Heart Failure Flashcards
What is the definition of Stroke Volume?
how much blood is ejected with each beat
What is Preload?
blood volume at the end of diastole, right before systole
What is Afterload?
The force that the contracting heart must generate to eject blood from the filled heart
What is Inotropic influence?
Increases cardiac contractility
What is Left Ventricular Ejection fraction (LVEF)?
the percentage of blood leaving the heart each time it contracts. (*normal = 55-65%)
What is Heart Failure?
- Clinical syndrome
- Structural or functional cardiac disorder
- Impairment of ventricular filling or ventricular ejection
What is Low Output heart failure?
pumping or filling ability impaired (is common)
What is High Output heart failure?
excessive need for high cardiac output but still inadequate (is rare)
What are the two types of left sided heart failure and where does the fluid back up?
There’s Systolic or diastolic dysfunction (or both). Fluid backs up into lungs (pulmonary edema), and eventually right heart & amp; systemic venous system.
What is right sided heart failure and where does the fluid back up?
Impaired contraction of right heart, fluid backs up into systemic venous system
What is Systolic Dysfunction?
Impaired ejection of blood from the heart during systole (heart failure with reduced HFrEF)
What is Diastolic Dysfunction?
Impaired filling of the ventricles during diastole (heart failure with preserved HFpEF)
What are the 4 Causes of Systolic Dysfunction?
- Ischemic heart disease
- Hypertension
- Valvular disease
- Idiopathic dilated cardiomyopathy
What are the 3 Causes of Diastolic Dysfunction?
- Longstanding Hypertension (stiff ventricles)
- Restrictive cardiomyopathies
- Valvular disorders (mitral valve stenosis)
What are the Classifications of Heart Failure?
Class I – symptoms only with significant activity
Class II – symptoms with ordinary activity of daily living
Class III – symptoms with only minimal exertion
Class IV – symptoms at rest
What are the 5 Symptoms of Heart Failure?
-Shortness of breath (especially with exertion (DOE)) -Orthopnea -Paroxysmal nocturnal dyspnea (PND) -Weight gain -Swelling – ankle edema, increased abd girth
3 Causes of Left sided Heart Failure on New Diagnosis?
- Acute myocardial infarction
- Recent myocardial infarction
- Afib with RVR or other tachyarrythmias
2 main triggers of decompensated Heart Failure in patients with known heart failure?
- Change in diet (increased salt, increased fluid)
- Change in medication (reduction in diuretic dose, missed doses, non-compliance)
6 Physical Exam Findings of acute heart failure?
- Weight gain
- Hypoxia
- Elevated jugular venous pressure (JVD) (+hepatojugular reflux)
- S3 gallop
- Pulmonary rales (crackles) & decreased breath sounds at bases
- Pitting edema of the lower extremities
4 Diagnostic Tests useful if there is a concern for acute heart failure?
- EKG
- Brain natriuretic Peptide (BNP)
- Chest xray (CXR)
- Echocardiogram for new diagnoses
Name 5 findings on CXR in acute heart failure?
- Blunting of costophrenic angles
- Pulmonary vein engorgement (increased interstitial markings)
- Cephalization
- Kerley B lines
- Cardiomegaly
3 Goals of Therapy for heart failure?
- Clinical improvement of symptoms
- Reduction of mortality and morbidity risk
- Reduction in rate of hospitalization
What are the 5 elements of the management of Heart Failure?
- Determine the severity
- Determine the underlying etiology or trigger
- Correct or treat underlying cause (MI) or systemic factors (thyroid dysfunction, infection)
- Remove excess fluid
- Improve cardiac output
- Lifestyle modification (salt restrict, fluid restrict, daily weights, medication compliance)
What is the class of medications used to remove fluid to treat acute decompensated heart failure & improve symptoms
Loop diuretics
What 3 classes of medications are used in heart failure to reduce afterload & Improve cardiac output?
- Angiotensin-Converting-Enzyme Inhibitors (ACE)
- Angiotensin-Receptor Blockers (ARBs)
- Angiotensin-Receptor-Neprilysin Inhibitos (ARNI)
What medication is used in heart failure to Improve remodeling (less scar tissue)?
Beta-Blockers
Which medication is used in the treatment of heart failure to Improve outcomes in African Americans?
Hydralazine & Isosorbide Dinitrate (Bidil)
Which medication is used in heart failure to reduce the frequency of hospitalizations?
Digoxin
Name 3 Loop Diuretics used to treat heart failure
- Furosemide (Lasix)
- Budesonide (Bumex)
- Torsemide (Demadex)
Name 2 Angiotensin Converting Enzyme Inhibitors (ACE) used in heart failure?
- Lisinopril (Zestril)
- Captopril
Name 3 Angiotensin Receptor Blockers (ARBs) used in heart failure treatment?
- Irbesartan (Avapro)
- Cozaar (Losartan)
- Diovan (Valsartan)
Name 2 beta-blockers used in the treatment of heart failure?
- Carvedilol
- Metoprolol
Which afterload reducing medication do you start with at time of diagnosis?
ACE-I or ARB as alternative
What medication do you start with during symptoms?
Furosemide (Lasix)
What medication is used as an adjuvent to Furosemide to increase diuretic response for persistent symptoms?
Add Aldosterone antagonist (spironolactone) to lasix
What afterload reducing medication should patients be switched to eventually if no contraindications?
Change from ACE-I or ARB to ARNI
What HF treatment should be considered if EF ≤ 35% in class II-III?
Internal cardiac defibrillator (ICD)
What 2 classes of medications are considered if there’s Severe Hemodynamic Compromise?
- Inotropic agents (Dobutamine or Milrinone)
2. Vasoconstrictors (Dopamine, epinephrine, phenylephrine, vasopressin)
Treatment of underlying valvular disease for HF?
-Surgical correction (repair vs. replace)
