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clinical medicine II > Heart failure > Flashcards

Heart failure Flashcards

1
Q

heart failure

A

complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood

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2
Q

systolic dysfunction

A

impaired cardiac contractile function

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3
Q

diastolic dysfunction

A

abnormal cardiac relaxation, stiffness or filling

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4
Q

SNS effect on HR, contractility, preload, afterload, and CO

A
  • HR increases
  • contractility increases
  • preload increases
  • afterload decreases
  • CO increases
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5
Q

preload

A

volume coming into ventricles (end diastolic pressure)

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6
Q

afterload

A

resistance-left ventricle must overcome to circulate blood

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7
Q

give examples of neurohormonal imbalances that can cause progressive heart disease by causes cardiac remodeling and decline in heart function

A
  1. overactivation of the renin-angiotensin-aldosterone system
  2. sympathetic nervous system
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8
Q

what is HFrEF

A
  • Heart failure with a reduced ejection fraction, also known as systolic heart failure
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9
Q

Signs of HFrEF

A
  • increased LV volumes
  • reduced LVEF (< or = 40%)
  • usually progressive chamber dilation and eccentric remodeling
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10
Q

causes of HFrEF

A
  • impaired contractility
    • CAD
    • cardiomyopathy
  • high afterload
    • HTN
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11
Q

HFpEF

A

Heart failure with preserved EF; also called diastolic heart failure

  • Diastolic dysfunction
    • abnormal mechanical properties of the ventricle
  • normal LVEF (> or = 50%)
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12
Q

differentiate between concentric and eccentric remodeling

A
  • concentric: walls are thicker
  • eccentric: walls are thinner
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13
Q

LV diastolic pressure

A

determined by volume of blood in ventricle and distensibility or compliance of ventricle

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14
Q

an elevated LV diastolic pressure will have what effect on pulmonary venous pressure

A

pulmonary venous pressure will increase causing

  • dyspnea
  • exercise intolerance
  • pulmonary congestion
  • may lead to RHF
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15
Q

what are the two most common causes of HFpEF

A
  • ischemia
  • left ventricular hypertrophy
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16
Q

most common caues of right heart failure

A

left heart failure

  • Rt heart does not tolerate increases in afterload
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17
Q

signs of Rt heart failure

A
  • increased pressurein veins, capillaries
  • increased formation of tissue fluid (peripheral edema and ascites)
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18
Q

risk factors of heart failure

A
  • coronary heart disease
  • smoking
  • HTN
  • obese
  • DM
  • valvular heart disease
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19
Q

what is the most common cause of heart failure

A

coronary artery disease

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20
Q

clinical presentation

  • dyspnea that becomes worse over time
    • DOE -> orthopnea -> PND -> dyspnea at rest
  • fatigue, weakness
  • dependent edema
  • weight gain
A

heart failure

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21
Q

what physical exam findings would you expect to see with heart failure

A
  • edema
  • elevated JVD
  • rales at bases
  • displaced PMI (laterally)
  • hepatomegaly
  • S3/S4 gallop
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22
Q

modified framingham clinical criteria lists major and minor criteria for the diagnosis of heart failure. what is needed to diagnose HF

A

at least 2 major symptoms or 1 major and 2 minor

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23
Q

left heart failure has what impact of CO? what are the effects?

A

decreased CO

  • activity intolerance, fatigue
  • signs of decreased tissue perfusion (confusion)
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24
Q

left heart failure causes pulmonary congestion. what are some signs and symptoms you would expect

A
  • impaired gas exchange
    • signs of hypoxia
  • pulmonary edema
    • cough with frothy sputum
    • orthopnea
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25
Q

these signs lead to what diagnosis

  • dependent edema
  • ascites
  • increased JVD
  • GI tract congestion
  • hepatic congestion
  • weight gain
A

right heart failure

26
Q

signs and symptoms point toward what disease

  • dyspnea
  • diaphoresis
  • tachypnea
  • tachycardia
  • rales
  • S3 or S4
A

left side heart failure

27
Q

patients with suspected HF should recieve the following diagnostic studies

A
  • ECG
  • echocardiography
  • chest radiograph
28
Q

a normal ECG makes which heart failure highly unlikely

A

systolic dysfunction

29
Q

what information can echocardiogram tell us regarding HF

A
  • ejection fraction > 50% is normal
    • systolic HF: signs/symptoms of HF + EF < or = 40%
    • diastolic HF: signs/symptoms of HF + normal EF
  • size of left ventricle
    • systolic HF: dilated LV
    • diastolic HF: LVH
30
Q

function of chest radiograph in diagnosis HF

A
  • evaluate CM
  • rule out pulmonary etiology
  • findings suggestive of HF
    • CM
    • cephalization of pulmonary vessels
    • Kerley B lines (interstitial edema)
    • pleural effusion
31
Q

when is a exercise ECG stress test contraindicated in HF

A

acute HF

32
Q

what labs would you get for suspected HF

A
  • cardiac enzymes
  • CBC
    • anemia/infection can exacerbate pre-existing HF
  • CMP
    • electrolytes
    • glucose: detect underlying DM
    • renal function
    • liver function tests to see if hepatic congestion is present
  • UA
  • lipid panel
  • thyroid panel: hypothyroidism can exacerbate HF
  • iron studies
33
Q

what lab is the marker for HF

A

brain type natriuretic peptide (BNP)

  • released in response to stretching of ventricular wall
  • elevated levels -> HF
    • higher level of BNP -> poorer the prognosis
34
Q

stages of heart failure

A
  • stage A: high risk but without structural changes or symptoms
  • stage B: structural heart disease but without signs or symptoms
  • stage C: structural heart disease with signs or symptoms
  • stage D: refractory heart failure including specialized interventions
35
Q

NYHA functional classification

A

class I-IV: used to classify patients in stages C and D of heart failure based on their symptoms

36
Q

goals of heart failure therapy

A
  1. reduce preload -> diminish congestive symptoms
  2. reduce afterload -> improve cardiac function
37
Q

recommended initial therapy for ALL patients with HF

A
  • ACE inhibitor
  • Diuretics
38
Q
A
39
Q

preferred diuretic in treatment of HF. Goal of diuretic

A
  • Loop diuretic preferred
    • Lasix
  • goal: reduce fluid overload
    • relieve dyspnea and peripheral edema
40
Q

what must you monitor when you place a patient on a diuretic

A

renal function

  • lasix causes hypokalemia and patient may require KCl supplement
41
Q

what must you monitor when you place a patient on a ACE inhibitors

A
  • BP
  • renal function
    • causes hyperkalemia
  • electrolytes
42
Q

benefit of ACE inhibitors

A

shown to reduce morbidity and mortality in both symptomatic and asymptomatic patients

43
Q

what medication can you give to patients in HF who can not tolerate ACE inhibitors

A

angiotensin II receptor blockers (ARBs)

44
Q

what must you monitor when you place a patient on a angiotensin II receptor blocker

A
  • BP
  • renal function
    • hyperkalemia
  • electrolytes
45
Q

when would you administer beta blockers to a patient with HF?

A
  • start ACE inhibitors first, wait until stable
  • administer only if patient is clinically stable
46
Q

main side effect of beta blockers

A

bradycardia

47
Q

what is mineralocorticoid receptor antagonist

A
  • aldosterone antagonist
  • potassium-sparing diuretic
48
Q

indications of mineralocorticoid receptor antagonist

A
  • patients with rest dyspnea withint past 6 months; post MI with systolic dysfunction
  • may result in hyperkalemia
49
Q

When is Digoxin given

A
  • use in patients with concomitant atrial fib
  • enhances exercise tolerance
50
Q

loss of what predicts a higher mortality rate

A

ADL: activities of daily living

51
Q

where do statins fall in treatment of HF

A
  • statins are not helpful
  • but if already on one for another indication, continue
52
Q

prognosis of HF

A
  • 30-40% die within 1 year
  • 60-70% die within 5 years
53
Q

what are the most common causes of death in a HF patient

A
  • progressive pump failure (decompensation)
  • malignant arrhythmias
54
Q

list some triggers for decompensation

A
  • uncontrolled HTN
  • A-Fib
  • ischemia
  • renal dysfunction
  • PE
  • infection
55
Q

name some drugs that can worsens heart failure

A
  • NSAIDs
  • metformin
  • PDE-5 inhibitors (Viagra)
  • Antiarrhythmics
56
Q

acute decompensated heart failure

A

elevated left sided filling pressures and dyspnea with or without pulmonary edema

57
Q

clinical presentation

  • dyspnea
  • productive cough
  • diaphoresis
  • rales, wheezes, rhonchi
A

cardiogrenic pulmonary edema

  • most often a result of acute decompensated HF
58
Q

what will CXR reveal in cardiogrenic pulmonary edema

A
  • Kerley B lines
  • edema
  • CM
59
Q

cardiogrenic pulmonary edema effect on pulmonary capillary wedge pressure

A

typically elevated ( > 25 mmHg)

60
Q

clinical presentation

  • cough
  • dyspnea
  • fatigue
  • peripheral edema
  • HTN
  • JVD
  • crackles
  • S3, S4 gallop
  • new murmur
A

acute decompensated HF

61
Q

managment of acute decompensated HF

A
  1. O2: keep sat > 90%
  2. diuretics
  3. nitroglycerin: reduce preload and capillary wedge pressure
  4. morphine: reduce anxiety and work of breathing
62
Q

the most common cause of heart failure

A

left ventricular systolic dysfunction

clinical medicine II (8 decks)

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