Heart Failure Flashcards
Types of categorization of heart failure
HFpEF = HF w/ preserved ejection fraction
- “diastolic Heart failure”
- > 50% EF
HFrEF = HF w/ reduced ejection fraction
- “systolic Heart failure”
- <40% EF
CHF = chronic heart failure/congestive heart failure
R or L HF
AHA Stages of heart failure
Stage A: high risk of HF without structural heart disease or symptoms of HF
Stage B: structural heart disease without signs/symptoms of HF
Stage C: structural heart disease w/ prior or current symptoms of HF
Stage D: refractory HF that always requires specialized interventions (surgery)
NYHA functional classification
Class 1: patients w/ heart disease without limitation of physical activity
- NO SYMPTOMS
Class 2: patients w/ heart disease resulting in slight limitation of physical activity with symptoms only appearing w/ strenuous activity (none at rest)
Class 3: patients w/ heart disease resulting in marked limitation of physical activity. Symptoms arise with mild-moderate activity but no symptoms at rest
Class 4: Patients w/ heart disease resulting in inability to carry on any physical activity without severe symptoms. Symptoms are present at rest.
- symptoms include fatigue and dyspnea and angina*
What stages and classes are homologous?
B = 1
C = can be 1-4
D = 4
Cardinal signs/symptoms for right sided heart failure
Peripheral edema (especially in the lower extremities)
Pitting edema
Ascites
RUQ w/ hepatomegaly
JVD
S3 heart sounds
Anasarca (generalized edema)
Cardinal signs/symptoms for left-sided heart failure
Fluid backup from heart-> lungs
Causes:
- dyspena
- rales in lungs
- pulmonary edema
Pulses alternans is almost 100% diagnostic for left sided heart failure, but it is only present in cardiac effusions
Common heart failure symptoms regardless of sided
Dyspena
Orthopnea
Fatigue
Weakness
Anorexia and cachexia (only in chronic)
Clinical tests/evaluations for heart failure
1) ECG:
HFrEF = low QRS complex on ecg
HFpEF =. Normal ECG
2) CBC, CMP and troponin
3) BNP levels
- HF has >400 pg/mL (this tells you that the dyspnea is caused by HF)
- if <100 pg/mL, is almost never heart failure
4) Chest radiography
5) Echo
Major criteria for heart failure
Any of the following symptoms
- paroxysmal nocturnal dyspnea
- orthopnea
- elevated JVD
- S3 sound
- pulmonary edema or cardiomegaly
- cardiac cachexia (w/ treatment)
2 major = HF
Minor criteria for heart failure
Any of the following symptoms
- Bilateral leg edema
- Nocturnal cough
- Dyspnea on ordinary
- Hepatomegaly
- Pleural effusion
- tachycardia
- cardiac cachexia (w/out treatment)
1 major and 1 minor = HF
What is the fluid restriction management for refractory HF?
1.5-2L per day max
Treatment of typical acute decompression w/ HF
If hypertensive causes
- use vasodilators
If volume overload causes
- use diuretics
Treatment of pulmonary edema acute decomposition
Combo of the following:
- Opiates
- Vasodilator
- Diuretics
Treatment of low output acute decomposition
A combo of
- vasodilators
- inotropic therapy (only in low BP)
- Hemodynamic monitoring