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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
What is right sided HF?
fluid builds up in the right ventricle that backs up into the systemic venous system sx: peripheral edema, congestive hepatosplenomegaly, jugular venous distension
26
What is forward HF?
same amount of blood goes into the heart but less comes out d/t less CO sx: fatigue, lethargy, weakness
27
What is backward HF?
ventricle is unable to pump the blood that is presented to the heart cxing less CO sx: dyspnea, orthopnea, pulmonary edema, peripheral edema
28
What is systolic HF?
- 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
How are kidneys affected in systolic dysfunction/failure?
goals: 1) increase blood pressure (via constriction of blood vessels) 2) increase volume (via angiotensin-aldosterone) ANP is also released
30
What is diastolic heart dysfunction/failure?
- 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
What is stroke volume?
blood left over in the ventricles after contraction
32
What is diastolic dysfunction related with?
- HTN - Age - Left Vent. hypertrophy - Female - DM - Coronary Art Dz
33
What can cause diastolic dysfunction?
- 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
What else can diastolic failure/dysfunction also be called?
Heart failure w/ preserved ejection fraction (HF - pEF)
35
Sx for LEFT HF?
- 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
Sx of Right HF?
- FATIGUE | - difficulty exercising
37
PE of Right HF?
- 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
Etiology of Right HF?
- 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
PE of HF?
``` 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
Labs for HF?
``` routine labs: -anemia -renal function -THYROID FXN (hypo and hyper can lead to HF) BNP: -indicates stretch on cardiac myocytes ```
41
ECG for HF?
atrial fib
42
CXR for HF?
- Cardiomegaly - Lung (upper lobe distribution, perihilar hazy, interstitial B lines) - Pleural effusion - Pulm edema - Pericardial Effusion (water bottle look)
43
Echo for HF?
TEST OF CHOICE - assess chamber size and contractility - measure ejection fraction - detect wall motion abnormalities
44
HF and Adaptive Mechanisms?
``` 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
Goals of Tx HF?
1) improve sx: - tx precipitating cx - correct REVERSIBLE cx - Tx underlying cx 2) SLOW progression 3) reduce mortality
46
Goals of Tx HF (lifestyle)?
Lifestyle 1) stop smoking and drinking 2) low Na intake 3) lose wt 4) exercise
47
Goals of Tx HF (control)?
1) reduce cardiac work load (preload and afterload) 2) correct the cx of retention of Na in the body 3) improve myocardial contractility
48
Goals of Tx HF (drugs)?
1) diuretics 2) ACE inhibitors 3) beta blocker 4) digitals glycosides (digoxin) 5) vasodilator therapy
49
Why diuretics for Tx?
(stay on good part of starling curve so fluid doesn't build up) -aldosterone improves survival in Class III - IV
50
Why ACE inhibitors for Tx?
- combats the activation of renin-angiotensin-aldosterone - controls fluid build up - reduce afterload - improve CO - IMPROVES SURVIVAL IN HF pts
51
Why beta blockers for Tx?
- positive remodeling | - IMPROVES SURVIVAL IN HF pts
52
Why digitals glycosides for Tx?
-hardly used d/t narrow therapeutic window
53
Types of vasodilator therapy for Tx?
- ACE inhibitor - Nitro - Nesiritide (postent vasodilator) - Alpha blockers - hydrazaline
54
What can the pt do for Tx?
- check wt daily (fluid build up = more wt) - NO Na - take meds - exercise
55
Advanced Tx for HF?
- 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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