Heart Failure Flashcards
A larger heart is a ____
weaker heart
Heart failure includes problems with __ and__
contraction and relaxation
Systolic dysfunction causes
decreased ej. fraction
Heart Failure symptoms (6)
- Fatigue and poor stamina
- Dyspnea
- PND (parox. nocturnal dyspnea)
- Orthopnea (nocturnal cough)
- Abdominal fullness
- Edema
Signs for HF
- Resting Tach
- Low Systolic with narrow PP
- High JVP
- Hepatojjugular reflex
- Pulmonary rales
- S3 and S4 gallop
- **********************************
Pathologic features..____ in left heart fail
Flooded lungs
High ____ Pressure in LHF
pulmonary venous pressure
____ is a development in LHF
Pulmonary edema (fluid in alveolar sp.)
Causes dyspnea and hemoptysis
___ and ____ on CXR for LHF
Enlarged cardiac shadow (Hypertrophy)
Pulmonary infiltrate
Auscultation of lungs in HF
Rales (pulm)
______ from high hepatic venous pressure
nutmeg liver
backpressure going into the liver from the IVC from the Rt heart, causing sinusoids to fill with blood, liver veins become dilated)
FIrst sign of volume overload
Jugular venous distension (Lay 30 degrees and look at IJV)Should be EMPTY normally
Always observe JVD on…
right side (more direct)
Symptoms of right CHF
Fatigue, edema *******
Reduced CO causes…
Increased RAAS = salt and water retention = increased volume
Increased SNS = vasoconstriction and increased afterload/contractility
Pathophysiology of HF
Myocardial cell death from Necrosis, apoptosis, fibrosis, _____
LV remodeling means heart has had ____
an insult area will either thicken or get thinned and stretched out)
Heart fail etiology
- Atheroscclerosis
- HTNDM
- Valve disease
- Alcohol
- Viral
- Familial
Stage A-D HF
A = at risk (with DM or HTN)
B = Asymptomatic, Uncontrolled HTN, Structural disease
C = Previous/current Sx
D = Refractory Sx
Functional stages of heart failure (NYHA) classification
1 = no symp or limitations to regular activity
2 = mild symptoms in ordinary physical activity
3 = marked symp with less than usual activity, comfort at rest
4 = Severe limmit and Sx at rest. Bedbound patients
People in Stage A can be in
Class 1
People in Stage C can be
class 2 or 3
Dx of HF
- Clinical exam
- ECG
- Chest film
- BNP
- ECHO
Heart fail ECG is usually…
usually abnormal but nonspecific
CXR - 6 signs
- Cardiomegaly
- Vascular enlargement
- Cephalization
- Kerley B lines
- Pleural eff
- Enlarged main PA
Many CXR signs may be
absent in chronic compensated HF
BNP is secreted as
pro BNP
BNP is released when there is…
increased pressure/stretch in the atrium
BNP is most increased during
CHF
Other conditions may cause small release, but CHF is highest by far
Echo for HF assesses… (5)
- Chamber size
- Severity of LV systolic dysfunction
- Regional LV function (CAD)
- Assess LV diastolic function and estimation of pressures
- Valve/pericardial/RV abnormalities
EF equation
Normal/severe?
LV EDV - LV ESV
____________
LVEDV
Normal 55-65%, Severe = less than 30%
Natural Hx of Heart failure
usually the time course varies, some may progress further/more rapidly than others
3 General Tx measures
Dietary sodium restriction
Daily weight
Vaccinations
Vax recommended in HF
influenza and pneumococcus
Meds that Improve Sx only
DIuretics and Digoxin
Meds that Improve Sx and prognosis
ACEI (-pril’s) / ARBs
Hydralazine and isosorbide
B-blockers
spironolactone
Devices (ICD, resynch)
___ is not first line Tx
DIgoxin
Next stage after Rx
ICD”call krause”
Indications for ICD (primary prevention)
CAD, prior MI with EF less than 30 EF less than 35, chronic class 2-3 CHF despite meds
People with chronic HF are prone to
sudden cardiac death
Resynchronization effects
improves LVEFImproves Symptoms and NHYA classReduces functional MR (improves survival)
Indication for resynch.
EF less than or equal to 35% ***************
Chronic inotropic support
DobutamineMilrinone
LVAD (left vent assist devices)
Bridge therapyDestination therapy
Last advanced therapy measure
cardiac transplantation
Chronic HF: Advanced therapies
Chronic inotropic supportLVADCardiac transplant
LVAD function
One end on LV, the other in aorta sucks blood from left ventricle and pumps it back into the aorta
5 most frequent acute decompensated HF causes
Diet noncompliance Med noncompliance failure to seek care Other (ischemia, HTN, Arrhythm.) Inappropriate Tx
Acute dcompensated CHF graph
Warm and Dry is normal (PCW ad CI nrmal)Warm and Wet (PCW elevated)Cold and dry (CI decreased)Cold and wet = PCW high, CI low)
Low perfusion at rest is indication for
Inotropic agents
___________ Y axis is indication for
Naturetic agents
Tx for acute CHF
Address precipitating causeseducate patient
HF with preserved LVEF
Increased LV filling pressure d/t abnormalities in LV relaxation and complience40% ____________************
Diastolic fail Tx
*******************************
______ is measured in HF
Anti-pro-BNP
