-BNP

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37
Q

Is BNP higher in HFrEF or HFpEF patients? Why?

A

HFrEF patients
Higher because of LV dilation and eccentric remodeling

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38
Q

Troponins are a measure of what in HF patients?

A

Risk prediction

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39
Q

C-reactive protein and growth differentiation factor-15 are indicative of what in HF?

A

Inflammation

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40
Q

What are the NYHA and ACC/AHA classifications?

A
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41
Q

What is the treatment for HFpEF?

A

Mitigation of symptoms
Exercise
Weight loss

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42
Q

What is the treatment for HFrEF?

A

Beta-blockers
ACE-I’s

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43
Q

What are the benefits of diuretics with HF?

A

Reduced LV pressures
Reduced Pulmonary venous congestion
Improve HF sx

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44
Q

CRT is recommended for what specific HF patients?

A

NYHA class III or IV w/ EF < 5% and a QRS duration 120-150 ms

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45
Q

What new system allows for monitoring of intracardiac pressures at home?

A

CardioMEMS Heart Failure System

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46
Q

What percentage of HF deaths are d/t sudden cardiac dysrhythmias?

A

50%

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47
Q

What are the 4 uses for LVAD therapy?

A

Temporary ventricular assistance
Awaiting cardiac transplant
Pts on inotropes or IABP
Advanced HF patients who aren’t transplant candidates

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48
Q

What is acute HF?

A

worsening preexisting HF (ADHF)
First time HF (de novo AHF)

49
Q

De novo AHF is characterized by:

A

Sudden increase in intracardiac filling pressures or acute myocardial dysfunction
Leading to decreased peripheral perfusion and pulmonary edema

50
Q

What is the leading cause of De Novo HF?

A

Cardiac ischemia via coronary occlusion

51
Q

What are less common causes of De Novo HF?

A

Viral
Drug-induced (toxic)
Peripartum Cardiomyopathies

52
Q

What is the 1st line treatment for acute HF?

A

Diuretics
(Furosemide, Bumetanide, Torsemide)

53
Q

What vasodilator is used as an adjunct to diuretic therapy?

A

Nitroglycerin

54
Q

What Vasodilator rapidly decreases afterload?

A

Sodium Nitroprusside

55
Q

What Vasopressin receptor antagonist is being used for HF managment?

A

Tolvaptan

56
Q

What four catecholamines are used in HF?

A

Epinephrine
Norepinephrine
Dopamine
Dobutamine

57
Q

What PDE inhibitor is used with HF?

A

Milrinone

58
Q

What calcium sensitization agent is used with HF?

A

Levosimendan

59
Q

What is the exogenous BNP agent described in lecture?

A

Nesiritide

60
Q

What is the INTERMACS?

A

MCS decision-making tool

61
Q

What does an IABP help with?

A

LV coronary perfusion by reducing LVEDP

62
Q

How do you confirm placement of a IABP?

A

TEE and X-ray

63
Q

Describe the two modes of an IABP

A

1:1 (Full support)
1:2 (Used with tachycardia)

64
Q

IABPs increase CO by how much?

A

0.5-1 L/min

65
Q

Impella’s can stay in place for how many days?

A

14 days

66
Q

Impella’s are used for what purpose?

A

Transition to recovery or bridge to cardiac procedure (CABG, PCI, VAD, Transplant)

67
Q

What are two cons of using Peripheral VADs?

A

Hemolysis and lower flow via heat generation

68
Q

When would you use a Central VAD/ECMO?

A

If adequate flows are not achievable peripherally

69
Q

What are benefits of central cannulation?

A

Complete ventricular decompression
Avoidance of limp impairment
Avoidance of SVC syndrome

70
Q

T/F
Inhaled anesthetics are limited with ECMO use?

A

True
Because of shunting of blood around the lungs

71
Q

What type of anesthetic should be used with ECMO patients?

A

TIVA

72
Q

T/F
ECMO patients tend to require higher doses of sedation

A

True
The ECMO membrane is lipophilic and tends to sequester a majority of administered medications (fentanyl, versed, propofol)

73
Q

HF patients have an increased risk of developing what 4 conditions?

A

Renal failure
Sepsis
Pneumonia
Cardiac arrest

74
Q

T/F
Surgery should be postponed in patients experiencing decompensation, recent clinical change, or de novo AHF

A

True

75
Q

T/F
Beta-blockers should be continued prior to surgery

A

True

76
Q

ACE-I’s can lead to what condition preoperatively if not held?

A

Hypotension

77
Q

What 2 things should be considered in the pre-op exam for HF patients?

A

12-lead EKG
TTE (for pts with worsening dyspnea)

78
Q

What consideration should be taken pre-op for patients with ICDs or PPMs?

A

Interrogation prior to surgery

79
Q

What are cardiomyopathies?

A

mechanical and/or electrical dysfunction that usually exhibit ventricular hypertrophy or dilation

80
Q

What are the two categories of cardiomyopathy?

A

Primary (confined to the heart muscle)
Secondary (pathophysiologic cardiac involvement in context of multiorgan disorder)

81
Q

What is the most common genetic cardiovascular disease?

A

Hypertrophic cardiomyopathy (HCM)

82
Q

HCM is characterized by what factors?

A

LVH in absence of other diseases
Hypertrophy of interventricular septum and anterolateral free wall

83
Q

T/F
myocardial ischemia is present in HCM whether or not they have CAD

A

True

84
Q

T/F
Dysrhythmias are a cause of sudden death in young adults with HCM

A

True

85
Q

T/F
In asymptomatic patients LVD may be the only sign of HCM

A

True

86
Q

What EKG abnormalities occur with HCM?
What percentage of patients have them?

A

High QRS voltage
ST-segment and T-wave alterations
Abnormal Q waves
LA enlargement
75-90% of patients

87
Q

Echocardiogram will show what feature with HCM?

A

Myocardial wall thickness >15 mm

88
Q

What is a normal EF for patients with HCM?

A

> 80%
Showing hypercontractility
(in terminal states, may be sev. depressed)

89
Q

What are the first two choices of medication for HCM?

A

Beta-blockers
CCBs

90
Q

What other medication can be added as adjunct for HCM if BBs and CCBs aren’t working?

A

Diuretics

91
Q

If BBs, CCBs, and diuretics aren’t working what final medication can be added?

A

Disopyramide (Sodium channel blocker)

92
Q

For HCM patients that develop Afib, what is the best antiarrhythmic agent?

A

Amiodarone

93
Q

What other consideration must be considered in HCM patients that develop Afib?

A

Long-term anticoagulation

94
Q

What surgical strategies are available for severe HCM?

A

Septal myomectomy
Cardiac cath w/injection to induce ischemia of septal perforator arteries
Echocardiogram-guided percutaneous septal ablation
If still asymptomatic, may insert prosthetic MV to counteract systolic anterior motion of mitral leaflet

95
Q

What is the primary treatment for patients at risk of sudden cardiac death d/t dysrhythmia?

A

ICD placement

96
Q

Dilated Cardiomyopathy (DCM) is characterized by _

A

LV or biventricular dilation, bi-atrial dilation, decreased ventricular wall thickness, and systolic dysfunction w/o abnormal loading conditions or CAD

97
Q

What is the initial sign of DCM?

A

Heart failure
(Potentially CP)

98
Q

Ventricular dilation with DCM can lead to _

A

Mitral regurgitation
Tricuspid regurgitation

99
Q

What conditions are common with DCM?

A

Dysrhythmias
Conduction abnormalities
Emboli
Sudden death

100
Q

Echocardiogram with DCM reveals what?

A

Dilation of all 4 chambers (esp LV)
Global hypokinesis

101
Q

How do you treat DCM?

A

Similar to Chronic HF
ACE-I
ARB
Anticoagulation

102
Q

What EKG changes are noted with DCM?

A

ST-segment and T-wave abnormalities
LBBB
PVCs
Afib

103
Q

Prophylactic ICD placement in DCM patients reduces risk of sudden death by _?

A

50%

104
Q

What condition is the principal indication for cardiac transplant?

A

DCM

105
Q

What is Stress Cardiomyopathy?

A

Apical Ballooning Syndrome
A temporary primary cardiomyopathy
characterized by LV apical hypokinesis w/ischemic EKG changes, however the coronary arteries remain patent

106
Q

What signs are present with Stress Cardiomyopathy?

A

Chest pain
Dyspnea

107
Q

What is the main causative factor of Stress Cardiomyopathy?

A

Trick question.
Stress (obviously)

108
Q

Does Stress Cardiomyopathy occur more in men or women?

A

Women

109
Q

What is Peripartum Cardiomyopathy?

A

Rare primary cardiomyopathy
Unknown cause
Starts in 3rd trimester-5 months post-partum

110
Q

Diagnosis of Peripartum Cardiomyopathy is dependent on what 3 things?

A

Development of HF in the period surrounding delivery
Absence of another explainable cause
LV systolic dysfunction with a LVEF <45%

111
Q

What is Secondary Cardiomyopathy?

A

d/t systemic diseases that produce myocardial infiltration and severe diastolic dysfunction

112
Q

What is the most common cause of Secondary Cardiomyopathy?
What are other causes?

A

Common:
Amyloidosis

Other:
Hemochromatosis
Sarcoidosis
Carcinoid tumors

113
Q

Diagnosis of Secondary Cardiomyopathy should be considered in _

A

Patient who have HF but no evidence of cardiomegaly or systolic dysfunction

114
Q

Secondary Cardiomyopathy patients tend to have _

A

Low to normal BP
Can develop orthostatic hypotension

115
Q

What is Cor Pulmonale?

A

RV enlargement (hypertrophy and/or dilatation) that may progress to right-sided heart failure

116
Q

What can cause Cor Pulmonale?

A

pulmonary hypertension
myocardial disease
congenital heart disease

or any significant respiratory, connective tissue, or chronic thromboembolic disease

117
Q

What is the most common cause of COPD and is more prevalent in males >50 y/o?

A

Cor Pulmonale

118
Q

What EKG changes occur with Cor Pulmonale?

A

RA & RV hypertrophy noted by peaked P-waves in leads II, III, and aVF
Right axis deviation and RBBB

119
Q

What is the most important determinant of Pulm HTN and Cor Pulmonale?

A

Alveolar hypoxia

Physical Assessment (3 decks)

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