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cardiology > Heart failure > Flashcards

Heart failure Flashcards

1
Q

What can cause acute heart failure?

A
  • CAD, ACS
  • Valvular disease - endocarditis and aortic dissection
  • Myopathies - myocarditis and postpartum CMP
  • HTN and arrhythmia
  • Acutely decompensated CHF due to other causes, COPD, drugs toxicity, volume overload, renal failure, and infection.
  • Non-cardiac origin - sepsis, anemia, tamponade PE, shunt, thyrotoxicosis
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2
Q

What can cause chronic heart failure?

A
  • IHD/CAD
  • DCM and other CMPs
  • HTN
  • Valvular disorders
  • Congenital
  • Alcohol/drugs
  • RHF due to COPD, PE, or pulm. HTN
  • Arrhythmia
  • Amyloidosis
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3
Q

NYHA classification

A

I: Symptoms at level of exertion that would limit normal individuals
II: Symptoms at ordinary exertion
III: Symptoms at less-than ordinary exertion
IV: Symptoms at rest

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4
Q

AHA/ACC stages of heart failure

A

Stage A: High risk for HF, but without structural heart disease or symptoms (e.g HTN, DM, metabolic syndrome, obesity, cardiotoxic drugs)

Stage B: Structural disease without symptoms of HF (previous MI, LV remodels such as LVH, ↓ EF, or asymptomatic.valve disease)

Stage C: Structural disease with prior or current symptoms of HF

Stage D: Refractory HF requiring special intervention

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5
Q

Forrest classification

A

Depend on the cardiac index and pulmonary capillary wedge pressure.

Stage I -> Warm + dry (Well compensated, hemodynamic stable, optimise oral chronic therapy ACE + BB)
Stage II -> Warm + wet ( symptoms of volume overload, Diuretics + vasodilators)
Stage III -> Cold + dry (Symptoms of ↓ CO, but dont have volume overload. Vasodilators or ionotropes, in case of ↓ BP use inotropes first)
Stage IV -> Cold + wet (Diuretics, vasodilation, ionotropes)

Cardiac index - cold is when perfusion is less than 2,2L/min/m2 and warm is above. Is about the afterload. Symptoms: Cold clammy extremities or altered mental status or and liver enzymes or ↑ serum createnine.

Pulomary - fluid state. wet is above 18 mmHg and dry is below. Is about preload. Symptoms: shortness of breath, pulmonary congestion, peripheral edema, JVD

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6
Q

Dilative cardiomyopathy causes

A 
Idiopathic
Inherited (25%) (E.g duchenne)
Myocarditis (e.g coxsakie B or Chagas)
Metabolic - hemocrhomatosis, thyrotoxicosis
Peristent tachycardia
Nutritional - vitamins deficiency (B1) - wet beriberi
Valve problems
Alcohol abuse
Drugs - chemotherapy, cocaine
Peripartum DCM
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7
Q

Symptoms of Dilative cardiomyopathy

A

Fatigue, dyspnea, orthopnea and PND

Also other features of HF and/or pulmonary edema

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8
Q

Dilative cardiomyopathy diagnostics

A

Physical examination:

  • Narrow PP (due to a drop in SV), ↓ BP, ↑ JVP
  • Displaced and diffuse apex, S3 gallop, murmur (MR/TR)
  • Possible signs of right sided HF - peripheral edema, ascites, and hepatomegaly.

ECG: LVH, arrhythmias, possible previous MI

Echo: Confirms diagnosis- assessing measurements of cardiac walls, EDV, ESV, EF. Can show MR, TR and LV mural thrombus.

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9
Q

Dilative cardiomyopathy treatment

A 
Relieve symptoms and improve diagnosis
Medical: 
- Inotropes
- Digitalis
- BB, ACEi
- Diuretics
- Vasodilators
- Antiarrhythmic agents
- Anticoagulants

Surgery: Valve replacement, aneurysm resection, remodelling, cardiac transplant

Device: Pacemaker, ICS, IABP, LVAD, transplantation

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10
Q

Causes of hypertrophic cardiomyopathy

A

Gene defect of the myocardial structural proteins (myosin, troponin) this causes:

  • Myofibril disarray
  • Myocardial fibrosis
  • Myocardial hypertrophy
  • LV outflow tract obstruction
  • Systolic/diastolic dysfunction.

Mainly a AD inherited condition, but can be sporadic due to de novo mutations as well.

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11
Q

hypertrophic cardiomyopathy symptoms

A

Often asymptomatic

If symptoms: Fatigue, dyspnea, angina, syncope, arrhythmias

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12
Q

hypertrophic cardiomyopathy diagnostics

A

S4, mid-systolic ejection murmur and/or pan systolic regurgitation murmur

ECG: LVH, pre-excitation and WPW

Echo: confirms diagnosis.

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13
Q

hypertrophic cardiomyopathy treatment

A

Medical: BB, CCB, Disopyramide, anti arrhythmic

Non-pharma: Surgical septal myotomy-myectomy
Alcohol septal ablation (To reduce LV outflow tract obstruction)
Dual-chamber pacing
ICD

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14
Q

Symptoms of heart failure

A

Right HF

  • Peripheral edema, and ascites
  • Distention/pulsation of neck veins
  • Portal HTN w/heptomegaly and GI congestion causing nausea and anorexia
  • Facial engorement, epistaxis, nocturina and depression

Left HF

  • Pulmonary congestion and edema
  • Dyspnea (exertion), orthopnea, and PND
  • ↓ Sp=2
  • Cough and wheezing
  • Blood in sputum
  • Fatigue, muscle wasting and weight loss, and poor exercise tolerance
  • Cold extremities
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15
Q

Killip classification of AHF in AMI

A

Class I : no congestive HF
Class II: Rales/crackles, S3, pulmonary venous HT
Class III: Pulmonary edema
Class IV: Cardiogenic shock

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16
Q

Treatment steps of AHF

A
  • Restoration of oxygenation and tissue perfusion
  • Monitore and insure IV access
  • Position - sit/half sit (45 degree)
  • Symptom guided treatment
  • Etiology evaluation and casual treatment
  • Evaluation and control of fluid
17
Q

Diagnostics AHF and CHF

A

ECG - strain/hypertrophy, ischemia, arrhythmia, conduction disturbances

CXR - Pulm.congestion, fluids, cardiomegaly

Blood test - BNP, cardiac enzymes, electrolytes, renal and liver function, glucose, thyroid hormones

ABG
Echo

Exersice test
NYHA classification, Forrester’s hemodynamic stages

18
Q

Drug treatment of AHF

A

Stable decompensated CHF
- Vasodilators, loop diuretics, positive inotropes (in case of hypo perfusion)

Cardiogenic shock

  • Fluid
  • Inotropes/vasopressors
  • Intubation, mechanical ventilation
  • IABP

Pulmonary edema

  • Morphine
  • Loop diuretics
  • Vasodilators if HTN
  • Inotropes if hypo perfusion

Isolated right HF
- Fluids and inotropes

19
Q

Non-pharmacological treatment of heart failure

A

Acute bridge therapy

  • IABP
  • Impella recover - pumping assistance for LV
  • ECMO
  • Tandem heart
  • LVAD, RVAD, BiVAD

Temporary pacemaker therapy

  • Antibrady-/tachycardia
  • Resynchonization - biventricular pacing

Mechanical ventilation
ICD

Cardiac transplantation
- Indications NYHA class III and IV

Lifestyle changes

  • Physical activity, diet and weight reduction
  • Salt and fluid restriction
  • Alcohol restriction
  • Smoking cessation
20
Q

Drug treatment of CHF

A 
Lower mortality with:
ACE
BB
Vasodilators
Spironolactone
Digoxin
Vasodilators (nitrates)
Positive inotropes
Anti-arrhythmic 
Anticoagulants and antiplatelet drugs

cardiology (5 decks)

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