Heart Failure Flashcards
Risk Factors for developing HF
HTN
DM
Metabolic Syndrome
Atherosclerotic dz
Metabolic Syndrome is when the patient has any 3 of the following
Abdominal adiposity
Hypertriglyceridemia
Low HDL
HTN
Fasting Hyperglycemia
Etiology of HF can be from?
Valvular dz
Cardiomyopathy
HTN
Ischemic Heart Dz - major cause of HFrEF
Pathophysiology of HF
Increased LVEDP d/t structural or functional impairment of ventricular filling or ejection of blood leads to?
Activation of SNS, RAAS, increased ADH
Pathophysiology of HF
Activation of SNS, RAAS, increased ADH leads to?
Vasoconstriction/increased blood volume
Pathophysiology of HF
Vasoconstriction/increased blood volume leads to?
Increased preload & afterload
Pathophysiology of HF
Increased preload & afterload leads to?
Decreased SV & congestion
Pathophysiology of HF
Decreased SV & congestion leads to?
Increased LVEDP d/t structural or functional impairment of ventricular filling or ejection of blood
RAAS activation
Renin secreted to low renal perfusion pressure leads to?
Cleaving of angiotensinogen to angiotensin I to II via ACE
RAAS activation
Cleaving of angiotensinogen to angiotensin I to II via ACE leads to?
Vasoconstriction, increased ADH & aldosterone secretion
RAAS activation
Vasoconstriction, increased ADH & aldosterone secretion leads to
Increased Na, H20 retention
RAAS activation
Increased Na, H20 retention leads to?
Increased preload, afterload, pressures in heart
RAAS activation
Increased preload, afterload, pressures in heart leads to?
cardiac remodeling, hypertrophy, sympathetic activity
RAAS activation
cardiac remodeling, hypertrophy, sympathetic activity leads to?
Renin secreted in response to low renal perfusion pressure
Diagnosis of HF
Assessment includes?
Clinical Hx
Physical examination
ECG, labs
Diagnosis of HF
Labs
NT-proBNP > 125 pg/mL
BNP >/= 35 pg/mL
Diagnosis of HF
Imaging?
TEE
Diagnosis of HF
HF Diagnosis Confirmed
Determine cause and classify
HFrEF is?
HFmrEF is?
HFpEF is?
LVEF </= 40%
LVEF 41-49%
LVEF >/= 50%
In pts w/ HF what should be assessed at each encounter to guide overall management including adjustment of what?
vital signs and evidence of clinical congestion
diuretics and other medications
In pts w/ symptomatic HF, clinical factors indicating the presence of what? should be sought via the what?
advanced HF
Hx and Physical Exam
In pt w/ cardiomyopathy, what should be obtained or updated when assessing the cause of the cardiomyopathy to identify what?
a 3-generation family hx
inherited dz
In pts presenting w/ HF what should direct diagnostic strategies to uncover specific causes that may warrant disease-specific management?
thorough hx and physical exam
In pts presenting w/ HF what should be obtained to identify what that might cause or accelerate the development or progression of HF?
thorough hx and physical exam
carddiac and noncardiac d/os, lifestyle and behavioral factors, and SDOH
Symptoms of HF
Typical include?
Breathlessness
Orthopnea
Paroxysmal nocturnal dyspnea
Reduced exercise intolerance
fatigue, tiredness
ankle swelling
inability to exercise
swelling of parts of the body other than ankles
bendopnea
Symptoms of HF
Less typical
Nocturnal cough
Wheezing
Bloated feeling
Postprandial satiety
loss of appetite
decline in cognitive function confusion (especially in elderly_
Depression
Dizziness, syncope
Signs of HF
More Specific
Elevated JVP
S3
Summation gallop w/ S3 and S4 heart sounds
Cardiomegaly, laterally displaced apical impulse
Hepatojugular reflux
Cheyne-stokes respiration in advanced HF
Signs of HF
Less specific
Peripheral edema
Pulmonary rales
unintentional weight gain (> 2 kg/wk)
Weight loss (in advanced HF) w/ muscl wasting and cachexia
Cardiac murmur
Reduced air entry and dullness to percussion at lung abases suggestive of pleural effusion
Tachycardia, irregular pulse
Tachypnea
Hepatomegaly/ascites
Cold extremities
Oliguria
Narrow pulse pressure
Diagnostic Lab Testing
For patients presenting w/ HF, the specific cause of HF should be explored using what? for appropriate managment.
additional lab testing
Diagnostic Lab Testing
For pts who are diagnosed w/ HF, lab evaluation should include what?
CBC
UA
BMP
Lipid profile
LFT
Iron studies
TSH
Diagnostic Lab Testing
For all pts presenting w/ HF what should be performed at the initial encounter to optimize management?
a 12-lead EKG
Diagnostic Lab Testing
Genetic screening and counseling are recommended in what patients, to detect cardiac dz and prompt consideration of treatments to decrease HF progression and sudden death?
in first-degree relatives of selected patients w/ genetic or inherited cardiomyopathies
Diagnostic Lab Testing
In pts presenting w/ dyspnea measurement of what is useful to support or exclude a diagnosis of HF?
B-type natriuretic peptide (BNP)
N-terminal prohormone of B-type natriuretic peptide
Diagnostic Lab Testing
In pts w/ chronic HF, measurements of BNP or NT-proBNP levels are recommended for what?
risk stratification
Diagnostic Lab Testing
In pts hospitalized for HF, measurements of BNP or NT-proBNP levels at admission is recommended to establish what?
prognosis
Diagnostic Imaging
What is typical Imaging to obtain for HF diagnosis?
CXR
TEE
Diagnostic Imaging
What is alternative imaging to obtain for HF diagnosis?
cardiac MRI
CT
Radinuclide imaging
Management Stage A
In pts w/ HTN, BP should be controlled in accordance w/ what?
Guideline Directed Medical Therapy for hypertension to prevent symptomatic HF
Management Stage A
In pts w/ DM T2 and either established CVD or at high CV risk, what should be used to prevent hospitalizations for HF?
SGLT2 inhibitors
Management Stage A
In the general population, what strategies are helpful to reduce future risk of HF?
healthy lifestyle habits such as regular physical activity, maintaining normal weight, healthy dietary patterns and avoiding smoking
Management Stage B
Pts w/ LEVEF </= 40% what should be used to prevent symptomatic HF and reduce mortality?
ACE inhibitors
Management Stage B
Pts w/ a recent MI and LVEF </= 40%
ARB if ACE inhibitor intolerant
Management Stage B
Pts w/ LVEF </= 30%; > 1yr survival; > 40d post MI should receive?
ICD
Management Stage B
Pts w/ a recent or remote hx of MI or ACS, what should be used to prevent symptomatic HF and adverse cardiovascular events?
statins
In pts w/ a recent or remote hx of MI or ACS and LVEF </=40% evidenced-based use of what reduces mortality?
Beta blockers
In pts w/ HF who have fluid retention, what should be used to relieve congestion, improve symptoms and prevent worsening HF?
diuretics
For patients w/ HF and congestive symptoms, addition of what? to treatment w/ loop diuretics should be reserved for pts who do not respond to moderate- or high-dose loop diuretics to minimize electrolyte abnormalities?
thiazide diuretic like metaloazone
In pts w/ HFrEF and NYHA class II to III symptoms, the use of what is recommended to reduce morbidity and mortality?
Angiotensin Receptor Neprilysin inhibitors (ARNi)
In pts w/ previous or current symptoms of chronic HFrEF, the use of what is beneficial to reduce morbidity and mortality when the use of ARNi is not feasible.
ACEi
In pts w/ previous or current symptoms of chronic HFrEF, who are intolerant to ACEi d/t cough or angioedema and when the use of ARNi is not feasible, the use of what is recommended to reduce morbidity and mortality?
ARB
