Heart Failure Flashcards
What’s the classification of HF with preserved EF (HFpEF)?
LVEF ≥ 50%
What’s the classification of HF with reduced EF (HFrEF)?
LVEF ≤ 40%
what are the main pathophysiology factors that result in HFrEF?
activation of SNS = increased CO
activation of RAAS = increased BP and BV
vasoconstriction = increased BP
what is the etiology of HFrEF?
direct injury to myocardium or disease state: *CAD* cardiomyopathies myocarditis valvular disease infections
what are the risk factors for HF?
age DM2 HTN smoking atherosclerosis obesity metabolic syndrome
what are the risk factors for HFrEF?
male LVH BBB previous MI smoking
what are the risk factors for HFpEF?
older age
female
HTN
AFib
what are the symptoms of congestion?
DOE paroxysmal nocturnal dyspnea orthopnea nocturnal cough weight fluctuations edema hepatojugular reflex elevated venous pressure
what are the symptoms of hypoperfusion?
exercise intolerance fatigue decreased mentation (AMS) cold intolerance
what heart sounds can indicate HF?
S3 gallop
enlarged/displaced PMI
right ventricular heave
what is the best imaging modality to diagnose HF?
ECHO
what labs should be ordered when HF is suspected?
cardiac enzymes (Troponin, BNP, CKMB) CMP (renal function and potassium)
what are the functional classifications of HF?
A - high risk
B - structural heart disease without signs of HF
C - structural heart disease with signs of HF
D - HF requiring specialized interventions
what are the treatment objectives in patients with HF?
improve symptoms
improve the quality and duration of life
prevent hospital admission
what treatment method results in the best quality of life?
cardiac transplant
A patient is diagnosed with HFpEF but doesn’t have HTN. What is your treatment plan?
diuretics ONLY
how would you treat a patient with HF that is mildly hypoperfused and mildly congested? (warm-dry)
up-titration of disease-modifying oral therapy
treat comorbidities
how would you treat a patient with HF that is mildly hypoperfused but moderately/severely congested? (warm-wet)
vasodilators
diuretics
consider renal replacement therapy
how would you treat a patient with HF that is moderately/severely hypoperfused but mildly congested? (cold-dry)
fluid challenge
inotropic agent
how would you treat a patient with HF that is moderately/severely hypoperfused and moderately/severely congested? (cold-wet)
consider vasodilator inotropic agent vasopressor diuretics MCS
what is the etiology of cor pulmonale?
develops in response to chronic pulmonary HTN:
parenchymal lung disease
primary pulmonary vascular disease
alveolar hypoxia
what is the pathophysiology resulting in cor pulmonale?
pulmonary HTN and increased RV afterload causing altered RV structure and function
what are the symptoms of cor pulmonale?
dyspnea
neck: elevated JVP
heart: S3 gallop
lungs: wheezing, crackles
abd: hepatomegaly, hepatojugular reflex & ascites
ext: LE edema and cyanosis
how do you diagnose cor pulmonale?
EKG
CXR
2D TTE
how do you treat cor pulmonale?
keep SaO2 >/= 90% diuretics fluid and Na restriction IV inotropes manage arrhythmias activity restriction while symptomatic
