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CVM > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is the mortality rate of class III and class IV HF pts

A

III 40%, IV 50%

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2
Q

What are the primary etiologies of Heart failure?

A

60-75% CAD
18% idiopathic
12% valvular heart disease
10% HTN

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3
Q

What are some basic causes of Heart Failure?

A

RV infarct, constrictive pericarditis, mitral stenosis, atrial myxoma, Thyrotoxicosis, A-V fistula Beri Beri

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4
Q

What are the Stages of heart failure?

A

ABCD

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5
Q

Walk through the different stages of “evolution of heart failure”

A

A-Risk factors no heart disease; no symptoms
B- Heart disease w/o sx
C- Prior or current HF symptoms, reduced exercise capacity
D- Refractory HF symptoms

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6
Q

Identify risk factors in Grade A staging of Heart failure

A

CAD, HT, DM, obesity, METABOLIC SYNDROME, excess EtOh

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7
Q

Discuss in greater depth Stage B, including structural changes, symptoms, or etiology

A

Has LVH, or impaired LV function, previous MI, valvular disease, structural heart disease; hemodynamically stable
Mortality rate is 15%

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8
Q

What are the different NYHA functional classification of Clinical Stages

A

Class I-IV

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9
Q

Discuss class I NYHA functional classifications

A

No limitations to physical activity

No sx with ordinary exertion

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10
Q

Discuss Class II NYHA Functional Classification. Include the one year mortality

A

Slight limitation of physical activity
Ordinary activity causes sx
One year mortality is 15-30%

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11
Q

Discuss class III NYHA Functional classification

A

Marked limitation of physical activity
Less that ordinary activity causes symptoms
Asymptomatic at rest
15-30% 1 yr mortality

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12
Q

Discuss Class IV NYHA functional classification

A

Inability to carry out physical activity w/o discomfort
Sx at rest
One year mortality 50-60%

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13
Q

What are the different pathogenesis of heart failure (pathobiology)

A 
Impaired systolic (contractile) function
Impaired diastolic function
Mechanical abnormalities
Disorders of Rate/Rhythm
Pulmonary heart disease
High output states
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14
Q

What are the different forms of heart disease you are able to see on Echo

A 
Hypertensive heart disease
Ischemic heart disease
Hypertrophic heart disease
Infiltrative heart disease
Primary valvular heart disease
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15
Q

Discuss Hypertensive heart disease on CXR and echo

A

LVH, bigger cardiac silhouette on echo

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16
Q

Discuss the findings on echo for ischemic heart disease

A

No change in wall size, a less compliant wall

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17
Q

How many degrees does the heart rate go up for every 1 degree F

A

10 bpm

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18
Q

Discuss the findings on echo for hypertrophic heart disease

A

Circumferential expansion of the heart including the septum

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19
Q

At what value of hemoglobin should you consider dialysis

A

<10

20
Q

Infiltrative Heart disease

A

You see specks on the Echo

21
Q

Discuss the findings on echo for Primary valvular heart disease

A

Bad valves

22
Q

What are the different classifications (types) of heart failure

A 
Systolic/Diastolic
High/Low
Acute/Chronic
Right/Left
Forward/Backwards
23
Q

Discuss systolic heart failure including EF, symptoms, pathogenesis, occurrence (in relationship to diastolic), associated diseases

A

More likely to be a systolic dysfunction but diastolic is increasing in number
Systolic- decreased SV, Increased ventricular filling pressure.
EF is less than 40%, hypoperfusion with impaired ventricular filling
Weak, fatigued, reduced exercise tolerance
DOE, orthopena, PND

24
Q

Discuss high type of heart failure, including disease associated, pathogenesis

A

High- pumping very hard but not pumping out a lot of volume
Hyperthyroidism, anemia, pregnancy, A-V fistula, beriberi, Paget’s
High CO, but low EF

25
Q

Discuss diastolic heart failure, including symptomology, pathogenesis, EF, associated diseases

A 
NORMAL EF
SOB, DOE, pulmonary edema
Inability for the LV to relax/fill, decreased ventricular diastolic capacity
Restrictive/constrictive pericarditis
Hypertensive/hypertrophic cardiomyopathy
Impaired Vent relax
Acute ischemia
Myocardial fibrosis
Amyloidosis
26
Q

Discuss associated diseases with low output type of heart failure

A

Ischemic heart disease, HTN

Dilated cardiomyopathy, valvular and pericardial disease

27
Q

Discuss associated diseases with right sided Heart failure

A

Affects RV
Pulmonary HTN due to pulmonary embolus
Edema, hepatomegaly venous distension

28
Q

Discuss associated diseases with left sided heart failure

A

LV is overloaded, AS, MI

Dyspnea, orthopnea, due to pul congestion

29
Q

Discuss the Compensatory mechanisms of heart failure- Neurohormonal Responses

A

SNS, RAAS, cytokine activation, Altered renal physiology, LV remodeling

30
Q

What is the RAAS mechanism of Heart failure?

A

Decreased renal perfusion, increased renin, angiotensinogen, A1, A1 ACEA11 increases BP by vasoconstriction, stimulates adrenal gland release aldosterone. Na and H2O retention (increase preload, congestive symptoms and volume (expansions)
A11- vasoconstrictor, PVR (increase afterload)

31
Q

Discuss the effects of Arginine Vasopressin- AVP or ADH

A

Stimulation of thirst leads to increase TBW and hyponatremia (dilutional) Increases preload (salt and water retention)

32
Q

What are some precipitating causes of heart failure (pt 1)

A 
Underlying progression of heart disease
Non-compliance with diet 25--50%
 (+ Na, calories, stimulants)
Non-compliance with medications 25-50%
(costly, side effects, worsening HF)
CCB, Beta blockers, NSAIDS, antiarrhythmics
33
Q

Is unilateral edema suggestive of heart failure?

A

Nah

34
Q

List other causes of heart failure (minor causes)

A 
Infection 20%, (look at the temp slide above)
Anemia
Increase O2 needs of tissues
Increased CO
Thyrotoxicosis/pregnancy
High CO state 
Arrhythmias 20-30%
Tachyarrhythmias- decrease diastolic filling time, leading to ischemia, bradycardia
35
Q

What are S/S of Heart Failure?

A

Decreased arterial perfusion to organs and venous congestion
DYSPNEA
Exercise interolance, orthopnea, PND, nocturnal angina (pul congestion)
PND increases likelihood of heart failure of 2x
Weakness
Pulmonary Edema
Transudation of fluid from pulmonary capillaries into alveolar spaces and interstitium

36
Q

S/S of Heart failure continued (think liver)

A

Hepatomegalia- passive congestion with increased LFTs, altered coagulation studies, ascites, increased abdominal girth, peripheral and sacral edema
JVD- volume overload, cardiac tamponade and COPD

37
Q

S/S of Heart failure

cont (think heart)

A

S3, S4 (s3 x11 likelihood of failure)
LV failure
Orthopnea, PND
Tachypnea, wheezing, crackles, decreased breath sounds
Dullness to percussion over pleural effusions

38
Q

S/S of heart failure cont (what about Right ventricular failure)

A

Peripheral sacral edema
Hepatomegalia
Ascites
Increased HVD, HJR

39
Q

What are tests you can do to help dx HF

A

No single test but consider
CXR
Shows cardiomegaly, pulmonary Edema with central peripheral infiltrates
Increased size

40
Q

What can Echo show you?

A 
Practical useful test
Mobile, bedside/ICU /ED
Chamber sizes, clots, tumors
Wall motion (ischemic), muscle thickness
Pericardial effusions
Valvular disease
Systolic/Diastolic heart failure-EF
41
Q

What will ECG show?

A

Ischemia, infarction, hypertrophy, Rhythm disturbances, Tachycardia/brady/blocks

42
Q

Discuss Cardiac Enzymes and Creatine Kinase, when they increase/peak

A 
Troponin T and I
Released from myocytes when damaged
Increase in 3-12 hours from onset of CP 
Peak 24-48 hours' return to baseline in 5-14 days
Creatinine kinase
Increase 3-12 hours from onset of chest pain
Peak 24 hours; baseline 1-3 days
Sensitivity
43
Q

What other labs can you get to help with dx

A 
CBC
Anemia 2nd degree to chronic disease
Anemia may aggravate HF
CMP
Electrolyte imbalance- Low Na,K
Pre-renal azotemia- high BUN to creatine
UA
Protein in urine
44
Q

Labs continue (think outside of the cardiac system)

A 
Thyroid
If >65 y/o with a fib YOU MUST CHECK
Free T4, TSH
ABG
May have hypoxia, metabolic acidosis from lactic acidosis
45
Q

Labs continued (what would help with diuresis of fluid)

A

BNP (neurohormone made in ventricles)
Lower EF, higher BNP
if less than 100 pg/ml there is a 97% chance of no HF
Increase BNP in heart failure, AMI, PE, renal failure, old age

46
Q

What is your DDx of HF

A 
Pulmonary
PE
Asthma
Pneumonia
Cirrhosis
Ascites
Edema
Renal- edema
Venous insufficiency edema

CVM (10 decks)

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