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Cardio Exam 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

heart failure definition:

A

-inability of the heart to pump sufficient blood to meet the metabolic needs of the body

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2
Q

myocardial failure definition:

A
  • defective myocardial contraction

- results in heart failure!

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3
Q

circulatory failure definition:

A
  • a condition in which an abnormality of some circulatory component (heart, vessels, blood volume, etc) is responsible for inadequate cardiac output
    ex) hemorrhage
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4
Q

prevalence of heart failure:

A
  • 23million worldwide

- 4.7 million in US (1.5-2%)

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5
Q

incidence of heart failure:

A

-declining rates!!

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6
Q

What is the neurohormonal mechanism of heart failure:

A

1) activation of sympathetic nervous system (with a concomitant suppression of parasympathetic NS)
- Inc adrenergic activation = more circulating NE = peripheral vasoconstriction
- dec myocardial NE =we dont know why
- Beta1 stim= inc HR and contractility
- alpha1 stim=mild inc in tropism and peripheral vasoconstriction
2) activation of the renin-angitensin system (happens later)
- decreased renal perfusion
- dec Na in distal renal tubule
- inc adrenergic stim = inc renin release
- more antiotensin I=more antiotensin II = organ fibrosis (heart and kidney) & enhanced NE release

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7
Q

Result of neurohormonal model in HF:

A
  • peripheral arterial constriction
  • Na/Water retention
  • activation of inflammatory mediators of cardiac remodelling
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8
Q

LV remodelling:

A

1) dilation and shape change
- neurohormonal activation = changed function/shape
- pressure overload = parallel or concentric hypertrophy
- volume overload = SERIES or eccentric hypertrophy
- action potential prolongs in advanced HF (fetal gene activation)=contractile dysf
- contractile and reg proteins altered
- inc myocardial wall tension (LVEDV rises)
- MV regurg (papillary muscle separation)

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9
Q

Backward HF:

A
  • as the LV fails to completely eject its contents - blood accumulates in the LA
  • pressure rises in pulmonary circulation
  • trasudation of fluid into the pulmonary interstitium = pulmonary congestion/edema
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10
Q

Forward HF:

A
  • inadequate delivery of oxygen into arterial system (reduced cardiac output)
  • results in dec perfusion of vital organs + mental clouding, weakness, and Na/water retention
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11
Q

RV HF -

A

1) most often a consequence of LV failure with pulmonary congestion
2) results in SYSTEMIC CONGESTION
- hepatomegally, mesentery and bowel edema, leg edema, ascites
- fluid retention becomes generalized in RV failure

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12
Q

LV heart failure is:

A

-true congestive heart failure due to central venous congestion

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13
Q

Systolic failure (LV):

A
  • abnormal systoic function
  • high EDV in ventricles
  • poor perfusion –> na and water retained
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14
Q

Diastolic failure (LV)

A
  • abnormal diastolic filing (heart cant fill-heart isnt stretching well)
  • high LV filling pressure
  • eventual pulmonary and systemic congestion
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15
Q

Pure R side failure due to

A

corpulmonale!!

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16
Q

Heart failure - precipitating causes:

A
  • ischemia/infarction (MOST COMMON)
  • hypertension
  • arrhythmias (a fib)
  • infectious/inflammatory
  • pulmonary embolus
  • physical, emotional, environmental stress
  • cardiac toxins (chemo,alcohol)
  • high output states
  • reduction of therapy (LEAST COMMON)
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17
Q

Symptoms of HF:

A

1) short of breath (progressive)
- exertional
- paroxysmal nocturnal dyspnea
- orthopnea
- resting dyspnea
2) diminished exercise capacity
3) fatigue/weakness
4) nocturia
5) CNS impairment (memory, insomnia)
6) symptoms of RV faiure

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18
Q

Classification of HF:

A

-class1=no limitation
-class2=slight limitation
(orginary activity causes symtpoms)
-class3=marked limitation
(Less than normal activity precipitate symptoms)
-class4=symptoms at rest

19
Q

Physical exam of HF patient:

A

1) pallor, cool extremities
- sympathetic tone causes cutaneous vasoconstriction
2) Anxiety, dyspnea at rest
3) Pulses normal to rapid, weak
- fast pulse from sympathetic tone & low SV
4) blood pressure varies
5) Pulmonary rales as LV fails
6) elevated jugular pulsations in RV failure
7) kussmauls sign in RV failure
- venous return is enhanced with inhalation = jugular veins are distended (normally not)
8) hepatojugular REFLUX
- 60 sec of pressure on dome of liver=jugular venous pulses rise in the neck
9) congestive hepatomegaly
10) edema - symmetrical, pitting, dependent
11) pleural effusion
12) ascites

20
Q

cardiac exam of HF patient:

A
  • cardiomegaly (apical impulse down and to the left)
  • S3 universal
  • S4 rare (not usually a poor compliance issue)
  • pulsus alternans
  • murmurs -systoc (MR, AS, TR) & diastolic (AI)
  • cardiac cachexia (late) - so much edema that the abdomen is full of fluid = cant eat
21
Q

Lab of HF patients:

A
  • electrolyte abn - water excess, renal dysf (hyponatremia-water/Na balance issue)
  • liver enzyme elevations
  • findings related to precipitating causes (thyroid studies)
22
Q

X-ray of HF patients:

A
  • cardiomegaly
  • pulmonary cogestion
  • pleural effusion
  • kerley B lines (engorged lymphatics)
23
Q

ECG and HF patient?

A

non-diagnostic - can help with ischemia or chamber elargement

24
Q

HF prognosis:

A
  • pooor bc it just keeps gettig worse
  • 1.7 year men and 3.2 years for women post diag
  • 5 year for men = 25%
  • 5 year for women=32%
25
Q

most HF patients die from:

A

pump failure

tachyarrhythmias

26
Q

worse HF prognosis factors:

A
  • male
  • ischemic heart disease (CAD)
  • S3
  • low pulse pressure
  • high functional class
  • reduced exercise capacity
27
Q

hgih output HF-

A
  • high CO but metabolic needs no met

- so much shunting of blood that tissues that need blood dont get it

28
Q

etiologies of high output HF:

A
  • anemia
  • AV fistula (hemo patients)
  • hyperthyroidism
  • beri-beri
  • pagets disease of bone
29
Q

Goals of HF therapy

A
  • relieve symptoms
  • prolong survival
  • improve quality of life
  • delay or prevent progression of myocardial dysf
30
Q

common causes of HF:

A
  • CAD (ischemic cardiomyopathy; MI)
  • HTN
  • valvular disease
  • cardiomyopathies
  • cor pulmonale
  • congenital heart disease
31
Q

General approach to HF Tx:

A
  • base therapies on Functional class
  • reverse potentially treatable problems (CAD=reperfusion;repair structural abn ex valvular disease)
  • aggressive screening for DM
  • immunize for pneumonia and influenza
  • appropriate activity and rest
32
Q

Meds that make HF WORSE:

A
  • verapamil, diltiazem (neg ionotropic)
  • NSAIDs
  • sotalol (anti-arrhythmic)
  • beta blockers
33
Q

Functional classes of HF:

A
  • 1=asymptomatic-no activity limit- no Sx
  • 2=mild symptoms-slight activity limit-some Sx with ordinary activity
  • 3=marked limit of activity-much more Sx with less than ordinary activity
  • 4=decompensated - MANY Sx at rest
34
Q

Heart Failure stages:

A
  • A= high risk for HF - no structural heart disease or Sx (yet)
  • B=structural dysf (LVH) but no Sx
  • C=structural Dysf (MI) with Sx (SOB) – MOST PEOPLE HERE
  • D=refractory HF
35
Q

Non-drug Tx:

A

-HF risk factor reduction
-education (smoking, EtOH, dietary Na, fluid intake, monitor WG)
-activity (heavy physical labor is no-no)
for compensated HF (func classes 1-3) regular moderate exercise helps
-Diet- restrict Na
-manage fluid status - make sure they dont drink to much fluid if kidneys and heart is bad

36
Q

prevent HF progresson by:

A

1) counteracting neurohormonal activation
- ventricular remodeling due to adrenergic activation
- renin angiotensin aldosterone system activation
- -> relieved symptoms
- -> tabilizes or reverses remodeling

37
Q

what drugs help with the neurohormonal activation of HF

A
  • angiotensin converting enzyme inh (ACEI) (BEST CHOICE!!!!)
  • angiotensin receptor blocker (ARBs)
  • beta blocker
38
Q

How ACEI help:

A 
-interfere with renin angiotensin loop 
=block effect of angio2 on AT-1 receptors
=stabilize LV remodeling
=improve symptoms (QOL improved)
=reduce/prevent hospitalization
=prolong life
39
Q

ACEI - the drugs:

A
  • captopril
  • enalapril
  • fosinopril
  • lisinopril
  • quinapril
  • ramipril

THE -PRILS

40
Q

beta blockers on HF

A
  • not always BAD
  • anti-adrenergic agents for chronic HF
  • interfere with adverse effects of adrenergic activation on beta1 receptor
  • USED WITH ACEI!
41
Q

Which beta blockers tolerated by HF aptients:

A
  • metoprolol (BETA1 BLOCKER)
  • carvedilol (beta1 block with alpha 1 aka vasodil properties)
  • bisoprolol )beta1 selective
42
Q

when do give beta blockers:

A

-patient is functional class 2 or 3 already on ACEI or diuretic with no contraindications (asthma, AV block)

43
Q

Spironolactone is used how?

A

-aldosterone antagonist - only when all other drugs used and not helping enough (lousy diuretic - K sparing/saving!)

44
Q

other HF tx:

A

1) Mechanical
- intra aortic balloon pump
- LV assist device
2) Transplant
3) artificial heart!?!

Cardio Exam 2 (16 decks)

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