Heart Failure Flashcards
What is Heart Failure?
A complex clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the heart to fill with or eject blood
Heart Failure symptoms
Fatigue/Poor Stamina Dyspnea Paroxysmal Nocturnal Dyspnea/Orthopnea Abdominal Fullness/Bloating/Nausea Edema
Physical Diagnostic Signs of CHF?
Resting Tachycardia Low systolic BP and narrow PP Elevated JVP/Hepatojugular Reflex Rales S3, S4, or Summation gallop. Hepatomegaly/Ascites/Edema
Special Symptoms of L CHF
Paroxysmal Nocturnal Dyspnea
Orthopnea
How is JVD measured
Prop them up to 30 degrees and measure how high above the sternal angle you can see the distended External Jugular. It should be not at all.
Symptoms associated with Right CHF
Ankle Swelling
Weight Gain
Fatigue
Musce Atrophy
In CHF, what happens after decreases in Cardiac Output.
Increases in sympathetic and RAAS activity. This will lead to increased preload, afterload, contractility, and vasoconstriction.
Overall – Increased Left Ventricular End Diastolic Pressure
Left ventricular remodeling is
Changes to the structure of the heart to make it thicker or more thin and stretched out
Causes of CHF
Coronary Atherosclerosis HTN Diabetes Vavluar Heart Disease Alcohol Viral
Four stages of CHF based on symptom presence.
Stage A – At risk
Stage B – Asymptomatic, but structural changes have begun
Stage C – Beginning Symptoms
Stage D – Worsening symptoms, usually with therapy
Four stages of CHF based on functional classification
I – No symptoms + No Limitations
II – Mild Symptoms to ordinary physical activity
III – Marked symptoms with ess than usual activity. Comfortable at rest.
IV – Severe limitations and symptoms at rest. Bedbound.
How to diagnose CHF?
CLinical Exam Ecg CXR BNP Echo
CXR Findings in Heart Failure
Cardiomegaly Vascular Engorgement Cephalization/Kerley B Lines Pleural Effusions Enlarged main PA
Whats the deal with BNP?
When the heart has increased levels of wall tension, BNP is released (also ANP)
A normal BNP is…
below 100
What might you find in the echo of a CHF patient?
Different chamber size, evaliate LV systolic and diastolic fxn, regional LV function.
Possibly valve, pericardial, RV abnormalities.
Normal Ejection Fraction
55-65%
Ejection fraction of Mild, Moderate, and Severe CHF
Mild – 40-50%
Moderate – 30-40
Severe – Below 30
General Measures common to chronic CHF treatments?
Sodium Restriction
Weighing yourself daily to check for holding too much water
Vaccinations (Influenza and Pneumococcus)
Drugs given purely for symptomatic management of CHF
Diuretics
Digoxin
Drugs given that improve the symptoms and prognosis of CHF
ACE Inhibiters/ARBs Hydralizine/isosorbide B-blockers Spironolactone Devices (like ICD, resync)
If medicinal treatment can’t get an ejection fraction above 30%, what should you do?
Put in a Defibrillator
Why do Cardiac resynchronization?
Improves LV EF
Improves Symptoms
Reduces Fxnal Mitral Regurh.
IMPROVES SURVIVAL
Three types of Advanced CHF treatments
Chronic Ionotropic Suport
LVAD
Cardiac Transplantation
Examples of chronic ionotropic support drugs
Dobutamine
Milrinone
Two ways to use an LVAD
Bridge therapy
Destination therapy
If a patient is “Warm and Wet”, how should you treat?
Lasix
If a patient is “Cold and Wet”, how should you treat?
Inotropic Drugs (Dobutamine, Milrinone, Ca Sensitizers)
Why give a CHF patient vasodilators?
to decrease preload and afterload
Treatment for acute CHF?
Address the precipitating cause (MI, offending meds, arrythmia, HTN)
Educate the patient
Important details for HF with Preserved LV EF
Increased LV filling pressure from LV abnormalities in relaxation and compliance
40-50% of CHF
Who gets HF with Preserved LV EF
Elderly, History of HTN
CAD Common
Treatment for Heart Failure with Preserved LV EF
Control BP
Relieve myocardial ischemia
Maintain sinus rhythm
Diuretic
