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Assessment Exam 4 > Heart Failure '24 > Flashcards

Heart Failure '24 Flashcards

1
Q

What are the stages of heart failure?

A

AT RISK, PRE-HEART FAILURE, HEART FAILURE, ADVANCED HEART FAILURE

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2
Q

What characterizes the AT RISK stage of heart failure?

A

Risk factors but no structural changes or symptoms

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3
Q

What characterizes the PRE-HEART FAILURE stage of heart failure?

A

Structural changes but no symptoms

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4
Q

What characterizes the HEART FAILURE stage of heart failure?

A

Symptoms like shortness of breath and fatigue

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5
Q

What characterizes the ADVANCED HEART FAILURE stage of heart failure?

A

Symptoms don’t respond to treatment

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6
Q

What is Heart Failure (HF) defined as?

A

Impairment of ventricular filling or blood ejection

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7
Q

What are the clinical manifestations of heart failure?

A

Fatigue, dyspnea, weakness, edema, weight gain

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8
Q

How is HF classified based on ejection fraction (EF)?

A

HFrEF (EF ≤ 40%) and HFpEF (EF ≥ 50%)

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9
Q

What is the label for a patient with EF between 40-50%?

A

Borderline HFpEF

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10
Q

Is diastolic dysfunction present in both HFrEF and HFpEF?

A

Yes

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11
Q

What serves as the main marker for establishing HF risk factors, treatment, and outcomes?

A

Ejection fraction (EF)

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12
Q

What percentage of heart failure patients have normal ejection fraction?

A

Approximately half

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13
Q

What conditions are contributing to the increasing prevalence of HFpEF?

A

HTN, DM, A-fib, obesity, metabolic syndrome, COPD, renal insufficiency, anemia

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14
Q

What are some modifiable risk factors more common in HFrEF compared to HFpEF?

A

Smoking, hyperlipidemia

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15
Q

What proportion of heart failure cases are HFpEF?

A

52%

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16
Q

Which gender is more likely to be affected by HFpEF?

A

Women

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17
Q

Which gender is more likely to be affected by HFrEF?

A

Men

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18
Q

What is the primary determinant of HFpEF?

A

LV diastolic dysfunction

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19
Q

What factors determine the LV’s ability to fill?

A

Pulmonary venous blood flow, LA function, mitral valve dynamics, pericardial restraint, and elastic properties of LV

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20
Q

When is LV diastolic function considered normal?

A

When factors provide sufficient COP without increasing pulmonary venous and LA pressures

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21
Q

What are most measurements of LVDD dependent on?

A

HR, loading conditions, myocardial contractility

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22
Q

What is needed to achieve normal end-diastole volume in HFpEF patients?

A

Higher LV filling pressures

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23
Q

What can a steeper rise of the end-diastolic pressure-volume curve indicate?

A

Delayed LV relaxation

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24
Q

What is a form of ‘active stiffening’ related to LV end-diastolic dysfunction?

A

Delays in relaxation

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25
Q

What can delays in relaxation be caused by in LV end-diastolic dysfunction?

A

Failure of actin-myosin disassociation

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26
Q

How does high afterload affect LV relaxation in hypertensive patients?

A

D/O LV relaxation

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27
Q

What exacerbates the failure of LV relaxation in LV end-diastolic dysfunction?

A

Tachycardia

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28
Q

What is seen in HFpEF despite having only a modestly depressed LV systolic function?

A

Profound exercise intolerance

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29
Q

How do delays in LV relaxation affect coronary artery compression?

A

Prolong compression

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30
Q

How does prolonged compression of coronary arteries contribute to LV end-diastolic dysfunction?

A

Restricts diastolic coronary blood flow

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31
Q

What does restricted diastolic coronary blood flow contribute to in LV end-diastolic dysfunction?

A

Subendocardial ischemia

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32
Q

What are the most common symptoms associated with HF?

A

fatigue, tachypnea, dyspnea at rest or exertion, paroxysmal nocturnal dyspnea, orthopnea, S3 gallop, JVD, peripheral edema, exercise intolerance, reduced tissue perfusion

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33
Q

Which symptoms are more common with HFpEF?

A

paroxysmal nocturnal dyspnea, pulmonary edema, dependent edema

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34
Q

Which symptom is more common with HFrEF?

A

S3 gallop

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35
Q

How is the diagnosis of HFpEF more challenging compared to HFrEF?

A

Initial diagnosis is often more difficult, especially when patient is asymptomatic or only mildly symptomatic at rest

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36
Q

What does a mean pulmonary capillary occlusion pressure >15mmHg at rest or 25mmHg during exercise indicate?

A

Strong evidence of HFpEF and predictor of mortality

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37
Q

What may a chest X-ray detect in the diagnosis of heart failure?

A

Pulmonary disease, cardiomegaly, pulmonary venous congestion, pulmonary edema

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38
Q

What is an early radiographic sign of left ventricular failure and associated pulmonary venous hypertension?

A

Distention of pulmonary veins in the upper lobes

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39
Q

What does perivascular edema appear as on a chest X-ray in heart failure?

A

Hilar or perihilar haze

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40
Q

What are Kerley lines in heart failure?

A

Reflect edematous interlobular septae, honeycomb pattern

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41
Q

How does alveolar edema appear on a chest X-ray in heart failure?

A

Homogeneous densities in butterfly pattern

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42
Q

What are the diagnostic criteria for HFpEF according to ACC/AHA?

A

HF sx, EF >50%, evidence of LVDD

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43
Q

What are the limitations of the ACC/AHA criteria for HFpEF diagnosis?

A

May be simplistic for subclinical HFpEF

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44
Q

What does the ESC diagnostic criteria for HFpEF involve?

A

Specific echocardiographic indices based on 2D measurements

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45
Q

How does ESC differ from ACC/AHA in their approach to HFpEF diagnosis?

A

Relies entirely on resting echocardiographic assessment

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46
Q

Why are ESC guidelines limited in HFpEF diagnosis?

A

Do not incorporate provocative testing

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47
Q

What EKG abnormalities are common in patients with heart failure?

A

LVH, previous MI, arrhythmias, conduction abnormalities

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48
Q

What is the predictive value of EKG alone in diagnosing heart failure?

A

Low predictive value

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49
Q

What are the important biomarkers used in heart failure diagnosis?

A

BNP & NT-proBNP

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50
Q

What are brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) concentrations related to in heart failure?

A

LV end-diastolic wall stress

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51
Q

What type of LV remodeling is common in HFrEF?

A

Eccentric remodeling

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52
Q

What type of LV remodeling is common in HFpEF?

A

Concentric hypertrophy

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53
Q

What laboratory marker reflects the inflammatory component of heart failure?

A

CRP and GDF15

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54
Q

What are the two classification systems for HF?

A

NYHA and ACC/AHA

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55
Q

What aspect does the NYHA classification focus on?

A

Degree of limitation during physical activity

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56
Q

What type of information does the ACC/AHA classification provide?

A

Presence and severity of the disease

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57
Q

Why is it important to note that the stages of HF are progressive?

A

Linked to reduced 5-year survival

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58
Q

How are patients often classified in terms of HF?

A

Combination of both scoring systems

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59
Q

What is the difference in mortality trends between patients with HFrEF and HFpEF?

A

HFrEF improving, HFpEF unchanged

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60
Q

What is the approach to medication treatment in HFpEF patients?

A

Relatively futile

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61
Q

What type of patients benefit from medication treatments in heart failure?

A

HFrEF patients

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62
Q

What is the treatment approach for HFpEF?

A

Mitigate symptoms, treat associated conditions, exercise, weight loss

63
Q

Which medications are commonly used in treating HFrEF?

A

Β-blockers and ACE-inhibitors

64
Q

What are loop diuretics recommended for in chronic HF treatment?

A

Reduce LV filling pressures, decrease pulmonary venous congestion, improve HFpEF/HFrEF sx

65
Q

In which patients can thiazide diuretics be useful to prevent the onset of HFpEF?

A

Pts with poorly controlled HTN

66
Q

Beta-Blockers are strongly recommended for which type of HF?

67
Q

Is the benefit of Beta-Blockers clearly established for HFpEF?

A

Benefit not clearly established

68
Q

What are the mainstay treatments for HFrEF?

A

ACE-inhibitors and ARBs

69
Q

In which type of heart failure do studies not show benefit for ACE-inhibitors and ARBs unless used for treatment of HTN?

70
Q

How does aerobic fitness impact patients with heart failure?

A

Reduces symptoms and increases quality of life

71
Q

What major risk factors for heart failure can weight loss help mitigate?

72
Q

What does the DASH diet improve in patients with HFpEF?

A

LV diastolic function, decreases arterial stiffness, and facilitates more favorable LV-arterial coupling

73
Q

What should be controlled in patients with heart failure?

A

HTN and blood glucose

74
Q

What is the goal of surgical treatment for chronic heart failure?

A

Prevent ventricular remodeling

75
Q

How can coronary revascularization help in chronic heart failure?

A

Reverse LV dysfunction

76
Q

What can successful early revascularization prevent in chronic heart failure?

A

Permanent EF reductions

77
Q

How much does CABG reduce 10-year mortality in chronic heart failure?

78
Q

What is cardiac resynchronization therapy (CRT) also known as?

A

‘Biventricular pacing’

79
Q

When is CRT recommended for patients with chronic heart failure?

A

NYHA class III or IV disease, EF < 5%, QRS duration 120-150 ms

80
Q

What benefits do patients who undergo CRT experience?

A

Fewer HF symptoms, better exercise tolerance, improved ventricular function, fewer hospitalizations, decreased mortality

81
Q

What are some risks associated with cardiac resynchronization therapy (CRT)?

A

Infection, misplacement, device failure

82
Q

What is the purpose of implantable hemodynamic monitoring in chronic heart failure?

A

Observe changes in intracardiac pressures to prevent decompensation

83
Q

How does the CardioMEMS Heart Failure system help manage heart failure?

A

Measuring LV filling pressures for medication titration

84
Q

What is the main function of implantable cardioverter-defibrillators (ICDs) in heart failure?

A

Prevent sudden death

85
Q

What percentage of heart failure deaths are attributed to sudden cardiac dysrhythmias?

A

Approximately 50%

86
Q

What is the benefit of LV assist devices for patients in the terminal stages of heart failure?

A

Increased survival and improved quality of life

87
Q

What can LV assist devices do in patients with heart failure?

A

Take over partial or total function of the damaged ventricle

88
Q

When are LVADs used for temporary ventricular assistance?

A

While heart is recovering its function

89
Q

What is the primary function of a continuous-flow LVAD?

A

To pump blood from left ventricle to aorta

90
Q

What components are included in a continuous-flow LVAD?

A

Motor, pump housing, outlet stater, diffuser, rotor, inlet stator, blood-flow straightener

91
Q

How is the blood flow in a continuous-flow LVAD described?

92
Q

What is chronic heart failure classified as?

A

Long-standing disease

93
Q

How is acute heart failure characterized?

A

Rapid onset, life-threatening

94
Q

What is the treatment goal for acute heart failure?

A

Decrease volume, stabilize hemodynamics

95
Q

What does ADHF stand for and what are its symptoms?

A

Acute decompensated heart failure, fluid retention, weight gain, dyspnea

96
Q

What is de novo AHF characterized by?

A

Sudden increase in intracardiac filling pressures, acute myocardial dysfunction

97
Q

What is the leading cause of de novo heart failure?

A

Cardiac ischemia

98
Q

What are some nonischemic causes of de novo heart failure?

A

Viral, drug-induced, peripartum cardiomyopathy

99
Q

How is management of de novo heart failure focused?

A

Stabilizing hemodynamics & restoring myocardial perfusion

100
Q

What might de novo heart failure lead to in the long term?

A

Long-term cardiac dysfunction

101
Q

What may allow for complete restoration of myocardial function in de novo heart failure?

A

Management of underlying cause

102
Q

What are the first-line treatment for Acute Heart Failure (AHF)?

103
Q

What should be given immediately in patients with fluid overload to mitigate symptoms and reduce mortality?

104
Q

What may AHF patients with hypotension or cardiogenic shock require prior to diuretic therapy?

A

Hemodynamic support

105
Q

Which medications like furosemide, bumetanide, and torsemide can be given as bolus or continuous infusions in AHF?

A

Loop diuretics

106
Q

What do loop diuretics cause the release of and decrease in AHF patients?

A

Prostaglandins and acute pulmonary edema

107
Q

How do pharmacologic agents increase cAMP?

A

Increase intracellular calcium

108
Q

What is the result of increased cAMP?

A

Efficient excitation-contraction coupling

109
Q

Why do different inotropic agents have unique side effects?

A

Due to different mechanisms of increasing cAMP

110
Q

How do catecholamines interact with β-receptors on the myocardium?

A

Activate adenylyl cyclase to increase cAMP

111
Q

How do PDE-inhibitors (milrinone) increase cAMP levels?

A

Inhibiting its degradation

112
Q

What is Nesiritide?

A

Recombinant BNP

113
Q

How does Nesiritide work?

A

Inhibits RAAS, promotes vasodilation

114
Q

What effects does Nesiritide have on LVEDP?

A

Decreases it

115
Q

What are some effects of Nesiritide?

A

Induces diuresis and natriuresis, relaxes cardiac muscle

116
Q

Is Nesiritide superior to traditional vasodilators?

117
Q

When is urgent mechanical circulatory support (MCS) indicated in AHF?

A

When medical management fails and organ dysfunction is present.

118
Q

What does the Inter-agency Registry of Mechanically Assisted Circulatory Support (INTERMACS) assist in?

A

MCS decision-making process.

119
Q

How does the Intraaortic Balloon Pump work?

A

Balloon inflation after aortic valve closure, deflation during systole

120
Q

What does the IABP significantly improve?

A

LV coronary perfusion

121
Q

What are the primary methods for evaluating placement of IABP?

A

TEE and x-ray

122
Q

How does the support provided by IABP vary?

A

Set augmentation volume, balloon size, supported beats ratio

123
Q

What indicates full support in IABP?

A

1:1 ratio (one inflation for every heartbeat)

124
Q

What is the ideal setting for tachycardic patients using IABP?

A

1:2 ratio (one inflation per every two heartbeats)

125
Q

What improvements does IABP offer in cardiac output?

A

0.5-1 L/min

126
Q

What limitation does IABP have in terms of long-term use?

A

Generally immobilizes patients

127
Q

What is Impella?

A

VAD for reducing LV strain in acute heart failure

128
Q

How is Impella placed?

A

Via the femoral artery under fluoroscopy or TEE guidance

129
Q

What is the purpose of Impella?

A

Transition to recovery or a bridge to cardiac procedures

130
Q

What types of surgical AHF treatment are there?

A

Peripheral VAD/ECMO and Central VAD/ECMO

131
Q

What is the difference between ECMO and VAD devices?

A

ECMO devices have an oxygenator in-line, while VAD devices do not

132
Q

Where are cannulas placed for central ECMO?

A

Right atrium (outflow) and aorta (inflow)

133
Q

What are the benefits of central ECMO?

A

Ventricular decompression, limb impairment avoidance, SVC syndrome avoidance

134
Q

What effect does ECMO have on lung perfusion?

A

Reduced lung perfusion

135
Q

How does ECMO affect the use of INH anesthetics?

A

INH anesthetics are limited

136
Q

What anesthesia should be considered for patients on ECMO?

137
Q

Why do many agents, including fentanyl, become sequestered within the ECMO circuit?

A

The ECMO membrane is lipophilic

138
Q

What is an alternative approach for biventricular support in AHF surgical treatment?

A

Centrally cannulate right and left sides separately

139
Q

How can separate circuits for biventricular support be achieved in AHF surgical treatment?

A

Percutaneous placement of ProtekDuo and Impella

140
Q

Why may it be desirable to decouple support of the ventricles with two independent circuits in AHF surgical treatment?

A

To allow for weaning of either side

141
Q

What are some risks that heart failure patients have in the preoperative period?

A

Renal failure, sepsis, pneumonia, cardiac arrest

142
Q

What should all patients with known heart failure undergo before surgery?

A

Comprehensive exam for compensation

143
Q

What signs may suggest volume overload in a patient with heart failure?

A

Elevated JVP, S3/S4 gallop, peripheral edema

144
Q

When should surgery be postponed in heart failure patients?

A

Decompensated state, recent change in status, de novo acute heart failure

145
Q

Should diuretics be held the day of surgery for heart failure patients?

146
Q

Why is maintaining beta-blocker therapy essential for heart failure patients?

A

Reduces perioperative morbidity and mortality

147
Q

Are ACE-inhibitors recommended for perioperative use in heart failure patients?

A

May put patients at risk of intraoperative hypotension

148
Q

What does the 2014 ACC/AHA guidelines recommend regarding cardiovascular therapy during the perioperative period?

A

Maintain therapy

149
Q

When is a transthoracic echocardiogram indicated during preoperative evaluation in heart failure patients?

A

Worsening dyspnea

150
Q

Is a chest X-ray routinely recommended for preoperative heart failure evaluation?

151
Q

Which labs are recommended for preoperative assessment in heart failure patients?

A

CBC, Electrolytes, liver function, coags

152
Q

Is BNP routinely recommended for preoperative heart failure evaluation?

153
Q

What should be done with ICDs and pacemakers during preoperative management of heart failure?

A

Interrogated

Assessment Exam 4 (9 decks)

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