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FALL15 N757 Primary Care Adults 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is ejection fraction?

A

Fraction of blood pumped out of the ventricle with each heart beat

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2
Q

What is a normal ejection fraction?

A

50-55% - 70-75%

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3
Q

What is HFrEF?

A

a.k.a. Systolic Dysfunction
characterized by decreased contraction of LV
EF is = 40%

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4
Q

What is the most common cause of HFrEF?

A

ischemia

>infarction > scar formation

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5
Q

What is HFpEF?

A

a.k.a. Diastolic Dysfunction
Normal contraction but decreased filling of Vs
Stiff ventricular wall
>/= 50%

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6
Q

What is the most common cause of HFpEF?

A

similar to HFrEF but most often HTN

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7
Q

Which is more common, systolic or diastolic dysfunction?

A

Systolic!

60%

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8
Q

What are some characteristics of a patient w/systolic dysfunction?

A 
S3 and/or S4
weak carotid upstroke
displaced PMI
CAD & ischemia
idiopathic cardiomyopathy
Valve dz
HTN
myocarditis
drug induced
toxin induced
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9
Q

What are some characteristics of a patient w/diastolic dysfunction?

A 
Impaired filling
normal carotid upstroke
forceful apical impulse
hypertrophic signs (cardiomyopathy, S4)
HTN
DM
Ischemia
aging
Pericardial dz
Restrictive cardiomyopathy
hypertrophic cardiomyopathy
Amyloidosis
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10
Q

Women vs men: HF and CAD

A

women have better prognosis in HF, worse prognosis in CAD

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11
Q

What is the mortality rate of HF?

A

50% die w/in 5 years

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12
Q

Symptoms of LV Dysfunction (S&D)

A 
DOE
PND
Tachycardia
Angina
Cough
Hemoptysis
Decreased mental acuity
Fatigue
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13
Q

Signs of LV Dysfunction (S&D)

A 
Basilar Rales
Pulmonary Edema
S3
Displaced and hyperkinetic PMI
Pleural effusion
Cheyne-Stokes Respiration (late sign)
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14
Q

Symptoms of RV Dysfunction (S&D)

A 
Abdominal Pain
Anorexia
Nausea
Bloating
Swelling
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15
Q

Signs of RV Dysfunction (S&D)

A 
Peripheral Edema
JVD
Abdominal Jugular Reflux
Hepatomegaly
Weight Gain
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16
Q

What lab tests should you order in Dx of HF?

A

CBC, U/A, electrolytes, BUN/Cre, glucose, lipids, LFTs, TSH, uric acid, A1c, BNP or N-terminal pro-B type natriuretic peptide

17
Q

What (non-lab) tests/ imaging should you order in Dx of HF

A

12 lead ECG, CXR, 2D Echo

18
Q

What are you looking for in CXR in Dx of HF?

A

cardiac silhouette
Sharp costal margins (normal)
cardiothoracic ratio: max horizontal cardiac diameter / max horizontal thoracic diameter. Normal is

19
Q

What are the stages of HF? (ACC/AHA)

A

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

20
Q

What are the NYHA Functional Classes of HF?

A

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

21
Q

Goals and Tx for Stage A HF

A

“pre-HF”
Encourage healthy lifestyle
Treat HTN and HLD
Meds: e.g., ACEi/ARBs, statins

22
Q

What kind of HF pt should get an ACEi?

A

all pts w/reduced EF, even if no Hx MI!

Even w/o reduced EF if other risk factors (e.g., DM)

23
Q

Goals and Tx for Stage B HF

A

Goals: prevent Sx & further cardiac remodeling
Drugs: ACE/ARB, BB

24
Q

What’s so great about ICDs?

A

primary prevention of SCD in nonischemic DCM or ischemic HD at least 40 days post-MI, LVEF

25
Q

Goals and Tx for Stage C HFpEF

A

Goals: Sx control, QoL, prevent hospitalization/mortality
Meds: diuretics, ACE, BBs
Treat comorbidities

26
Q

Goals and Tx for Stage C HFrEF

A

Goals: Sx control, QoL, prevent hospitalization/mortality
Meds: ACE/ARB, BB, Diuretics, aldosterone antagonists

27
Q

Goals and Tx for Stage D HF

A

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…

28
Q

What drugs can be harmful to CHF patients?

A

CCBs, NSAIDs, TZDs

29
Q

Who is a candidate for an ICD?

A

EF less than 35%
LE greater than 1yr
NYHA II-III, optimally medically managed

FALL15 N757 Primary Care Adults 2 (13 decks)

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