heart failure Flashcards

(49 cards)

1
Q

What is heart failure?

A

Chronic, progressive condition in which the heart muscle is unable to pump enough blood to maintain cardiac output to meet demand

This results in insufficient oxygen delivery to tissues and fluid accumulation in the lungs.

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2
Q

What is the essential feature of congestive heart failure?

A

Dyspnea

Dyspnea refers to difficulty or discomfort in breathing.

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3
Q

What symptoms are associated with left-sided heart failure?

A

Symptoms include:
* Dyspnea on exertion
* Orthopnea
* Paroxysmal nocturnal dyspnea
* Wheezing
* Easy fatigability

These symptoms are predominantly respiratory.

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4
Q

What symptoms are associated with right-sided heart failure?

A

Symptoms include:
* Peripheral edema
* Ascites
* Raised JVP
* Hepatomegaly

These symptoms indicate fluid accumulation in the body.

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5
Q

What is heart failure with reduced ejection fraction (HF - REF)?

A

Condition where EF is LOW (<45%)

It is characterized by systolic dysfunction and impaired contraction.

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6
Q

What is heart failure with preserved ejection fraction (HF - PEF)?

A

Condition where EF is = or more than 50%

It is characterized by diastolic dysfunction and impaired relaxation.

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7
Q

What are the main causes of heart failure with reduced ejection fraction?

A

Main causes include:
* Myocardial Infarction (CAD)
* Valvular Heart Disease
* Dilated Cardiomyopathy
* Hypertension

Hypertension can initially preserve EF but may lead to systolic dysfunction over time.

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8
Q

What are the main causes of heart failure with preserved ejection fraction?

A

Main causes include:
* Hypertension
* Other conditions leading to heart dilation
* left ventricular hypertrophy
* age related heart stiffening

Over time, hypertension may lead to reduced EF.

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9
Q

What is the relationship between ejection fraction and survival in heart failure?

A

The lower the EF, the poorer the survival

This indicates the severity of heart failure.

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10
Q

True or False: There are effective therapies for heart failure with reduced ejection fraction.

A

True

Therapies aim to treat the underlying cause and manage symptoms.

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11
Q

What are the added sounds associated with heart failure with reduced ejection fraction?

A

Added S3 sound

This sound is indicative of heart failure.

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12
Q

What are the added sounds associated with heart failure with preserved ejection fraction?

A

Added S4 sound

This sound is often associated with diastolic dysfunction.

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13
Q

Fill in the blank: Heart failure with preserved ejection fraction has an EF of _____

A

[50% or more]

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14
Q

Fill in the blank: Heart failure with reduced ejection fraction has an EF of _____

A

[<45%]

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15
Q

What is Class I in the NYHA Classification of Heart Failure Severity?

A

No symptoms with ordinary physical activity

This classification helps in assessing the severity of heart failure.

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16
Q

What characterizes Class II in the NYHA Classification?

A

Mild limitation of physical activity; symptoms with ordinary physical activity

This indicates a moderate level of heart failure severity.

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17
Q

What is the definition of Class III in the NYHA Classification?

A

Marked limitation of physical activity; symptoms with less than ordinary physical activity

Patients in this class experience significant functional impairment.

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18
Q

What does Class IV represent in the NYHA Classification?

A

Unable to perform any physical activity; symptoms at rest

This is the most severe classification, indicating advanced heart failure.

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19
Q

What is the SINGLE MOST IMPORTANT DIAGNOSTIC TEST for heart failure?

A

Echocardiogram

It provides essential information on heart structure and function.

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20
Q

What is the best initial test for heart failure diagnosis?

A

Transthoracic echo

This test is non-invasive and widely available.

21
Q

What does echocardiography estimate in heart failure?

A

Ejection fraction

It differentiates between HF - REF and HF - PEF.

22
Q

What abnormalities can an echocardiogram show?

A
  • Chamber dilation or hypertrophy
  • Wall motion abnormality
  • Valvular disease
  • Cardiomyopathy
  • severity of LV dysfunction

These findings help in identifying the underlying cause of heart failure.

23
Q

What does ECG help detect in heart failure?

A
  • Arrhythmias (e.g., heart block, A. fib)
  • Evidence of CAD & old MI (HF - REF)
  • Evidence of left ventricular hypertrophy (HF - PEF)

ECG is crucial for evaluating electrical activity and structural changes.

24
Q

What is the role of a Holter monitor in heart failure investigations?

A

To detect paroxysmal arrhythmias

these are arrhythmias that come and go

It provides continuous ECG monitoring over 24 hours or more.

25
What can a chest X-ray reveal in heart failure patients?
* Cardiomegaly * Dilated upper lobe veins * Pulmonary edema (bat wing appearance) * Kerly lines (interstitial edema) * Pleural effusion ## Footnote These signs indicate congestion and structural changes due to heart failure.
26
What blood tests are important in heart failure investigations?
* CBC (to look for anemia) * Renal and liver profile * BNP * Thyroid function ## Footnote These tests assess underlying conditions that may exacerbate heart failure.
27
What does a normal BNP indicate in heart failure assessment?
Excludes CHF ## Footnote BNP levels can help differentiate cardiac from respiratory causes of acute dyspnea.
28
What is the purpose of cardiac catheterization in heart failure?
* Precise valve diameters & septal defects * Diagnosis of ischemic HF * Revascularization ## Footnote This invasive procedure provides detailed anatomical information.
29
What is the main goal of treatment in heart failure?
Improve Survival ## Footnote Treatment strategies focus on enhancing survival rates for heart failure patients.
30
What medications must be given to all patients at all stages of heart failure?
ACE inhibitors or ARBs ## Footnote ACE inhibitors and angiotensin receptor blockers are essential for all heart failure patients.
31
Which beta-blockers are beneficial for heart failure patients?
Metoprolol, Bisoprolol, Carvedilol ## Footnote Mnemonic: MBC.
32
What are the effects of beta-blockers in heart failure treatment?
Anti-ischemic, antiarrhythmic, decrease in HR ## Footnote Beta-blockers help improve heart function and reduce heart rate.
33
When are beta-blockers not given in heart failure treatment?
Acute treatment of HF episode ## Footnote They are used in maintenance treatment only.
34
What is the role of mineralocorticoid antagonists in heart failure?
Added in more advanced stages of HF (class II and IV) ## Footnote Spironolactone is commonly used, with eplerenone having fewer side effects.
35
What are the side effects of mineralocorticoid antagonists?
Hyperkalemia and gynecomastia ## Footnote Eplerenone has less incidence of gynecomastia.
36
What therapy is used if ACEI/ARB cannot be used? + used for who in which NYHA class
Hydralazine and isosorbide dinitrates used in african american patients as additional therapy classes III and IV ## Footnote These act as vasodilators in heart failure management.
37
What is ARNI in heart failure treatment?
Combination of valsartan (ARB) and sacubitril (neprilysin inhibitor) ## Footnote ARNI improves symptoms in heart failure management.
38
What is the initial treatment for managing symptoms in heart failure?
Diuretics ## Footnote Loop diuretics like furosemide are often used.
39
What is the role of digitalis in heart failure?
Used to control symptoms in symptomatic patients on both ACEI and BB ## Footnote Its use is controversial.
40
What is the purpose of an implantable cardioverter-defibrillator (ICD) in heart failure?
Reduces sudden death from ventricular arrhythmias ## Footnote It is indicated for patients with specific risk factors.
41
What are the indications for ICD placement?
* EF < 30% on optimal medical therapy * Previous cardiac arrest due to VT/VF * Previous MI with non-sustained VT on 24 h monitoring & EF < 35% * Long QT syndrome * Brugada syndrome * HOCM (hypertrophic obstructive cardiomyopathy) ## Footnote These criteria help determine who benefits from an ICD.
42
What is CRT in heart failure treatment?
Cardiac resynchronization therapy, also known as biventricular pacemaker ## Footnote It is used for patients with persistent symptoms and low EF.
43
What are the criteria for CRT?
* Persistent symptoms of HF * EF < 35% * LV systolic dysfunction * Dilated heart * Wide QRS ## Footnote These conditions indicate the need for CRT.
44
What surgical interventions can be performed in heart failure?
* Coronary Revascularization (for CAD) * Valve repair/replacement (for Valvular Heart Disease) * Cardiac transplantation in end-stage HF ## Footnote These procedures aim to improve symptoms and survival.
45
Fill in the blank: Heart failure with mid range ejection fraction has an EF of _____ (HFmrEF)
[41-49%]
46
Give 2 examples of SGLT2 Inhibitors that reduce mortality and heart failure hospitalizations that is used in both diabetic and non-diabetic patients.
Dapagliflozin, Empagliflozin
47
True or false: Management for HFpEF focuses on symptom relief and comorbidity control.
True
48
What drugs help with managing HFpEF
* diuretics (furosemide) * SGLT2 inhibitors (dapaglidlozin, empaglifolzin) * B blockers, ACE, ARBs, MRA (treat comorbidities only) * control A fib * treat diabetes and HTN
49
Treatment in HFpEF vs. HFrEF