Heart Failure Flashcards
What is ejection fraction?
Fraction of blood pumped out of the ventricle with each heart beat
What is a normal ejection fraction?
50-55% - 70-75%
What is HFrEF?
a.k.a. Systolic Dysfunction
characterized by decreased contraction of LV
EF is = 40%
What is the most common cause of HFrEF?
ischemia
>infarction > scar formation
What is HFpEF?
a.k.a. Diastolic Dysfunction
Normal contraction but decreased filling of Vs
Stiff ventricular wall
>/= 50%
What is the most common cause of HFpEF?
similar to HFrEF but most often HTN
Which is more common, systolic or diastolic dysfunction?
Systolic!
60%
What are some characteristics of a patient w/systolic dysfunction?
S3 and/or S4 weak carotid upstroke displaced PMI CAD & ischemia idiopathic cardiomyopathy Valve dz HTN myocarditis drug induced toxin induced
What are some characteristics of a patient w/diastolic dysfunction?
Impaired filling normal carotid upstroke forceful apical impulse hypertrophic signs (cardiomyopathy, S4) HTN DM Ischemia aging Pericardial dz Restrictive cardiomyopathy hypertrophic cardiomyopathy Amyloidosis
Women vs men: HF and CAD
women have better prognosis in HF, worse prognosis in CAD
What is the mortality rate of HF?
50% die w/in 5 years
Symptoms of LV Dysfunction (S&D)
DOE PND Tachycardia Angina Cough Hemoptysis Decreased mental acuity Fatigue
Signs of LV Dysfunction (S&D)
Basilar Rales Pulmonary Edema S3 Displaced and hyperkinetic PMI Pleural effusion Cheyne-Stokes Respiration (late sign)
Symptoms of RV Dysfunction (S&D)
Abdominal Pain Anorexia Nausea Bloating Swelling
Signs of RV Dysfunction (S&D)
Peripheral Edema JVD Abdominal Jugular Reflux Hepatomegaly Weight Gain
What lab tests should you order in Dx of HF?
CBC, U/A, electrolytes, BUN/Cre, glucose, lipids, LFTs, TSH, uric acid, A1c, BNP or N-terminal pro-B type natriuretic peptide
What (non-lab) tests/ imaging should you order in Dx of HF
12 lead ECG, CXR, 2D Echo
What are you looking for in CXR in Dx of HF?
cardiac silhouette
Sharp costal margins (normal)
cardiothoracic ratio: max horizontal cardiac diameter / max horizontal thoracic diameter. Normal is
What are the stages of HF? (ACC/AHA)
A: high risk for HF w/o structural DO of heart
B: Structural DO w/o Sx HF
C: Past or current Sx of HF associated w/structural heart Dz
D: End stage, requires specialized Tx
What are the NYHA Functional Classes of HF?
I: No Sx w/ordinary activity
II: Slight limitation of physical activity (symptomatic w/moderate exertion)
III: Marked limitation of physical activity (Symptomatic w/minimal exertion)
IV: Symptomatic at rest
Goals and Tx for Stage A HF
“pre-HF”
Encourage healthy lifestyle
Treat HTN and HLD
Meds: e.g., ACEi/ARBs, statins
What kind of HF pt should get an ACEi?
all pts w/reduced EF, even if no Hx MI!
Even w/o reduced EF if other risk factors (e.g., DM)
Goals and Tx for Stage B HF
Goals: prevent Sx & further cardiac remodeling
Drugs: ACE/ARB, BB
What’s so great about ICDs?
primary prevention of SCD in nonischemic DCM or ischemic HD at least 40 days post-MI, LVEF
Goals and Tx for Stage C HFpEF
Goals: Sx control, QoL, prevent hospitalization/mortality
Meds: diuretics, ACE, BBs
Treat comorbidities
Goals and Tx for Stage C HFrEF
Goals: Sx control, QoL, prevent hospitalization/mortality
Meds: ACE/ARB, BB, Diuretics, aldosterone antagonists
Goals and Tx for Stage D HF
Goals: Sx control, QoL, prevent hospitalization and readmissions, establish goals of care
Meds: ACE/ARB, BB, Diuretics, aldosterone antagonists
Options: advanced care measures, transplant, VAD, palliative care/hospice, ICD deactivation…
What drugs can be harmful to CHF patients?
CCBs, NSAIDs, TZDs
Who is a candidate for an ICD?
EF less than 35%
LE greater than 1yr
NYHA II-III, optimally medically managed
