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Heart Failure Flashcards

1
Q

What is heart failure?

A

the cardiac output is not enough for the tissues in the body to perfuse

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2
Q

What is the most and least common results of heart failure?

A
  • most: the heart is unable to function d/t the lack of perfused tissues (LOW cardiac output)
  • least: the heart overworks in attempts to perfuse the body (HIGH cardiac output)
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3
Q

What is the 5 year survival rate in heart failure?

A

50%

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4
Q

What are the determinants of heart failure?

A

1) heart rate

2) stroke volume

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5
Q

What happens if you have hyperthyroidism?

A

hormone tells body to increase metabolism –> body overworks –> high CO

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6
Q

What are the 4 intertwined variables that influence CO?

A

1) heart rate
2) contractility
3) preload
4) afterload

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7
Q

What factors influence end diastolic stretch/length (preload)?

A

-ventricular filling pressure/preload
-myocardial compliance (stiff or compliant)
-atrial kick as part of preload
if there is increase of compliant –> increase EDV –> increase SV

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8
Q

What happens if LV is not compliant?

A

since the LV has a low limit, as pressure increases, the blood backs up into the pulmonary cxing pulmonary edema

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9
Q

What factors influence afterload?

A
  • blood pressure (systemic pressure affects LV; pulmonary pressure affects RV)
  • valvular heart dz
  • vessel compliance (larger arteries)
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10
Q

What is preload?

A
  • end diastolic volume

- the amount of blood in the ventricle there is after “filling”

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11
Q

What are the causes of heart failure? (13)

A
  • CAD
  • Cardiomyopathies
  • Cardiac arrhythmia
  • Cardiotoxic drug therapy
  • Pregnancy
  • DM
  • Smoking
  • Fam hx
  • Toxin exposure
  • MI
  • valvular heart dz
  • hyperthyroid
  • Pathophysiology increasing CO
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12
Q

What are the stages of HF?

A

-stage a, b, c, d

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13
Q

*What is stage A?

A

pts are at HIGH RISK b/c they have the underlying conditions to develop HF

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14
Q

*What is stage B?

A

pts heart structure is STRONGLY associated with HF but has NO signs/sx of HF

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15
Q

*What is stage C?

A

pts have underlying heart dz WITH current or prior sx of HF

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16
Q

*What is stage D?

A

pts have HF at REST WITH structural heart dz

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17
Q

What are the classes if HF?

A

Class I, II, III, IV

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18
Q

What is class I?

A

pts who have cardiac dz but does NOT have any limitation of physical activity (fatigue, palpitation, dyspnea, anginal pain)

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19
Q

What is class II?

A

pts who have cardiac dz and has SOME limitation of physical activity but NOT at REST (fatigue, palpitation, dyspnea, anginal pain)

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20
Q

What is class III?

A

pts who have cardiac dz and has a little bit more than some limitaion of physical activity but NOT at REST; can get fatigue, palpitation, dyspnea, anginal pain with less than ordinary activities

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21
Q

What is class IV?

A

pts who have cardiac dz that cannot do any physical activities; discomfort at rest with increasing anginal syndrome/heart failure

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22
Q

What are the different types of heart failure?

A

TIME FRAME and MECHANISM

1) acute/chronic
2) right and left sided/both
3) backward and forward
4) systolic and diastolic
5) high and low output

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23
Q

Right vs Left sided Heart failure /both

A

-accumulations in one or both ventricles

24
Q

What is left sided HF?

A

fluid builds up in the left ventricle that backs up into the pulmonary tree
hydrostatic pressure increases –> tissues swell –> TRANSUDATE LEAKS –> sx: dyspnea, orthopnea, pulmonary edema

25
Q

What is right sided HF?

A

fluid builds up in the right ventricle that backs up into the systemic venous system
sx: peripheral edema, congestive hepatosplenomegaly, jugular venous distension

26
Q

What is forward HF?

A

same amount of blood goes into the heart but less comes out d/t less CO
sx: fatigue, lethargy, weakness

27
Q

What is backward HF?

A

ventricle is unable to pump the blood that is presented to the heart cxing less CO
sx: dyspnea, orthopnea, pulmonary edema, peripheral edema

28
Q

What is systolic HF?

A
  • heart is unable to contract normally
  • HALLMARK: ejection fraction is LESS than 45%
  • pt can have SYSTOLIC failure WITHOUT heart failure
  • LV hypertrophy b/c it’s trying to increase ejection fraction to pump blood out –> heart becomes dilated (MORE blood comes in but not ALL are ejected)
  • b/c it’s unable to eject blood out, other organs are activated such as: renin-angiotensin-alodsterone system
29
Q

How are kidneys affected in systolic dysfunction/failure?

A

goals:
1) increase blood pressure (via constriction of blood vessels)
2) increase volume (via angiotensin-aldosterone)
ANP is also released

30
Q

What is diastolic heart dysfunction/failure?

A
  • heart is unable to relax so it can’t fill all the way (decreased compliance of the ventricle)
  • HALLMARK: ejection fraction is more than 45%
31
Q

What is stroke volume?

A

blood left over in the ventricles after contraction

32
Q

What is diastolic dysfunction related with?

A
  • HTN
  • Age
  • Left Vent. hypertrophy
  • Female
  • DM
  • Coronary Art Dz
33
Q

What can cause diastolic dysfunction?

A
  • myocardial (ischemia and fibrosis [scar tissue doesn’t stretch])
  • cardiomyopathy (Hypertensive and infiltrative [ventricles become rigid and is unable to relax])
  • constrictive pericarditis [inflammation of the pericardium = scarring and thickening]
34
Q

What else can diastolic failure/dysfunction also be called?

A

Heart failure w/ preserved ejection fraction (HF - pEF)

35
Q

Sx for LEFT HF?

A
  • DYSPNEA (early: on exertion; overtime: even at rest) b/c everything is backing up into the lungs –> pulm edema
  • ORTHOPNEA: relieved by sitting upright (pt sleeps w/ elevated pillows) b/c blood that was in the feet (lower half of body) distributes to the lungs (too much blood in lungs cxing SOB)
  • PAROXYSMAL NOCTURNAL DYSPNEA: wakes up at night w/ severe SOB and coughing that continues even after sitting/standing for 60-90min
  • ACUTE CARDIOGENIC PULMONARY EDEMA: chronic increase in pulmonary cap pressure cxing alveolar edema (SOB, coughing w/ blood, tachycardia and S3, rales, hypoxemia)
36
Q

Sx of Right HF?

A
  • FATIGUE

- difficulty exercising

37
Q

PE of Right HF?

A
  • JVD
  • hepatojugular reflex (pressure on liver that cxs JVD - there is too much blood in the liver so when you push on it, it goes UP!)
  • dependent edema (edema under the skin at the lower body)
38
Q

Etiology of Right HF?

A
  • LEFT HF CXS RIGHT HF
  • chronic lung dz –> pulmonary HTN (COPD, asthma)–> cxs right HF
  • obstructive sleep apnea –> pulm HTN –> right HF
  • right vent infarction
39
Q

PE of HF?

A 
vitals:
-BP: normal (mild), elevated (mild - mod), hypo (mod to severe)
-Pulse: tachycardia
FORCE OF PULSE
fundoscopic exam:
-AV nicking = HTN
Cardiac:
-HEAVES
*-S3 that is OVER 45 yo = HEART FAILURE*
Pulm (left HF):
-insp rales
-dullness at bases 
d/t pulm edema
JVD (right HF)
Hepatojugular reflex
Cardia edema 
-dependent edema (pretibial and sacral)
40
Q

Labs for HF?

A 
routine labs:
-anemia
-renal function
-THYROID FXN  (hypo and hyper can lead to HF)
BNP:
-indicates stretch on cardiac myocytes
41
Q

ECG for HF?

A

atrial fib

42
Q

CXR for HF?

A
  • Cardiomegaly
  • Lung (upper lobe distribution, perihilar hazy, interstitial B lines)
  • Pleural effusion
  • Pulm edema
  • Pericardial Effusion (water bottle look)
43
Q

Echo for HF?

A

TEST OF CHOICE

  • assess chamber size and contractility
  • measure ejection fraction
  • detect wall motion abnormalities
44
Q

HF and Adaptive Mechanisms?

A 
Renin-angiotensin-aldosterone system:
increase preload!
-increase aldosterone secretion, increase ADH secretion, fluid retention
Increase afterload!
-peripheral vasoconstriction
Increase catecholamine secretion: 
-cardiac remodeling occurs:
the heart is working harder
45
Q

Goals of Tx HF?

A

1) improve sx:
- tx precipitating cx
- correct REVERSIBLE cx
- Tx underlying cx
2) SLOW progression
3) reduce mortality

46
Q

Goals of Tx HF (lifestyle)?

A

Lifestyle

1) stop smoking and drinking
2) low Na intake
3) lose wt
4) exercise

47
Q

Goals of Tx HF (control)?

A

1) reduce cardiac work load (preload and afterload)
2) correct the cx of retention of Na in the body
3) improve myocardial contractility

48
Q

Goals of Tx HF (drugs)?

A

1) diuretics
2) ACE inhibitors
3) beta blocker
4) digitals glycosides (digoxin)
5) vasodilator therapy

49
Q

Why diuretics for Tx?

A

(stay on good part of starling curve so fluid doesn’t build up)
-aldosterone improves survival in Class III - IV

50
Q

Why ACE inhibitors for Tx?

A
  • combats the activation of renin-angiotensin-aldosterone
  • controls fluid build up
  • reduce afterload
  • improve CO
  • IMPROVES SURVIVAL IN HF pts
51
Q

Why beta blockers for Tx?

A
  • positive remodeling

- IMPROVES SURVIVAL IN HF pts

52
Q

Why digitals glycosides for Tx?

A

-hardly used d/t narrow therapeutic window

53
Q

Types of vasodilator therapy for Tx?

A
  • ACE inhibitor
  • Nitro
  • Nesiritide (postent vasodilator)
  • Alpha blockers
  • hydrazaline
54
Q

What can the pt do for Tx?

A
  • check wt daily (fluid build up = more wt)
  • NO Na
  • take meds
  • exercise
55
Q

Advanced Tx for HF?

A
  • implantable cardioverter defibrillators (pacemaker)
  • CABG
  • valve replacement
  • ventricular restoration (repair of ventricle)
  • cardiac resynchronization (biventricular pacemaker)
  • ventricular assist devices
  • cardiac transplantation

Cardiology (10 decks)

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