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2020 CPR II Cardio Exam 1 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What are the 3 most common causes of HF?

A
  • CAD - ischemic heart disease
  • Idiopathic, dilated cardiomyopathy
  • Valvular heart disease
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2
Q

What are 4 causes of restriction/obstruction to ventricular filling which can lead to HF?

A
  • RV infarct
  • Constrictive pericarditis
  • Mitral stenosis
  • Atrial myxoma
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3
Q

Using the AHA/ACC heart failure staging guidelines, what does stage A represent?

A

Pts at high risk for HF but WITHOUT structural heart disease or sx’s of HF

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4
Q

Using the AHA/ACC heart failure staging guidelines, what does stage B represent?

A

Asymptomatic pts WITH structural heart disease (i.e., LVH and/or impaired LV function (low EF), valvular dz, but hemodynamically stable

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5
Q

Using the AHA/ACC heart failure staging guidelines, what does stage C represent?

A

Pts WITH current or prior sx’s of HF WITH structural heart disease; SOB, fatigure, reduced exercise tolerance

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6
Q

Using the AHA/ACC heart failure staging guidelines, what does stage D represent?

A

Pts w/ refractory HF requiring specialized treatment/interventions

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7
Q

Using the NYHA functional classification for HF, what does class I-class IV represent?

A
  • Class I = asymptomatic; no physical activity limitations
  • Class II = no sx’s at rest; exertional sx’s w/ ordinary activity
  • Class III = no sx’s at rest; sx’s with minimal activity
  • Class IV = sx’s AT rest
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8
Q

Which imaging modality is essential in the evaluation of heart disease and for distinguishing systolic HF from diastolic HF?

A

Echocardiogram

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9
Q

List 5 causes of acute HF

A
  • Acute MI
  • Ruptured papillary muscle
  • MR
  • AI
  • Toxins
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10
Q

What are some distinguishing sx’s of systolic HF vs. diastolic HF?

A
  • Systolic HF = DOE, orthopnea, paroxysmal nocturnal dyspnea
  • Diastolic HF = SOB, DOE, and pulmonary edema
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11
Q

Which type of HF (diastolic/systolic) is associated with HTN, obesity, DM, CAD, and aging?

A

Diastolic HF

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12
Q

What are 3 common underlying causes of imparired ventricular relaxation leading to diastolic HF?

A
  • Acute ischemia
  • Myocardial fibrosis
  • Amyloidosis
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13
Q

List 6 causes of high-output HF?

A
  • Hyperthyroidisim
  • Anemia
  • Pregnancy
  • A-V fistula
  • Beriberi
  • Paget’s
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14
Q

What are the CO and EF like in high output HF?

A
  • High CO
  • Low EF
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15
Q

Which hormones released as a compensatory mechanism for HF causes an increased preload and which causes inceased afterload?

A
  • Aldosterone —> Na and H2O retention = ↑ preload, congestive sx’s and volume expansion
  • Angiotensin II –> vasoconstrictor –> ↑PVR (↑ afterload)
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16
Q

What is the effect of increased ADH released during compensatory phase of HF?

A
  • Stimulates thirst –> ↑ TBW and hyponatremia (dilutional)
  • ↑ preload (Na and H2O retention)
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17
Q

What are 2 major non-compliance issues which precipitate HF?

A
  • Non-compliance with diet = too much Na+, too many kcals, too many stimulants
  • Non-complance with meds = AE’s and cost
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18
Q

What are 4 medication classes which can worsen/precipitate HF?

A
  • Antiarrhythmics
  • Beta-blockers
  • CCBs
  • NSAIDs
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19
Q

How can anemia precipitate HF?

A

↑ O2 needs of tissues –> ↑ CO

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20
Q

By which mechanism do tachyarrhythmias lead to ischemia?

A

↓ diastolic filling time

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21
Q

What is the most common sx of HF?

A

Dyspnea –> ↓ arterial perfusion to organs and venous congestion

22
Q

Presence of which sx ↑ the likelihood of HF by 2-fold?

A

Paroxysmal nocturnal dyspnea

23
Q

Which PE of the lung is common with HF?

A

Crackles in lung due to pulmonary edema; may wheeze or cough (frothy- pink fluid)

24
Q

What are 4 signs/sx’s of RV failure?

A
  • Peripheral/sacral edema
  • Hepatomegalia
  • Ascites
  • ↑ JVD, hepatojugular reflex
25
Q

When measuring JVP, how many cm’s is considered above normal?

A
  • >3 cm above the sternal angle
  • 8-9 cm in total distance above the RA
26
Q

What are findings on a CXR associated with HF?

A
  • Cardiomgalia
  • Pulmonary edema w/ central peripheral infiltrates
  • ↑ size of vessels in upper portions of lungs
  • Pleural effusions
27
Q

What is the usefulness of ordering a CBC, CMP, and UA when assessing possible HF?

A
  • CBC looking for anemia 2’ to chronic disease
  • CMP looking for electrolyte imbalance; pre-renal azotemia (BUN:Cr)
  • UA looking for protein in urine
28
Q

Which lab must always be ordered in pt with HF who is >65 yo with Afib?

A

Thyroid

29
Q

What is the significance of a BNP <100 pg/mL in terms of HF?

A

97% chance of NO HF

30
Q

BNP is a neurohormone made in the ventricle that is sensitive to what (i.e., what are the stimuli)?

A
  • Sensitive to ventricle stretching and volume overload.
  • Preload/afterload are the stimuli
31
Q

What are pulmonary and liver problems which may mimic HF?

A
  • Pulmonary = PE, asthma, and pneumonia
  • Liver = cirrhosis –> ascites + edema
32
Q

What is a non-pharmacologic approach to tx of HF if pt’s Na+ is <126 mEq/L?

A

Fluid restriction to <2 L/day

33
Q

Which type of activity should be avoided in HF and what should be encouraged?

A
  • AVOID isometric acivity which ↑ SVR and afterload
  • ENCOURAGE isotonic activity - walking, hiking, golf
34
Q

Why is enoxaparin (subcut lovenox) given to someone with HF?

A

Prophylaxis for DVT’s

35
Q

What does a class II recommendation mean in evidence based medicine?

A

Conflicting evidence and/or divergence of opinion

36
Q

What does a grade of A-C represent in levels of evidence for evidence based recommendations?

A
  • A = data from meta-analysis or multiple RCT’s; multiple populations evaluated
  • B = data from single RCT or non-randomized studies; limited population evaluated
  • C = only consensus opinion of experts, case studies, or standard of care, very limited populations evaluated
38
Q

Which drug class is useful for all NYHA functional classification with systolic HF?

A

ACE inhibitors

39
Q

ACE-I should be used cautiously in pt’s with what 2 underlying conditions?

A
  • Renal insufficiency
  • K+ >5 mEq/L
40
Q

You should not give an ARB to a pt that had what AE from an ACE-I?

A

Angioedema

41
Q

There is a survival benefit with using beta-blockers with what 2 underlying heart conditions?

A
  • Chronic systolic HF
  • Dilated cardiomyopathy
42
Q

Which NYHA functional classes of HF are beta-blockers recommended in?

A

Class II and III

43
Q

The US Carvedilol HF program showed improvement in what 2 pt parameters?

A
  • Improved LVEF
  • Improved well being
44
Q

Beta-blockers should never be used in pt’s who are in what classification of HF?

A

Unstable (Class IV)

47
Q

Which level of evidence exists for the use of beta-blockers in all stable pt’s with sx’s of HF and reduced EF, unless contraindicated?

A

Level A

48
Q

Diuretics are able to relieve congestive (pulmonary) sx’s by decreasing what?

A

Preload

49
Q

Which inotropic agent is useful in HFrEF and A.fib for ventricular rate control?

A

Digitalis

50
Q

Which level of evidence exists for the use of Spironolactone in decreasing mortaility and decreasing HF hospitalization?

A

Level B

51
Q

Which drug used in HF is an inotropic vasodilator?

A

Milrinone = PDE inhibitor

52
Q

Which inotropic agent used in HF stimulates beta-1 receptors and is useful short-term?

A

Dopamine

53
Q

Which drug given for HF is an arterial vasodilator, which reduced afterload and SVR?

A

Hydralazine

54
Q

When is hydralazine plus isosorbide dinitrate used for HF?

A
  • Better response in African Americans
  • Can be used in general if intolerant to ACE-I/ARB

2020 CPR II Cardio Exam 1 (31 decks)

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