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

Heart Failure Flashcards

1
Q

Which stages of ACC/AHA are considered “at risk” for heart failure?

Which stages are considered “heart failure”

A

at risk = stage A and B

heart failure = stage C and D

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2
Q

What physical findings are associated with pulmonary congestion associated with left heart failure

A 
pulmonary edema
cough with frothy pink sputum 
cyanosis 
orthopnea
PND
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3
Q

You’re doing a physical exam on someone who has acute heart failure. What do you see/hear/feel?

(7 things)

A
  1. Edema
  2. JVD
  3. Crackles at bases
  4. displaced PMI
  5. S3/S4 gallop
  6. hepatomegaly
  7. hepatojugular reflex
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4
Q

What is a reasonable response for the edema to diminish in a patient who started furosemide (Lasix)

A

1kg/day weight loss

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5
Q

goals of therapy:

reducing afterload will have what desired effect

A

improve cardiac function

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6
Q

What labs do you order when evaluating for heart failure?

A
  1. cardiac enzyme to rule out acute ischemia
  2. CBC
  3. CMP
  4. Brain-type natriuretic peptide (BNP)

(THESE ARE THE MAIN FOUR)

others : UA, lipid, thyroid, iron

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7
Q

Which stage of NYHA classification

ordinary physical activity does not cause breathlessness, fatigue, or palpitations

A

Stage 1

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8
Q

Which stage of NYHA classification

ordinary physical activity results in undue breathlessness, fatigue, or palpitations

A

Stage 2

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9
Q

A patient with suspected heart failure should get what diagnostic tests? (3)

A
  1. EKG
  2. echo
  3. Chest x-ray
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10
Q

Which diagnostic exam is the most useful in determining heart failure

A

echo

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11
Q

the most common type of heart failure is

A

left ventricular systolic dysfunction

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12
Q

A patient with a Brain-type natriuretic peptide (BNP) less than 100 has a ________ prognosis

A patient with a Brain-type natriuretic peptide (BNP) greater than 400 has a ______ prognosis

A

good

poor

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13
Q

If a patient has a Brain-type natriuretic peptide (BNP) less than 100, what can you rule out?

A

heart failure

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14
Q

What is important to remember about starting a patient on ACE inhibitors for the first time?

A

titrate to maximum/target dose
monitor for hyperkalemia
they may get a cough

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15
Q

NYHA classification is based on

A

limitations of activity

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16
Q

Which type of heart failure is associated with reduced ejection fraction? (less than 40%)

A

systolic/ HFrEF

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17
Q

What are the four findings on a chest x-ray that are suggestive of heart failure

A
  1. cardiomegaly
  2. cephalization of pulmonary vessels (more prominent at the apex of the lungs to compensate for fluid filled base)
  3. Kerley-B lines (interstitial edema)
  4. Pleural effusions
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18
Q

cardiomegaly is a cardiac to thoracic ratio of:

A

greater than 50%

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19
Q

What are the four basic principles of treatment of heart failure

A
  1. manage underlying cause
  2. manage precipitating cause
  3. control symptoms of failure
  4. review medications
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20
Q

right heart failure is due to a ____ pressure, _____ compliance system

A

low pressure, high compliance system

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21
Q

the most common cause of heart failure (either side)

A

coronary artery disease

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22
Q

Which stage of NYHA classification

breathlessness, fatigue, or palpitations at rest

A

Stage 4

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23
Q

What is the most common cause of right heart failure

A

left heart failure

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24
Q

What physical findings are associated with congestion of peripheral tissues associated with right heart failure

A

peripheral edema
RUQ pain
JVD
ascites

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25
Q

acute heart failure most important symptoms

A
  1. DYSPNEA (DOE–> orthopnea –> PND–> dyspnea at rest)
  2. fatigue/weakness
  3. dependent edema
  4. weight gain (10/12 lbs in A DAY)
  5. cough- nocturnal, nonproductive
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26
Q

Which type of diuretics do you give to HF patients

A

loop

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27
Q

pathophysiology of left heart failure is characterized by elevated ______

A

left ventricular filling pressures

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28
Q

What is significant about left ventricular compliance with HFpEF

A

decreased compliance - inability to relax

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29
Q

structural heart disease + asymptomatic is what stage of the ACC/AHA

A

Stage B

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30
Q

In HFrEF, what is different about the left ventricular volume?

A

increased

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31
Q

Which type of heart failure is associated with volume overload

A

HFrEF / systolic

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32
Q

HFrEF is what kind of dysfunction + symptoms of heart failure?

A

systolic

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33
Q

inotropy is another term for

A

contractility

34
Q

at risk for HF and asymptomatic is what stage of the ACC/AHA

35
Q

What medication would you consider for a patient with at rest dyspnea within past 6 months, or is post-MI with systolic dysfunction

A

Mineralcortocoid Receptor Antagonist (MRA)

Aldoseterone antagonist, potassium-sparing dieretic, spironolactone, eplerenone

36
Q

What medication would you consider for a patient with atrial fibrillation?

Does this reduce mortality or management of sxs?

A

Digoxin

sxs only

37
Q

chronotropy is another term for

A

heart rate

38
Q

What abnormality will you SEE on an echo with systolic dysfunction

A

dilated left ventricle ****

39
Q

What is the most common cause of death associated with heart failure?

A

decompensation (progressive pump failure)

malignant arrhythmias

40
Q

Elongating myocytes is what kind of chamber remodeling

41
Q

Left heart failure = congestion of _________

Right heart failure = congestion of _________

A

Left heart failure = congestion of pulmonary

Right heart failure = congestion of peripheral tissues

42
Q

Which improves symptoms and which reduces morbidity and mortality?

ACE inhibitors versus loop diuretics

A

loop diuretics = symptoms

ACE inhibitors = reduces morbidity and mortality

43
Q

Thickening myocytes is what kind of chamber remodeling

A

concentric

44
Q

ACC/AHA classification system is based off of:

A

structural manifestations of the disease

45
Q

dramatic form cardiogenic alveolar pulmonary edema is defined as

A

“flash” pulmonary edema

46
Q

When is Brain-type natriuretic peptide (BNP) released?

A

in response to stretching of the ventricle wall

47
Q

What is your initial dose of loop diuretics for patients with HF? What is the name of the medication?

A

20-40 mg furosemide (Lasix)

48
Q

What is the role of statins in heart failure?

A

not helpful in patients with systolic HF

appropriate if already on statins for a different indication at the time they develop HF

49
Q

What is the MARKER for heart failure?

A

Brain-type natriuretic peptide (BNP)

50
Q

What abnormality will you SEE on an echo with diastolic dysfunction

A

left ventricle hypertrophy ***

51
Q

refractory heart failure + specialized interventions is what stage of the ACC/AHA

52
Q

8 drugs that can WORSEN heart failure

A
  1. NAIDs
  2. Metformin
  3. Cilostazol
  4. PDE-5 inhibitors (dick drugs)
  5. Antiarrhythmics
  6. Tricyclic antidepressants
  7. Itraconazole
  8. Carbamazepine (for nerve pain, seizures, BPD)
53
Q

Where are patients best treated for heart failure?

A

heat failure clinic

54
Q

if your patient has acute decompensated heart failure and they have HYPOtension, what does that indicate?

55
Q

Which medication should you never administer during acute decompensation

A

beta blockers

56
Q

When would you use cardiac catheterization for heart failure?

A

active CAD- like an acute MI

not routine for HF

57
Q

diastolic dysfunction is defined by impaired

A

relaxation

58
Q

systolic dysfunction is defined by impaired _____

A

contractility

59
Q

What is the major difference in the management of HFpEF versus HFrEF?

A 
HFpEF = manage comorbidities (diastolic)
HFrEF = mange the HFrEF (systolic)
60
Q

structural heart disease + prior or current symptoms of HF is what stage of the ACC/AHA

61
Q

How does the sympathetic nervous system compensate when stroke volume is decreased

A

increased heart rate

62
Q

Which heart sound is associated with acute heart failure

A

s3/s4 gallop

63
Q

HFpEF is what kind of dysfunction + symptoms of heart failure

64
Q

Which medication can also be toxic, and you must monitor serum levels?

65
Q

In patients with HFpEF versus HFrEF, they tend to be:

A

older
more frequently have HTN
overweight
women

66
Q

how can you tell the difference between systolic and diastolic heart failure on an echo?

A 
diastolic = normal EF (50-55%)
systolic = less than 40%
67
Q

Which type of heart failure is associated with increasing pulmonary venous pressure

A

HFpEF / diastolic

68
Q

If you suspect a patient has heart failure and they have a NORMAL ekg, what can you rule out?

A

systolic heart failure

“highly unlikely”

69
Q

You have admitted your patient to the hospital for acute decompensated heart failure, what is the management plan?

A

O2
diuretics
nitro
opioids (or alternative pain management because the faculty is too afraid to tell us to give opioids and avoid it like the plague)

70
Q

goals of therapy:

reducing preload will have what desired effect

A

diminish congestive symptoms

71
Q

What type of remodeling is associated with HFpEF

A

HFpEF = diastolic = hypertropy = concentric remodeling

72
Q

Which type of heart failure is associated with increased formation of tissue fluid such as peripheral edema, and ascities

A

right heart failure

73
Q

with myocardial disease, there is impaired ventricular performance or ventricular arrhythmias, what is the first line compensation?

A

neurohormonal stimulation:
overactivation of RASS (alter CO thru plasma volume control)
SNS increase heart rate

74
Q

Causes of HFrEF

A

impaired contractility due to CAD or cardiomyopathy

High afterload due to HTN

75
Q

What can happen when you start a stable patient on beta blockers

(patient should ALWAYS be stable if you are starting beta blockers)

A

can worsen the clinical picture, exacerbate failure when the first start

76
Q

Which type of heart failure is associated with pressure overload

A

HFpEF / diastolic

77
Q

Which stage of NYHA classification

less than ordinary physical activity such as getting up to go to the bathroom causes breathlessness, fatigue, or palpitations

78
Q

pulmonary edema on a chest x-ray

A

butterfly pattern

always bilateral

79
Q

What type of chamber remodeling is associated with HFrEF

A

HFrEF = systolic = progressive chamber dilation and eccentric remodeling

80
Q

Recommended initial pharmacologic therapy for HFrEF

A

(systolic)
ACE inhibitor
Diuretic

Clin Med Exam 1 (Shelby) (10 decks)

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