Heart failure Flashcards
what is heart failure?
complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood
heart failure is characterized by s/s of …… and ……
reduced CO; volume overload
MC cause of death for HF
- progressive HF
- sudden cardiac death
risk factors for HF
- CAD/atherosclerosis
- DM
- HTN
- Obesity
what is considered acute HF
symptoms began within last few days to weeks
s/s of acute HF
- SOB
- paroxysmal nocturnal dyspnea
- orthopnea
- RUQ pain
what is considered chronic HF
symptoms present for months
s/s of chronic HF
- fatigue
- anorexia
- abdominal distention
- pitting edema
High vs Low Output HF
- high: heart is unable to meet the demands of the peripheral needs
- low: insufficient forward output
Causes of high output heart failure
- thyrotoxicosis
- severe anemia
- sepsis
Causes of Low Output Heart Failure
- reduced EF
- hypovolemia
HFrEF vs HFpEF
- HFrEF: reduced EF (systolic) (EF below 40)
- HFpEF: preserved EF (diastolic) (EF over 50)
patients with EF 41-49 can appear similarly to patients with ….
HFpEF
MC side of HF
left
s/s related to LHF
- DOE
- PND
- orthopnea
- fatigue
MCC of RHF
LHF
causes of RHF
- COPD
- PE
- Pulm HTN
- valvular disorders
s/s associated with RHF
- JVD
- hepatic congestion
- ascites
- anorexia
- lower extremity edema
NYHA classification of HF
- Class 1: no limitations
- Class 2: slight limitations of physical activity
- Class 3: Marked limitation of physical activity
- Class 4: inability to do physical activity without discomfort and sx at rest
ACC/AHA stages of HF classify based on the _____ of HF
evolution
ACC/AHA stages of HF
- A: at risk for HF but no structural heart disease or symptoms of HF
- B: structural heart disease without s/s of HF
- C: structural heart disease with prior or current symptoms of HF
- D: refractory HF requiring specialized interventions
neurohormonal adaptations of HF
compensatory mechanisms used in attempt to adjust for a reduction in cardiac output
compensatory mechanisms
- maintain systemic pressure by vasoconstriction
- restored cardiac output by increasing myocardial contractility and HR
drugs used to treat the compensatory mechanisms of HF such as:
* increased sympathetic activity
* vasoconstriction
* RAAS system
- increased sympathetic activity: beta blockers
- vasoconstriction: vasodilators
- RAAS: ACEI/ARBS/aldosterone antagonists
… is one of the first responses to low CO
activation of the SNS
activation of the SNS results in … and … of NE
- increased release
- decreased uptake
effects of activated SNS
- increased ventricular contractility
- increased HR
- vasoconstriction
- enhanced venous tone
SNS stimulated proximal tubular …. rebsorption
Na
SNS results in an increase of ….. concentration
plasma NE
RAAS system is stimulated by ….
- decreased glomerular filtration
- increased beta-1- adrenergic activity
actions of RAAS
- increases Na reabsorption
- induces systemic and renal vasoconstriction
RAAS and apoptosis
RAAS can be detrimental because as HF progresses, myocytes develop more AT2 receptors, which results in cell apoptosis
low CO and ADH
activation of baroreceptors cause release of ADH and thirst stimulation
ADH promotes ……
water retention
the degree of ….. with ADH release parallels the severity of HF
hyponatremia
ANP
Released from atria in response to increased volume
ANP rises in ….
early HF
BNP
released from the ventricles in response to high ventricular filling pressures
BNP is present in …..
chronic or advanced HF
why is BNP the preferred test?
longer half life
maladaptive consequences of HF
elevation in diastolic pressures are transmitted to the venous circulations which leads to pulmonary vascular congestion and peripheral edema
PE of pulmonary vascular congestion
rales/crackles in lung bases
increase in ….. can depress cardiac function and enhance deterioration
peripheral resistance (afterload)
….. and …… can worsen coronary ischemia
- catecholamine-stimulated contractility
- increased HR
…. and ….. promote myocyte loss, resulting in cardiac remodeling
- catecholamines
- angiotensin II
3 major determinants of the LV stroke volume
- preload: venous return and end diastolic volume
- contractility: force generated at any given end-diastolic volume
- afterload: vascular resistance
with systolic dysfunction, there is a reduction in …..
myocardial contractility
presenting s/s of HF
symptoms due to low CO and fluid accumulation
* dyspnea
* fatigue
* fluid retention
vital signs of HF
- resting sinus tachy
- narrow pulse pressure
- diaphoresis
- diminished peripheral pulses
volume assessment of HF
- pulmonary congestion
- peripheral edema
- elevated jugular venous pressure
cardio PE findings for HF
- pulsus alternans
- precordial palpitation
- heart sounds
….. is pathognomonic of severe LV failure
pulsus alternans
precordial palpatation
laterally displaces apical impulse usually indicated LV enlargement
heart sounds of HF
- S3 in systolic HF
- S4 in diastolic HF
initial testing for HF
- EKG
- chest xray
EKG for HF
may show an arrhythmia that is the cause or result of HF
CXR of HF
- pulmonary congestion
- cardiomegaly
- kerley b lines
- pleural effusions
best test for HF evaluation
BNP and NT-proBNP
BNP is used to …… as a cause of symptoms because it has a …….
exclude HF;very high negative predictive value
normal BNP
under 100
normal NT-proBNP
under 300
NP-proBNP and BNP both arise from …
proBNP
Limitations to BNP/ NT-proBNP
- may present with more than one cause of their sx
- patients with severe chronic HF may have persistently elevated elevated BNP
- other causes of BNP elevation
significant elevation in troponin I or T indicates…
ischemic source of HF
echo of HF provides…
- info on ventricular size and fxn
- detect regional wall motion abnormalities
t/f denying CP is enough reason to exclude CAD
false
when is stress testing useful in the diagnosis of HF?
when you’re trying to rule out CAD
even if stress test is normal, if no other cause can be determined…
the patient should undergo coronary angiography
treatment of HF is aimed at …
- relieving symptoms
- improving functional status
- preventing death and hospitalizations
BNP greater than ….. is suggestive of HF
100
HFrEF
EF < 40%
HFpEF
EF > 50%
treatment of HF is aimed at …
- relieving symptoms
- improving functional status
- preventing death and hospitalizations
which type of HF has the most evidence for clinical benefits?
HFrEF