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Cardio 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is HF?

A

Inability to pump blood forward due to dec CO or inc intra-cardaic pressures

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2
Q

Factors controlling CO

A

Preload - PCWP…EDV

Contractility - EF…ability to develop force independent of preload and afterload

Afterload - SVR…blood at which ventricle has to work against to eject

HR and rhythm

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3
Q

HFpEF

HFrEF

A

HFpEF…inability to fill due to still ventricel…dec compliacne or relaxation…EF preserved

HFrEF - inability to contract or empty…EF under 40.

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4
Q

Progression

A

WIth Excpetion of transplant or mech support, txs dec morbidity and delay mortality

Compensatory mechs help inc CO but worsen underlying dz

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5
Q

Compensatory mechs

A

Intial fall in LV and wall stres…activate RAAS and SNS which

1) fibrosis, apoptosis, hypertrophyh, myotoxicty
2) inc HR and LV remodeling
3) AT2 inc SVR and leads to edema

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6
Q

Sx of HF

A

Low output - renal faiure, cool extremities, lethargy

Inc cogenstion - DOE< orthopnea, PND

Sx of RV failure - nausea, ab distension and bloating, LE edema

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7
Q

Acute deompensated HF

A

No cong, low perfusion - warm and dry…PCWP and CI normal

Congested and low perfusion - Warm and wet…PCWP elevated and CI normal

Low perfusion but no congestion - Cold and dry PCWP low/normla and CI decreased

Congestion and low persuon - COld and wet PCWP elevated, CI dec

CI cutoff 2, PCWP 18

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8
Q

Adjunct testing

A

CXR for edema and congestion of pulmonary

ECG - look for chamber abnormlities, arrhythmias, ischemi/infarction

Lab testing - NT-pro BNP, sodium

Echo

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9
Q

LF signs and sx

A 
Dyspnea
Orthopnea
Cough
PND
Pulm edema
Pleural effusion
Bibasilar rales
S3 gallop
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10
Q

RF signs and sx

A 
Peripoheral edema
JVD
Hepato/splenomegaly
Ascites
Nausea/anorexia
Hepatojugular reflux
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11
Q

Fxns classes

A

1 - no limitation
2 - slight on exertion
3 - marked (act of daily living)
4 - at rest

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12
Q

Tx

A

Short term - tx underlying etiology and improve hemodynamics

LT - lifestyle mods, ACEI, B blocker, aldosterone antags, defib

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13
Q

Acute meds

A

Dec preload - diuretics

Improve contractility - inotropic agents and mech circulatory support

Dec afterload

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14
Q

Non pharm approahc to chonic HF

A 
Reduce salt intake
Fluid restriction
Weight loss if obese
Exercise
Defib
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15
Q

INhibition of hypertrophic growht response and cardiac remodeling

A

Beta blockers
ACEIs/ARB
Aldosterone antags

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16
Q

ACE inhibs

A

LVEF under 40%

Afterload and preload reduction with RAAS inhibiton

IMprove sx and reduce remodeling

17
Q

Angiotensin antags

A

ACEIs should be used first

If chronic cough move to ARBs

If angioedema with ACEIs, do not use ARBs

PReg contraindication

18
Q

Beta blocker - general

A

Dec in HR without inc in stroke volume is NOT good

Inhbit SNS
Reduce afterload and inc EF
Reduce remodeling 
Reduce hospitalization
Reduce mortality
19
Q

Beta blocker indication

A 
LVEF under 40% 
Not a class effect

Carvedilo, metoprolol, bisoprolo

20
Q

Beta blocker pearls

A

Start on stable pts

Low and slow
May havbe to inc diuretic to inc BB

21
Q

Aldosterone antags

A

LFEV under 35 or under 40 post MI

Already on ACEI and BB

Class effect - epleronone and spironlacton

Conta if renal failure (Cr over 2) and hyperklaemia (K over 5)

22
Q

Diuretics
Hydralazine and isosorbide
Ivabradine

A

Sx of congestion

Motrality benefit in African americnas

HR over 75 on max BB

23
Q

Digoxin

A

Improves sx but narrow therpaeutic index

24
Q

ICD

A

Implantable cardiac defibrillator

MOst effective tx of vent arrhytmias

25
Q

Who qualifies for ICD

A

LVEF below 35
At least 40 days post MI
Good med therapy
High risk of sudden cardiac death

26
Q

Contraind for ICD

A

VT from reversible cause
Unlikely to survive 1 year
Incessant VT
Psychiatric illness

27
Q

Biventricular pacing

A

Cardiac resynchronization

Dyssynchroy - diff in timing of the contractions of the 2 ventricles or the septal or lateral wall of left ventricle

Goes through coronary sinus

28
Q

Who gets biventriclar pacing

A 
Low LVEF (under 35)
Wide QRS (over 150 msec)
Class 3 or 4
29
Q

Biventricular pacing benefits

A

6 minute walk test better

Dec hospitalizing

Reduction in mortality

Cardio 2 (23 decks)

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