Heart Failure Flashcards
1
Q
What are the stages of heart failure?
A
At Risk
Pre-heart failure
Heart Failure
Advanced Heart Failure
2
Q
Characteristics of pre-heart failure
A
Structural changes, but no symptoms
3
Q
Characteristics of heart failure
A
symptoms like SOB and fatigue
4
Q
Advance heart failure symptoms ___________
A
don’t respond to treatment
5
Q
HF leads to______________
A
systemic hypoperfusion
6
Q
HF symptoms include
A
Fatigue
Dyspnea
Weakness
Edema
Weight Gain
JVD
S3 Gallop
Orthopnea
7
Q
Systolic HF (HFrEF)
A
HF with EF<40%
8
Q
Diastolic HF (HFpEF)
A
HF>50%
9
Q
Borderline HFpEF
A
Symptomatic HF w/EF 40-49%
10
Q
What are the distinguishing features b/t HFrEF and HFpEF?
A
LV dilation patterns and Remodeling
11
Q
What is the main marker for determining HF risk factors, treatment, and outcomes?
A
EF
12
Q
True or false: Diastolic dysfunction is present in both HFrEF and HFpEF
A
True
13
Q
Who are more likely to be affected by HFpEF?
A
Women
14
Q
Who are more likely to be affected by HFrEF?
A
Men
15
Q
Which HF is more likely to be associated with modifiable risk factors?
A
HFrEF
16
Q
LV ___________ dysfunction is the primary determinant of ________ whereas LV_________ dysfunctionis the primary determinant for ________
A
Diastolic
HFpEF
Systolic
HFrEF
17
Q
What is the LV’s ability to fill determined by?
A
*pulmonary venous blood flow
*LA function
*mitral valve dynamics
*pericardial restraint
*the elastic properties of the left ventricle
18
Q
What is required to achieve normal EDV in HFpEF?
A
higher LV filling pressures
19
Q
What part of the pressure-volume curve is indicative of delayed LV relaxation and increased myocardial stiffness?
A
Steeper rise of the end diastolic
20
Q
What does reduced LV compliance lead to?
A
LA hypertension, LA dysfunction, pulmonary venous congestion and exercise intolerance
21
Q
Common causes of LVED dysfunction?
A
Age >60
Acute MI
Myocardial stunning, hibernation, or infarction
Ventricular remodeling after infarction
Pressure-overload hypertrophy
Hypertrophic obstructive cardiomyopathy
Dilated CM
Restrictive CM
Pericardial disease
22
Q
What can cause delays in relaxation?
A
inadequate perfusion or dysfunctional intracellular Ca++ homeostasis
23
Q
________exacerbates diastolic dysfunction
A
Tachycardia
24
Q
True of false: exercise intolerance occurs with HFpEF
A
True
25
What symptoms are more common with HFpEF?
paroxysmal nocturnal dyspnea
pulmonary edema
dependent edema
26
What symptoms are more common with HFrEF?
S3 Gallop
27
What test defines elevated LV systolic and diastolic stiffness using pressure-volume analysis?
Cardiac cath
28
What pulmonary cap wedge pressures indicate HFpEF and predict mortality?
>15mmHg at rest
>25mmHg during exercise
29
What is an early sign of LV failure and pulmonary venous HTN seen on a CXR?
distention of the pulmonary veins in upper lobes
30
Kerley lines
Honeycomb pattern on CXR that reflects interlobular edema
31
Alveolar edema is presented in what type of pattern on CXR?
Butterfly
32
What echo criteria are more specific and incorporate echo indexes?
European society of cardiology
33
ACC/AHA diagnostic criteria
HF symptoms
EF>50%
Evidence of LVDD
***may be too simplistic for subclinical HFpEF
34
True of False: EKG abnormalities are common in HF patients and are a good predictor for HF diagnosis.
False
They normally have abnormalities but is not a good predictor
35
What are important biomarkers for HF?
BNP and N-terminal pro-BNP
36
Which HF will BNP be higher in?
HFrEF because of LV dilation & eccentric remodeling
37
What type of hypertrophy if HFpEF associated with?
Concentric
38
What labs are important besides BNP?
Troponin
CRP
GD15
39
What labs represent the inflammatory component of HF?
CRP and GDF15
40
How are patients classified for HF?
Typically a combo of both NYHA and ACC/AHA
41
Describe the NYHA Classifications
I-No limitation and symptoms with ordinary activity
II-Mild limitation with activity and comfortable at rest or w/mild exertion
III-Significant limitation with any activity and comfortable only at rest
IV-Discomfort with any activty and symptoms occurring at rest
42
Describe the ACC/AHA Classifications
A-High risk for development, but no deficits
B- Structural heart deficit, but no symptoms
C-HF symptoms d/t structural heart deficit w/medical management
D- Advanced disease requiring hospitalization, transplant, or palliative care
43
What classes of NYHA and ACC/AHA coordinate?
I-B
II-C
III-C
IV-D
44
Treatment for HFpEF
Mitigation of sx’s
treat associated conditions exercise
weight loss
**Medication treatments are ineffective
45
HFrEF treatment
BB
ACEi
46
Use of diuretics in HF
*Loop diuretics are recommended to reduce LV filling pressures, decrease pulmonary venous congestion, and improve HF sx
*Thiazide diuretics may be useful in poorly controlled HTN pts to prevent the HFpEF
47
What is the mainstay treatment for HFrEF?
ACEi and ARBS
48
DASH Diet
improves LV diastolic function, decreases arterial stiffness, and facilitates LV-arterial coupling in pts w/ HFpEF
49
What does DASH stand for?
Salt-restricted Dietary Approaches to Stop Hypertension
50
Goal of surgical treatment for chronic HF
Prevent ventricular remodeling and preserve natural geometry
51
Surgical Treatment Options for HF
Coronary revascularization
Cardiac resynchronization therapy (CRT)
Implantable hemodynamic monitoring
Implantable cardioverting-defibrillators
LV assist devices
52
_________causes 50% of death in HF
sudden cardiac dysrhythmias
53
What is CRT?
Cardiac resynchronization therapy (bi-ventricular pacing) used for HF with a ventricular conduction delay (prolonged QRS) to stimulate the heart to contract more synchronously
54
When is a CRT recommended?
EF<35% and QRS 120-150ms
55
What are LVADs used for?
Temporary ventricular assistance while heart is recovering its function
Pts awaiting cardiac transplant
Pts are on inotropes or balloon pump (IABP) with reversible medical conditions
Pts with advanced HF who aren’t transplant candidates
56
ADHF symptoms
Fluid retention
Weight gain
Dyspnea
57
What are the two forms of acute HF?
1. exacerbated preexisting HF (acute decompensated heart failure [ADHF])
2. Initial onset HF (de novo acute HF)
58
De novo HF
sudden increase in filling pressures or acute myocardial dysfunction, leading to decreased perfusion and pulmonary edema
59
What is the leading cause of de novo HF and what is treatment?
Cardiac ischemia
Treatment focuses on restoring perfusion, improving contractility, and stabilizing hemodynamics
60
Other causes of de novo HF
Viral
Drug-induced
Peripartum cardiomyopathy
61
What is the 1st line treatment for AHF?
Diuretics
-Furosemide, Bumetanide, and Torsemide
62
Hemodynamic presentation of AHF
Low CO
High ventricular filling pressures
HTN or hypotension
63
Use of Vasodilators in AHF
reduce filling pressures and afterload
-SNP, NTG
**Not shown to improve outcomes
64
Vasopressin receptor antagonists in AHF
used to reduce the arterial constriction, hyponatremia, and volume overload associated with AHF
65
Mainstay tx for AHF patients with acute reduced contractility or cardiogenic shock?
Positive Inotrops (catecholamines and PDE-i)
*both increase cAMP
66
Nesiritide
Exogenous BNP that inhibits RAAS and promotes vasodilation, induces diuresis and natriuesis and relaxes cardiac muscle
67
What IABP setting is preferred in tachycardic patients?
1:2
68
IABP
balloon inflation after aortic valve closure, followed by deflation during systole improving LV coronary perfusion by reducing LVEDP
69
How much does IABP improve CO?
0.5-1L/min
70
Impella
a VAD, placed percutaneously to reduce LV strain and myocardial work by a miniature rotary blood pump inserted through the femoral artery, advanced through the aortic valve and sits in the LV and draws blood continuously from the LV through the distal port and ejects it into the ascending aorta through its proximal port
71
Can an impella or IABP be used longer?
Impella can be used for 14 day. IABP requires immobility
72
Disadvantages of Peripheral VAD
Generates heat, causing more hemolysis and lower flows
73
Where are the cannulas placed in central VAD/ECMO?
Right atrium and aorta
74
What is the preferred anesthetic plan for ECMO patients?
TIVA
75
ECMO membrane is ________causing many agents, including ________, to become sequestered within the circuit
lipophilic
Fentanyl
76
BiVAD
Once a pt on central ECMO is stabile, decoupling support of the ventricles with two circuits facilitates weaning of the left- or right-sided support
77
When should surgery be postponed?
pts experiencing decompensation, a recent change in clinical status, or in de novo acute heart failure
78
What are HF more at risk of developing?
Renal failure
sepsis
pneumonia
cardiac arrest
79
What meds need to be held for surgery?
Diruetics
ACEi
80
Preop Labs/Tests for HF
EKG
TTE (if worsening dyspnea)
CBC, elctrolytes, liver, coags
ICDs and PM should be interrogated
81
Cardiomyopathy
cardiac disease associated with mechanical and/or electrical dysfunction, often with ventricular hypertrophy or dilation
82
Primary cardiomyopathies
confined to heart muscle
83
Secondary Cardiomyopathies
pathologic cardiac involvement assoc w/multiorgan disorder
84
Is hypertrophic CM primary or secondary?
Primary
85
What is the most common genetic CV disease?
HCM
86
HCM usually presents w/ hypertrophy of the ___________ and the _________free wall
intraventricular spetum
anterolateral
87
HCM has ___________ compliance
decreased
88
Common EKG abnormalities of HCM
high QRS voltage
ST-segment and T-wave alterations
abnormal Q waves
left atrial enlargement
89
What is normal EF of HCM?
>80%
90
What may an Echo show in HCM?
myocardial wall thickness >15mm
91
Medical Tx for HCM
BB &CCB
Diuretics
Disopyramide
Amio-if afib
Anticoagulation -if afib
92
Most effective antidysrhythmic for HCM patients
Amiodarone
93
When is surgery indicated for HCM?
Patients wiht large outflow tract gradients and severe symtpoms
94
Primary treatment for patients at risk of cardiac death due to dysrhythmias
ICD
95
Surgical treatment for HCM
Septal myomectomy
Cardiac Cathw/injection to induce of septal perforator arteries
Echo guided septal ablation
96
Dilated cardiomyopthy (DCM)
characterized by atrial and ventricular dilation, decreased ventricular wall thickness, and systolic dysfunction
97
What may ventricular dilation lead to?
mitral and/or tricuspid regurgitation
98
Echo of DCM typically reveals_____
dilation of all 4 chambers predominantly the LV, as well as global hypokinesis
99
EKG abnormalities of DCM
ST-segment and T-wave abnormalities and LBBB
common dysrhythmias: afib, PVC
100
What is the principal indication for cardiac transplant?
DCM
101
prophylactic ICD placement decreases the risk of sudden death by _________ in DCM
50%
102
Stress CM
Aka "Apical ballooning syndrome" is a LV hypokinesis w/ischemic EKG changes, however the coronary arteries remain patent causing Temporary disruption of LV contractility, the rest of the heart has normal contractility
103
Who does stress CM normally affect?
women > men
104
Peripartum CM
form of dilated cardiomyopathy that arises during the peripartum period (3rd trimester-5 months postpartum)
105
Criteria for diagnosis of peripartum CM
1. development of peripartum HF
2. Absence of another explainable cause
3. LV systolic dysfunction with EF <45%
106
What is the most common cause of secondary cardiomyopathies?
amyloidosis
107
Causes of secondary CM
amyloidosis
hemochromatosis
sarcoidosis
carcinoid tumors
108
Secondary CM symptoms
HF without cardiomyopathy or systolic dysfunction
*low to normal BP and can develop orthostatic hypotension
109
Cor Pulmonale
RV enlargement that may progress to right heart failure
110
What is the most common cause of cor pulmonale?
COPD
111
EKG abnormalities of cor pulmonale
RA & RV hypertrophy
Right axis deviation and RBB
112
What is RA hypertrophy indicated by on EKG?
peaked P waves
113
What commonly causes HFrEF?
obstructive ischemic heart disease
114
What factors induce LVOT obstruction in HCM?
Hypovolemia
Tachycardia
Increase contractility
Decreased afterload
115
What is the most common form of CM and 2nd most common cause of HF?
DCM
116
What is the most important determinant of pulmonary HTN and cor pulmonale in patients w/chronic lung disease?
What is the best treatment?
Alveolar hypoxia
Long-term oxygen
