HEART FAILURE Flashcards
heart failure definition + classifications (3 ways)
chronic progressive ds where heart is unable to meet the body circulatory demand
- results in abnormal fluid retention causing VENOUS congestion (backup/flow) due to pathologic change
classify: high vs. low output, diastolic vs. systolic, right sided vs. left sided
Congestive HF: High output causes
INC in CO
- anemia
- thyrotoxiosis (excess TH)
- hemachromatosis
- pregnancy
- wet beriberi (thiamine def.)
- paget’s ds of bone
- AV fistula
potential causes of INC CO= vasodilation, impaired relaxation, inc blood volume and venous return, dec oxygen compensation
Congestive HF: low output causes
DEC in CO
- dec in myocardial contractility (cardiomyopathies)
- valvular ds
- diastolic dysfunc
Systolic HF
reduced LEFT ventricular EF (LVEF)
- 45% or LESS
- difficulty with myocardial contractility (failure to contract)
Systolic HF causes
- CAD (post MI)
- HTN (cause hypertrophy)
- valvular ds
- myocarditis
- alc abuse
- radiation tx
think you are WEAKENING the hearts ability to push blood OUT
Diastolic HF
preserve LVEF with impaired ventricular FILLING
- difficult with RELAXATION of the myocardium (failure to relax)
Diastolic HF causes
- LVH (MC CAUSE)
- valvular ds
- restrictive cardiomyopathy (amyloidosis, sarcoidosis, hemachromatosis)
making it hard for heart to FILL w blood
Left Sided HF
- symptoms
- signs
PULM VASCULAR CONGESTION (wet lungs)
Symp: dyspnea, orthopnea, paroxysmal noctural dyspnea, cough, confusion, fatigue
Signs: rales, dec breath sounds at bases, tachypnea, S3 ventricular gallop
blood going to body now backing up into lungs
Right sided HF
- symptoms
- signs
SYSTEMIC VASC CONGESTION
symp: anorexia, nausea/vom
signs: JVD (JVD reflex), hepatomegaly, ascites, periph pitting edema
LEFT HF is MC CAUSE OF RIGHT HF
blood going to lungs now backing up into body
CHF- Dx
names of tests
- Labs, CXR, EKG, Echocardiogram, Stress test, cardiac angiogram
CHF Dx
- labs
- EKG
CLINICAL DX
Labs: CBC, CMP, TFTs, B-type natruiretic peptide/BNP (released from ventricles with volume overload or expansion)
EKG: non specific
BNP released in response to volume overload, and tells heart to pump harder + promotes diuresis
CHF Dx contd.
- CXR
- Echocardiogram
- Stress Test
- Cardiac Angiogram
CXR: cardiomegaly, kerley B lines (interstitial edema/horizontal lines at periphery of lungs), pulm dilation, pleural effusions
Echo: LVEF, valvular abnormalities, perficardial effusion (lose costophren angles)
stress test- identification of ischemia
cardiac angiogram (blockages or narrowing)
Class I Functional classification
No limitations, ordinary activity does NOT cause symptoms
pt may have low EF but can do activities normally
Class II Functional classification
Slight limitation with physical activity, ordinary physical activity results in symptoms
Class III Functional classification
Marked limitation of physical activity, comfortable at rest.
Less than ordinary activity causes symptoms (ADLs)
can’t do ADLs without sitting
Class IV Functional classification
Unable to engage in physical activity without discomfort, symptoms at REST
HF tx
- lifestyle mods
- TX any underlying causes
- Lifestyle Mod:** low sodium diet** (1800 mg or less), fluid restriction, wt loss, alc reduce, smoking cessation, exercise, monitor daily weight, ANNUAL FLU AND PNEUMOVAX
HF- what amount of wt gain is concerning that pt is going into HF
pt should weigh themselves morning after using the bathoom (dry weight)
- if they gain more than 3 pounds from one morning to the next–> GOING INTO HF
HF tx
- medication types
Diuretics
ACE inhibitors
Beta Blockers
Digoxin
other inotropes
Sacubitrial-Vasartan (Entresto)
SGLT-2 Inhibitors (Jardiance)
HF tx
- Diuretic purpose and types
MOST effective w symptomatic relief
- loop: furosmide (most potent)
- thiazide: HCTZ
- aldosterone antag: spirinolactone, eplerenone (potassium sparing- more effective in adv stages)
HF Tx
- ACE purpose
- alternatives
- side effects
reduce MORTALITY and risk of nephropathy
- decrease LV stress (pre and afterload)
- slow remodeling
- causes atrial and venous dilation
- ARBs if pt is intolerant of ACE
- Side effects: hyperkalemia, angioedema, cough (bradykinin production)
HF Tx
- BB types and purpose
dec mortality post-MI HF
- dec remodeling
- slow HF, dec rate of O2 consump
- antiarrhythmic + anti-ischemic
- metoprolol, carvedilol
HF Tx
- digoxin
- purposes and side effects
pts with reduced EF or severe Afib
- pos inotropic/inc CO
- second line tx
side effects: Green halos around lights, n/v/d, AV blocks or ventricular arrhythmias, disorientation, memory impairment
HF Tx- other inotropes (names)
mildirone, dobutamine
HF Tx
- Entresto
- purpose and effects
- for what kind of HF patients is this best Tx?
- neprilysin inhibitor—> INC levels of natriuretic peptide (feedback to make body inc contractility and diuresis)
- inc vasodilation, dec volume through sodium excretion
- for systolic HF pts w/ class II-IV HF
- dec mortality and hospitalizations
HF Tx
- SGLT-2 Inhibitors (jardiance)
- effect/purpose
reduces risk of cardiovasc death and hospitalization for HF for pts w REDUCED or PRESERVED LVEF, also w/or w/out diabetes
Therapies to avoid
- thiazolidinediones
- most CCB (DO NOT USE CENTRAL CCB, peripheral allowed- amlodipine and felodipine)
- NSAIDS
- Cyclooxygenase-2 inhibitors (cause sodium/water retention and renal impairment)
- Combo of ACEi, ARB, Aldosterone blocker (inc risk of hyperkalemia)
HF Tx- Devices
- type of device
- for what kind of pt?
ICDs (cardiodefib)- prevent sudden death, for pt LVEF <35%, PPM-AICD options
LVADs (L ventricular assist device)- pt who requires frequent hospitalizations, bridge to transplants/destination therapy, NEED ANTICOAG THERAPY
CardioMEMs- monitor pulm artery pressure for titration of diuretics
Cardiac Transplantation
LVADs- provide enough perfusion for pt to get heart transplant OR older pt that cant get transplant and it keeps them alive
