Heart Failure Flashcards
Top 4 causes of heart failure?
IHD, Idiopathic (dilated cardiomyopathy), valve issues (especially calcified aorta), and hypertensive heart disease
4 causes of restrictive heart failure and what do we mean by restrictive heart failure?
RV infarction, constrictive pericarditis, mitral stenosis, and atrial myxomatous. Restrictive to filling.
What is stage A of heart failure and what patients fall in this category?
High risk for heart failure but no symptoms or structural heart disease. HTN, Diabetes, CAD, obesity, family history
What is stage B of heart failure and what patients fall in here?
Patients who do have structural heart disease but do not have signs or symptoms. LVH, Prior MI, Valve disease, LVEF drop
What is stage C heart failure and what patients fall in here?
Patients with structural heart disease with prior HF symptoms or current symptoms. Patients with a structural disease and dyspnea, fatigue, and don’t tolerate exercise very well.
What is stage D heart failure and what patients fall in this category?
HF needing intervention. These people are having problems at rest, all the time, and nothing is working.
How does the NYHA classify Heart failure?
Functional classification based on exercise capacity and if there are any symptoms.
What is the limitation on activity and what amount of exercise brings on symptoms for the 4 classes?
- No limitation on activity, no symptoms
- Slight limitation. Ordinary exercise brings on symptoms.
- Marked limitation. Less than ordinary causes symptoms, but still no symptoms at rest.
- No activity without symptoms and they are even at rest.
What are the 6 steps of the patho of heart failure?
Systolic problem, diastolic problem, mechanical problem, rhythm/rate off, pulmonary problems, and high output state.
5 classifications/types of HF?
Systolic/diastolic, acute/chronic, high/low, right/left, backward/forward
3 characteristics of Chronic HF?
Multivalvular with a dilated heart, slow progressing, edema and weight gain.
What is the main problem with systolic heart failure and what is the main consequence and clinical sign?
Ejection fraction sucks, like less than 40 so you aren’t sending blood out to the body. These people are tired and weak.
What is the problem with diastolic heart failure and what is the main consequence and what do these patients present with?
Can’t fill the ventricle because its too stiff. Backs up into the lungs so DOE and Pulmonary edema
What is going on with high output heart failure?
High CO because the body demands it, but a low EF.
3 causes of low output HF?
Dilated cardiomyopathy, valve disease and pericardial disease
5 compensatory responses to heath failure syndrome?
SNS, RAAS, cytokines, altered renal physiology and LV remodeling
6 precipitating causes of HF?
Non compliance with diet, non compliance with meds, infection, pregnancy because of high output, anemia, and arrhythmias
4 meds that worsen HF?
CCB, beta blockers, NSAIDS, Antiarrhythmics
What is the most common symptom of HF and what is causing the symptom?
Dyspnea. You’re not getting the blood out as CO so you’re getting a back up causing venous congestion.
What is a physical exam finding of volume overload in heart and what two conditions do we really see this in?
JVD distention because of an increase in CVP. Tamponade and COPD
What physical exam finding increases heart failure 11 fold?
S3 gallop
What 3 symptoms most likely increase the probability of HF?
Dyspnea, PND, and s3 gallop
What 4 things am I looking for on chest x ray for heart failure?
Big heart, pulmonary edema, pleural effusion, increased vessel size of upper lung (congestion)
When are cardiac troponin levels increased, when do they peak, and when do they return to baseline? What about CKMB?
3-12 from chest pain start, 24-48, and 5-14 days
3-12 from chest pain start, 24, 1-3 days
What would I be looking for in a CBC for HF?
Anemia, which can be secondary to HF and make it worse.
What two things would I be looking for in the CMP with HF?
Electrolyte imbalance with sodium and K.
Pre renal azotemia - high bun to creatinine ratio
Why would I want to do a Urine analysis with HF?
See if protein is in the urine. Kidney function.
What patient population am I checking the thyroid in related to HF?
HF, greater than 65 years old and a fib.
5 conditions that mimic HF or are in my differential?
PE, asthma, pneumonia, edema and ascites
