Heart Failure Flashcards
What is Heart Failure w/ Systolic Dysfunction
Ejection fraction (EF) is 40% or less
Problem is with ejection
What is Heart Failure w/ Diastolic Dysfunction?
EF is > 50%
Problem is with filling, but ejection is ok
What is Acute Decompensated Heart Failure?
Abrupt onset of symptoms that are severe enough to merit hospitalization
What is Heart Failure?
Clinical syndrome that is characterized by S/S associated with
HIGH INTRACARDIAC PRESSURES
and DECREASED CARDIAC OUTPUT
What is BNP
B-type natriuretic peptide
Released by VENTRICLE when ventericle is under wall stress in attempts to dialate and decrease ventricular pressure
When does BNP elevate?
When the left ventricle is under stress (left ventricular failure) or, to a lesser degree, BNP elevates when the right ventricle is under stress (pulmonary hypertension, pulmonary embolism)
What is meant by venticular remodeling?
hypertrophy, chamber dilation, apoptosis
What drugs are used as treatment in systolic heart failure?
Beta blockers
ACEI/ARBs
Diuretics
Dilators
Aldosterone Antagonists (blocks aldosterone receptros)
Positive Inotropes
What drugs are used to treat Diastolic heart failure?
Beta Blocks
ACEI/ARB
CCB
Diuretics
Aldosterone Antagonists
What drugs are contraindicated in SYSTOLIC heart failure?
Negative inotropes (CCB and in acute phase, beta blockers)
What drugs are contraindicated in DIASTOLIC heart failure?
Positive inotropes
Dehydration further worsens filling
Tachyarrythmias increases filling time/worsen symptoms
ACE Inhibitors are used in systolic heart failure? What is the rationale?
Examples: Enalapril, Lisinopril, Ramipril
Rationale:
ACE inhibitors block the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor.
This results in vasodilation, which reduces afterload (the pressure the heart has to pump against).
They also inhibit the RAAS (renin-angiotensin-aldosterone system), reducing aldosterone levels, which helps in reducing fluid retention and preventing cardiac remodeling.
Beta Blockers are used in treatment of SYSTOLIC heart failure. Why?
Examples: Carvedilol, Metoprolol succinate, Bisoprolol
Rationale:
Beta-blockers block the effects of norepinephrine on the heart by inhibiting the sympathetic nervous system (SNS).
This reduces heart rate, myocardial oxygen demand, and prevents arrhythmias.
Chronic use of beta-blockers in systolic heart failure has been shown to improve survival, reduce hospitalizations, and improve heart function by reducing excessive sympathetic stimulation that worsens heart failure.
Angiotensin Receptor Blockers (ARBs) are used in the treatment of systolic heart failure. Why?
Examples: Losartan, Valsartan, Candesartan
Rationale:
ARBs block the angiotensin II receptor, providing similar benefits to ACE inhibitors without some of the common cough associated with ACE inhibitors.
Like ACE inhibitors, they help reduce afterload, improve cardiac output, and prevent cardiac remodeling.
They are often used in patients who cannot tolerate ACE inhibitors
Diuretics are often used in the treatment of systolic heart failure. Why?
Examples: Furosemide, Bumetanide, Torsemide
Rationale:
Diuretics reduce fluid overload by increasing urine output, which helps relieve symptoms such as dyspnea, edema, and ascites.
They primarily work by blocking sodium and chloride reabsorption in the kidneys, which leads to increased urine output and decreased blood volume.
While they do not improve mortality, they are critical in the acute management of fluid overload and can improve symptoms and exercise tolerance.
Aldosterone antagonists are used in systolic heart failure. Why?
Rationale and Mechanism of Action:
Aldosterone is a hormone that promotes sodium and water retention, leading to fluid overload, increased preload, and hypertension. It also contributes to cardiac fibrosis, remodeling, and arrhythmogenesis in heart failure.
Aldosterone antagonists block the effects of aldosterone by binding to the mineralocorticoid receptor in the kidneys, heart, and vasculature, preventing sodium retention and potassium loss.
By inhibiting aldosterone, these medications help reduce fluid buildup, lower blood pressure, and prevent fibrosis in the heart, which is important for preventing further deterioration of heart function.
What is the treatment goal of SYSTOLIC HEART FAILURE?
In systolic heart failure, the goal of treatment is to improve contractility (not reduce it), enhance cardiac output, and relieve symptoms.
Why are NEGATIVE INOTROPES (CCBs) contraindicated in SYSTOLIC HF?
negative inotropes are contraindicated in systolic heart failure because they further reduce the heart’s pumping ability, worsening the already compromised cardiac output and symptoms
What is the treatment goal of DIASTOLIC HF?
Relieve Symptoms (e.g., shortness of breath, fatigue, fluid retention)
Control Blood Pressure (manage hypertension to reduce heart muscle stiffening)
Reduce Fluid Retention (use diuretics to manage edema and pulmonary congestion)
Improve Left Ventricular Relaxation (indirectly through blood pressure control and reduced workload)
Control Comorbid Conditions (e.g., atrial fibrillation, diabetes, obesity)
Prevent Further Heart Damage (lifestyle modifications like diet, exercise, smoking cessation)
Improve Exercise Capacity and Quality of Life (through cardiac rehab and exercise)
Dilated Cardiomyopathy often results from which type of heart failure?
Systolic
What are 3 cardiomyopathies that result in Diastolic HF?
Idiopathic Hypertrophic Subaortic Stenosis (IHSS)
Hypertrophic Cardiomyopathy (HCM)
Restrictive
What are the chest x-ray findings for Systolic HF?
Large, dilated heart, but can also be normal.
Enlarged heart is often associated with a shift of the PMI from the midclavicular to the LEFT
What are the chest x-ray findings of DIASTOLIC HF?
Noram heart size
12-lead may show evidence of left ventricular hypertrophy pattern
What are causes of Right-Sided HF?
Acute RV Infarct (V3R, V4R, JVD 45 degree, ST elevation)
PE (massive)
Septal defects
Pulmonary Stenosis/Insufficiency
COPD
PHTN
Left ventricular failure
What are some causes of Left-Sided HF?
CAD, Ischemia
MI
Cardiomyopathy
Fluid overload
Chronic, uncontrolled HTN
Aortic Stenosis/Insuficiency
Mitral Stenosis/Insufficiency
Cardiac Tamponade
Signs and Symptoms of Right-Sided HF
R = REST OF BODY
Heptomegaly
Splenomegaly
Dependent Edema
Venous Distention
Elevated CVP/JVD
Tricuspid Insufficiency
Abdominal Pain
Signs and Symptoms of Left-Sided HF
L = LUNGS
Orthopnea, dyspnea, tachpnea
Hypoxemia
Tachycardia
Crackles
Cough with pink frothy sputum
Elevated PA diastolic/PAOP
Diaphoresis
Anxiety/Confusion
American Heart Association, Stage A
High risk, no evidence of dysfunction
American Heart Association, Stage B
Heart Disorder or Structural Defect, NO symptoms
American Heart Association, Stage C
Heart Disorder or Structural Defect, SYMPTOMS (past or present)
American Heart Association, Stage D
End-stage cardiac disease, symptomatic despite maximal therapy (inotropic or mechanical support)
NYHA Class I
Normal activity and no symptoms
NYHA Class II
Comfortable at rest, but ordinary activity produces symptoms
NYHA Class III
Comfortable at rest, MINIMAL activity causes symptoms
NYHA Class IV
symptomatic at rest
What are 2 classes of Cardiomyopathy?
Dilated and Hypertropic
What is Dilated Cardiomyopathy?
SYSTOLIC DYSFUNCTION
enlarged ventricles and reduced heart function, leading to symptoms of heart failure and potential arrhythmias
symptomology similar to that of systolic HF (<40% ef, S3, BNP elevated, BP low/normal, PMI shift)
What is Hypertrophic Cardiomyopathy
DIASTOLIC DYSFUNCTION
Increased thickening of heart at septum INWARDLY at expese of LV chamber
Fatigue, chest pain, S3,S4, presyncope, syncope, dyspnea
RISK FOR SUDDEN CARDIAC DEATH
