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Acute Care I > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Risk Factors for developing HF

A

HTN
DM
Metabolic Syndrome
Atherosclerotic dz

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2
Q

Metabolic Syndrome is when the patient has any 3 of the following

A

Abdominal adiposity
Hypertriglyceridemia
Low HDL
HTN
Fasting Hyperglycemia

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3
Q

Etiology of HF can be from?

A

Valvular dz
Cardiomyopathy
HTN
Ischemic Heart Dz - major cause of HFrEF

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4
Q

Pathophysiology of HF
Increased LVEDP d/t structural or functional impairment of ventricular filling or ejection of blood leads to?

A

Activation of SNS, RAAS, increased ADH

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5
Q

Pathophysiology of HF
Activation of SNS, RAAS, increased ADH leads to?

A

Vasoconstriction/increased blood volume

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6
Q

Pathophysiology of HF
Vasoconstriction/increased blood volume leads to?

A

Increased preload & afterload

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7
Q

Pathophysiology of HF
Increased preload & afterload leads to?

A

Decreased SV & congestion

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8
Q

Pathophysiology of HF
Decreased SV & congestion leads to?

A

Increased LVEDP d/t structural or functional impairment of ventricular filling or ejection of blood

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9
Q

RAAS activation
Renin secreted to low renal perfusion pressure leads to?

A

Cleaving of angiotensinogen to angiotensin I to II via ACE

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10
Q

RAAS activation
Cleaving of angiotensinogen to angiotensin I to II via ACE leads to?

A

Vasoconstriction, increased ADH & aldosterone secretion

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11
Q

RAAS activation
Vasoconstriction, increased ADH & aldosterone secretion leads to

A

Increased Na, H20 retention

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12
Q

RAAS activation
Increased Na, H20 retention leads to?

A

Increased preload, afterload, pressures in heart

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13
Q

RAAS activation
Increased preload, afterload, pressures in heart leads to?

A

cardiac remodeling, hypertrophy, sympathetic activity

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14
Q

RAAS activation
cardiac remodeling, hypertrophy, sympathetic activity leads to?

A

Renin secreted in response to low renal perfusion pressure

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15
Q

Diagnosis of HF
Assessment includes?

A

Clinical Hx
Physical examination
ECG, labs

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16
Q

Diagnosis of HF
Labs

A

NT-proBNP > 125 pg/mL
BNP >/= 35 pg/mL

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17
Q

Diagnosis of HF
Imaging?

A

TEE

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18
Q

Diagnosis of HF
HF Diagnosis Confirmed
Determine cause and classify
HFrEF is?
HFmrEF is?
HFpEF is?

A

LVEF </= 40%
LVEF 41-49%
LVEF >/= 50%

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19
Q

In pts w/ HF what should be assessed at each encounter to guide overall management including adjustment of what?

A

vital signs and evidence of clinical congestion
diuretics and other medications

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20
Q

In pts w/ symptomatic HF, clinical factors indicating the presence of what? should be sought via the what?

A

advanced HF
Hx and Physical Exam

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21
Q

In pt w/ cardiomyopathy, what should be obtained or updated when assessing the cause of the cardiomyopathy to identify what?

A

a 3-generation family hx
inherited dz

22
Q

In pts presenting w/ HF what should direct diagnostic strategies to uncover specific causes that may warrant disease-specific management?

A

thorough hx and physical exam

23
Q

In pts presenting w/ HF what should be obtained to identify what that might cause or accelerate the development or progression of HF?

A

thorough hx and physical exam
carddiac and noncardiac d/os, lifestyle and behavioral factors, and SDOH

24
Q

Symptoms of HF
Typical include?

A

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

25
Q

Symptoms of HF
Less typical

A

Nocturnal cough
Wheezing
Bloated feeling
Postprandial satiety
loss of appetite
decline in cognitive function confusion (especially in elderly_
Depression
Dizziness, syncope

26
Q

Signs of HF
More Specific

A

Elevated JVP
S3
Summation gallop w/ S3 and S4 heart sounds
Cardiomegaly, laterally displaced apical impulse
Hepatojugular reflux
Cheyne-stokes respiration in advanced HF

27
Q

Signs of HF
Less specific

A

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

28
Q

Diagnostic Lab Testing
For patients presenting w/ HF, the specific cause of HF should be explored using what? for appropriate managment.

A

additional lab testing

29
Q

Diagnostic Lab Testing
For pts who are diagnosed w/ HF, lab evaluation should include what?

A

CBC
UA
BMP
Lipid profile
LFT
Iron studies
TSH

30
Q

Diagnostic Lab Testing
For all pts presenting w/ HF what should be performed at the initial encounter to optimize management?

A

a 12-lead EKG

31
Q

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?

A

in first-degree relatives of selected patients w/ genetic or inherited cardiomyopathies

32
Q

Diagnostic Lab Testing
In pts presenting w/ dyspnea measurement of what is useful to support or exclude a diagnosis of HF?

A

B-type natriuretic peptide (BNP)
N-terminal prohormone of B-type natriuretic peptide

33
Q

Diagnostic Lab Testing
In pts w/ chronic HF, measurements of BNP or NT-proBNP levels are recommended for what?

A

risk stratification

34
Q

Diagnostic Lab Testing
In pts hospitalized for HF, measurements of BNP or NT-proBNP levels at admission is recommended to establish what?

A

prognosis

35
Q

Diagnostic Imaging
What is typical Imaging to obtain for HF diagnosis?

A

CXR
TEE

36
Q

Diagnostic Imaging
What is alternative imaging to obtain for HF diagnosis?

A

cardiac MRI
CT
Radinuclide imaging

37
Q

Management Stage A
In pts w/ HTN, BP should be controlled in accordance w/ what?

A

Guideline Directed Medical Therapy for hypertension to prevent symptomatic HF

38
Q

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?

A

SGLT2 inhibitors

39
Q

Management Stage A
In the general population, what strategies are helpful to reduce future risk of HF?

A

healthy lifestyle habits such as regular physical activity, maintaining normal weight, healthy dietary patterns and avoiding smoking

40
Q

Management Stage B
Pts w/ LEVEF </= 40% what should be used to prevent symptomatic HF and reduce mortality?

A

ACE inhibitors

41
Q

Management Stage B
Pts w/ a recent MI and LVEF </= 40%

A

ARB if ACE inhibitor intolerant

42
Q

Management Stage B
Pts w/ LVEF </= 30%; > 1yr survival; > 40d post MI should receive?

A

ICD

43
Q

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?

A

statins

44
Q

In pts w/ a recent or remote hx of MI or ACS and LVEF </=40% evidenced-based use of what reduces mortality?

A

Beta blockers

45
Q

In pts w/ HF who have fluid retention, what should be used to relieve congestion, improve symptoms and prevent worsening HF?

A

diuretics

46
Q

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?

A

thiazide diuretic like metaloazone

47
Q

In pts w/ HFrEF and NYHA class II to III symptoms, the use of what is recommended to reduce morbidity and mortality?

A

Angiotensin Receptor Neprilysin inhibitors (ARNi)

48
Q

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.

A

ACEi

49
Q

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?

A

ARB

50
Q
A

Acute Care I (30 decks)

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