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ICM-Cardio > Heart failure > Flashcards

Heart failure Flashcards

1
Q

another name for heart failure

A

congestive heart failure

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2
Q

what is heart failure

A

complex clinical syndrome resulting from structural or functional cardiac disorders

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3
Q

pumping difficulties

A

systolic heart failure

-depressed EF

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4
Q

difficulty filling

A

diastolic heart failure

-preserved EF

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5
Q

normal venrticular pumping

A

SVC/IVC->RA-RV-Pulmonary artery-> lungs-> pulmonary veins-> LA-> LV-> systemic circulation

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6
Q

symptoms of heart failure

A
  • fatigue
  • poor stamina
  • dyspnea: on exertion
  • paroxysmal nocturnal dyspnea: in bed at night
  • nocturnal cough (orthopnea)
  • abdominal fullness, bloating, nausea
  • edema
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7
Q

signs of heart failure

A
  • resting tachycardia
  • low systolic BP and narrow pulse pressure
  • volume overload
  • elevated BP
  • hepatojugular reflex: press on abdomen
  • pulmonary rales
  • S3, S4 or summation gallop
  • displaced PMI
  • murmurs: mitral or tricuspid regurgitation
  • hepatomegaly
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8
Q

why have shortness of breath: left side

A

difficulty of pumping/filling-> back pressure goes into pulmonary circulation-> liquid seeps into alveoli-> alveolar edema (pulmonary edema)

  • high pulmonary venous pressure
  • see narrow pulse pressure
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9
Q

why have shortness of breath: what happens on right side

A

back pressure goes-> pulmonary artery

  • high pulmonary artery pressure
  • get jugular-venous distention
  • can go to liver-> ascites
  • edema
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10
Q

what is seen on X-ray

A

pulmonary infiltrates

-enlarged heart (maybe)

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11
Q

what is heard on auscultation of lungs?

A

crackles or rales on lung bases

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12
Q

symptoms of right CHF

A

ankles swelling
weight gain
fatigue
muscle atrophy

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13
Q

heart failure pathophysiology

A
  • decreased CO
  • poor circulation to organs
  • low circulation to musculoskeletal system
  • low circulation to kidneys
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14
Q

low circulation to kidneys results in

A

increase RAA-> salt and water retention, plasma volume expansion, and increased preload

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15
Q

what happens to heart in CHF: systolic heart failure

A

in systolic heart failure: heart muscle walls thin, cavity sites get bigger

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16
Q

Etiology of heart falire

A 
coronary artery disease=atherosclerosis
hypertension
diabetes
alcohol
valvular heart disease
viral
familial
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17
Q

what happens to heart in CHF: diastolic heart failure

A

in diastolic heart failure: heart muscle thickens, and cavity site gets smaller

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18
Q

how to we stage heart failure

A
  • Stage A: at risk of CHF (have diabetes, alcoholics)
  • Stage B: asymptomatic structural disease (thinning wall or thickening wall)
  • StageC: previous/current symptoms
  • Stage D: refractory symptoms
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19
Q

class I classifications

A

no symptoms and no limitations to ordinary physical activity

20
Q

class II

A

mild symptoms to ordinary physical activities

21
Q

class III

A

marked symptoms with less than usual activity, comfortable at rest

22
Q

class IV

A

severe limitations and symptoms at rest. Bed bound patient

23
Q

steps in diagnosis of CHF

A
  1. clinical exam
  2. ECG
  3. chest film
  4. BNP
  5. echocardiography
24
Q

what to look for on CXR

A
  • enlargement of heart base

- congested lungs

25
Q

big heart is

A

inefficient heart

26
Q

BNP

A

comes from heart

  • released from wall tension
  • enlarged heart-> if increased pressure or volume overload—-> release BNP
  • normal BNP <100
27
Q

what can you see on echo

A 
chamber sizes
presence and severity of LV systolic dysfunction
valve lesions
regional LV function
assessment LV diastolic function
Valvular abnormalities 
Pericardial diseases
RV abnormalities
28
Q

normal EF

A

55-65%

LV EDV- LV ESV)/ (LV EDV

29
Q

hyperdynamic circulation

A

70-90% EF

30
Q

what happens when someone is diagnosed with CHF

A

-natural progression

31
Q

treatment of CHF

A
  • diet: low sodium restriction, 2gm or less
  • daily weight: check everyday (morning)
  • vaccinations (drugs): influenza and pneumococcus)
  • limit how much fluid they drink in a day: 1-1.5 liters
32
Q

drugs that improve symptoms for CHF

A

improve symptoms:
diuretics
digoxin: to strengthen heart contractility

33
Q

most common drugs to treat CHF

A

diuretics, beta-blockers and ACE inhibitors
Spironolactone
Devices

34
Q

drugs that improve symptoms/prognosis

A

improve symptoms and prognosis

  • ACE inhibitors/ARB’s
  • beta-blockers
  • hydralazine/isosorbide
  • spironolactone
  • devices
35
Q

cardiac resynchronization

A

improves LV EF
improves symptoms
Reduces function MR

Indications: EF 120ms

36
Q

advanced therapies

A
  1. chronic inotropic support (first option, if fails, go to 2)
    - dobutamine
    - milrinone
  2. LV assist devices (LVAD): helps heart to squeeze
    - Bridge therapy
    - destination therapy
  3. Heart transplantation (last option)
37
Q

acute decompensated CHF

A
  1. don’t follow diet
    - drink too much fluid
    - get volume overload
  2. don’t take medicine
  3. progression of disease itself: chronic hypertension
38
Q

treatment of acute CHF

A
  1. Diuretics: reduced volume overload
  2. Vasodilators: decrease preload and afterload, ACE inhibitors, beta-blockers
  3. Inotropes: augment contractility (stage D patients)
39
Q

reasons for acute CHF and treatment

A
  1. address precipitating causes
    - correct myocardial ischemia
    - remove offending medications
    - treat arrhythmias
    - control elevated BP
  2. Patient education
40
Q

heart failure with preserved LV EF (diastolic heart failure)

A

increased LV filling pressure due to abnormalities in LV relaxation and compliance
-elderly, history of HTN, CAD common

41
Q

treatment heart failure with preserved LV EF

A 
control BP
diet
drugs
maintain sinus rhythm 
Diuretics 
Relieve MI
42
Q

larger heart is

A

NOT stronger heart

-weak

43
Q

chest pain is symptoms of

A

MI or heart attack

44
Q

first line drugs to improve symptoms in CHF

A

diuretics

45
Q

What is seen on Chest radiograph

A 
Cardiomegaly 
Vascular engorgement 
Cephalization 
Kerley B lines
Pleural effusion
Enlarged main PA

Many may be absent in chronic compensated CHF

ICM-Cardio (21 decks)

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