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Clin Med Exam 1(Lauren) > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is the definition of heart failure?

A

Heart is not meeting the needs of the body

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2
Q

What are the two types of dysfunction that can cause Left sided heart failure?

A

Systolic dysfunction

Diastolic dysfunction

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3
Q

What is systolic dysfunction?

A

Impaired contraction

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4
Q

What is diastolic dysfucntion?

A

Abnormal relaxation, stiffness or filling

(LV not ballooning out to receive the blood. Low compliance in LV. Cardiac output goes down becasue its not filling well enough

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5
Q

What is the main cause of Right-sided heart failure?

A

Left sided HF

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6
Q

What causes heart failure?

A

There is some initial insult (MI, chronic HTN causing pressure and volume overload, etc)

Then the body responds to the initial insult to maintain CO using neurohormonal stimulation (RAS or SNS).

This ends up making it worse over time (ventricular dilation, increased impedance)

Now ventricular performance is even more impaired, and the body will try to maintain CO with neurohormonal stim again.

Vicious cycle.

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7
Q

Is an asymptomatic patient usually in heart failure or heart dysfunction ?

A

Dysfucntion

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8
Q

What kind of dysfunction causes HFrEF?

A

Systolic dysfunction

HFrEF is also known as Systolic Heart Failure

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9
Q

What will the EF be in HFrEF?

A

40% or less

Normal is 50-55%

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10
Q

What happens to the volume of the LV in HFrEF?

A

Increases

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11
Q

What kind of remodeling occurs in HFrEF?

A

Eccentric remodeling with chamber dilation (volume overload)

The myocytes elongate and get all thin and floppy

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12
Q

What kind of dysfunction causes HFpEF?

A

Diastolic dysfunction

HFpEF is also known as Diastolic Heart Failure

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13
Q

What is the EF with HFpEF?

A

Normal. (50% or higher)

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14
Q

What kind of remodeling occurs in HFpEF?

A

Concentric remodeling or hypertrophy

Walls get very thick=low LV compliance= reduced filling

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15
Q

What is it called when the LV mass is normal and there is concentric geometry?

A

Concentric remodeling

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16
Q

What is the difference between concentric remodeling and concentric hypertrophy?

A

In concentric hypertrophy, the LV mass is increased

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17
Q

What is the difference between eccentric remodeling and eccentric hypertrophy?

A

In eccentric hypertrophy, the LV mass is increased.

Dilated and hypertrophic=floppy, doesn’t contract well

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18
Q

What are the long term effects of HFpEF?

A

Increased diastolic pressure in the LV causes an increase in pulmonary venous pressure, which then causes SOB and pulmonary congestion/edema.
This can then increase pulmonary arterial pressure, increasing afterload on the RV causing Right sided heart failure

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19
Q

What are the causes of HFrEF?

A

Impaired contractility (CAD or cardiomyopathy)

High afterload (HTN)

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20
Q

What are the causes of HFpEF?

A

HTN

LV hypertrophy

Aging

CAD

DM

Sleep apnea

Obesity

Kidney disease

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21
Q

What things cause HFpEF and HFrEF?

A

Old age

HTN

CAD

DM

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22
Q

Patients with HFpEF (vs HFrEF) tend to be:

A

Older

Have HTN

Overweight

Women

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23
Q

What causes the peripheral edema and ascites in Right HF?

A

Elevated pressures in the right atrium (as a resusult of high pressure in the RV)

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24
Q

What are the risk factors for heart failure?

A

CAD

Smoking

HTN

Overweight

Diabetes

Valvular heart disease

(Obvious shit)

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25
Q

What is the most commmon cause of heart failure?

A

Coronary artery disease (CAD)

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26
Q

What are the symptoms of heart failure? (There’s a lot)

A

Dyspnea**

Cough

Fatigue/weakness*** worse on exertion

Dependent edema**

Weight gain**

Ascites

RUQ discomfort/early satiety (hepatic congestion)

Nocturia (secondary to increased renal perfusion when lying down)

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27
Q

What is the progression of dyspnea as the heart filaure gets worse?

A

DOE —> orthopnea -> PND —> dyspnea at rest

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28
Q

What is the cough in HF like?

A

Nocturnal, nonproductive

OR pink frothy sputum

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29
Q

What kinds of things will you find on your physical exam on a pt with HF?

A

Edema

Elevated JVD

Crackles at base of lungs

Displaced PMI (heart is enlarged)

S3/S4 gallop (early decompensation)

Hepatomegaly

Hepatojugular reflux

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30
Q

Right or Left HF:

Dyspnea

Diaphoresis

Tachypnea

Tachycardia

Rales

S3 or S4

A

Left

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31
Q

Left or Right HF:
Peripheral edema

RUQ pain

JVD

Ascites

A

Right

32
Q

What 3 diagnostic studies should every patient with suspected HF receive?

A

ECG

Echo

CXR

33
Q

A normal ECG makes _________dysfunction HIGHLY unlikely

A

Systolic

Most pts with systolic dysfunction have abnormal EKG

34
Q

What will you see on an echo of systolic dysfunction?

A

Dilated** left ventricle

35
Q

What will you see on an echo of someone with diastolic dysfuncion?

A

Left ventricle hypertrophy*

36
Q

What CXR findings are highly suggestive of HF? (KNOW THESE)

A

Cardiomegaly

Cephalization of pulmonary vessels (pulmonary vessels more prominent at apex of lung)

Kerley B-lines (interstitial edema)

Pleural effusions

Butterfly sign if pulmonary edema is present🦋

37
Q

What labs are we going to get when we think our patient has CHF?

A

Cardiac enzymes- make sure its not ischemic

CBC- anemia/infection may exacerbate

CMP

Brain-type Natriuretic Peptide (BNP)*****

38
Q

What is Brain Natriuretic Peptide (BNP)?

A

Its a marker for heart failure, because it is released in response to the stretching of ventricular wall.

39
Q

What do higher BNP levels (usually over 400) indicate?

A

Worse prognosis/outcome of CHF

40
Q

If your BNP is less than _______, it is safe to rule out CHF

A

100

41
Q

If your BNP is over ______, you can safely say you have CHF.

A

400

42
Q

According to NYHA functional classification, if your patient has no limitation of physical activity, they are in what class of CHF?

A

Class I

43
Q

According to NYHA functional classification, if your patient has a slight limitation of physical activity, where ordinary physical activity results in SOB, fatigue, or palpitations, what class are they in?

A

Class II

Ex: SOB when mowing the lawn

44
Q

According to NYHA functional classification, if your patient has marked limitation of physical activity, where any ordinary physical activity results in SOB and fatigue, what class are they in?

A

Class III

Ex: getting up to pee, walking to kitchen, or folding laundry make them short of breath

45
Q

According to NYHA functional classification, if your patient is unable to do ANY physical activity without discomfort, and they may have symptoms at rest, what class are they?

A

Class IV

46
Q

Reducing (Preload/afterload) will diminish congestive symptoms

A

Preload

47
Q

Reducing (preload/afterload) will improve cardiac function

A

Afterload

48
Q

What two drugs do ALL patients with HFrEF get right away?

A

ACE-inhibitor

Diuretics

49
Q

What is the preferred type of diuretic for CHF?

A

Loop diuretics.

Thiazides may added for a synergistic effect

50
Q

How much Lasix do you start your CHF patient on?

A

20-40 mg

51
Q

How much weight loss should you expect to see when you start your CHF patient on Lasix?

A

1kg/day

52
Q

How do you find the right dose of ACE-inhibitor for your patient?

A

Start low, and slowly titrate to target dose

53
Q

What are the 2 common side effects of ace inhibitors?

A

HYPERkalemia

Cough

54
Q

Do ace inhibitors reduce preload or afterload?

A

Afterload

55
Q

If your patient is not tolerating the ACE-inhibitor you put them on, or their cough is too much to handle, what can you do?

A

Replace it with an ARB

56
Q

So you’ve started your patient on their Lasix and their ace inhibitor, and you’ve decided that a beta-blocker may be helpful for them. What do you need to do?

A

Make sure they are ~stable~ on their ace and Lasix first

Make sure they are not in acute decompensation

Start with a low dose and slowly titrate up

57
Q

What is the main side effect of beta blockers?

A

Bradycardia

58
Q

Will beta-blockers decrease morbidity and mortality?

A

Yes

59
Q

Will adding digoxin to your CHF patient’s cocktail have any effect on their mortality?

A

No. But it is great for Symptomatic relief!

Remember it increases contractility of the heart, so it might help them mow their lawn more or whatever they like to do.

60
Q

If a patient can not do their normal activities do daily living, what does that mean?

A

Higher mortality rate

Bathing, dressing, transferring from bed or chair, walking, eating, toileting, grooming

61
Q

What is this:

“Medically-supervised program to slow, stabilize, or reverse the progression of CVD”

A

Cardiac rehabilitation

62
Q

Should your CHF patient be on a statin?

A

Will NOT help their systolic heart failure (HFrEF)

BUT if they’re already on one for something else, continue it

63
Q

Is there a good prognosis for patients with heart failure?

A

No

30-40% die in 1 year

60-70% die in 5 years :(

64
Q

What are the most common causes of death when a patient has heart failure?

A

Progressive pump failure (decompensation)

Malignant arrhythmias

65
Q

What are the 8 drugs that can worsen heart failure?

A

NSAIDS

Metformin

Cilostazol

Erectile dysfunction drugs

Antiarrhythmics

Tricyclic antidepressants

Itraconazole

Carbamazepine

66
Q

What is Acute Decompensated Heart Failure?

A

Just like what it sounds like….it can be new or an exacerbation of chronic disease.
Either way it is an EMERGENCY.

67
Q

Is Acute Decompensated Heart Failure a big deal?

A

Yes. It is VERY SEVERE, and is a EMERGENCY

68
Q

What usually causes cardiogenic pulmonary edema?

A

Acute Decompensated Heart Failure

69
Q

How will a patient present if they have cardiogenic pulmonary edema?

A

Shortness of breath

Pink frothy sputum

Sweating

Rales/crackles, wheezing, rhonchi

70
Q

What will you see on a CXR if your patient has cardiogenic pulmonary edema?

A

Kerley B lines

Edema

Cardiomegaly

71
Q

What is “flash” pulmonary edema

A

Cardiogenic pulmonary edema that is really dramatic, and requires you to act even faster to implement initial therapy.

72
Q

What will you find on physical exam of your patient in acute decompensated heart failure?

A

HTN

JVD

Breathing fast

Accessory muscle use

Crackles

Tachycardia

S3/S4 gallop

New murmur

Edema in legs

73
Q

How will a patient with acute Decompensated heart failure present?

A

This stuff rapidly became much worse:
Cough

shortness of breath

Fatigue

Peripheral edema

74
Q

How do you manage your patient in acute decompensated heart failure?

A

Admit to hospital

Oxygen

Diuretics

Nitro

Opioids maybe

75
Q

What is the most common type of heart failure?

A

Left ventricular systolic dysfunction

Clin Med Exam 1(Lauren) (8 decks)

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