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IM > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Cardinal clinical SYMPTOMS of heart failure

A

dyspnea

fatigue

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2
Q

Clinical SIGNS of heart failure

A

edema

rales

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3
Q

Depressed EF (<40%)

A

CAD- myocardial infarction and myocardial ischemia

Chronic pressure overload - HPN, obstructive valvular disease

Chronic volume overload - regurgitant valvular disease, intracardiac (L-R) shunting, extracardiac shunting

Chronic Lung Disease - Cor pulmonale, pulmonary vascular disorders

Nonischemic dilated cardiomyopathy - familial/genetic disorders, infiltrative disorders

Toxic/drug-induced damage - metabolic disorder, viral

Chagas disease

Disorders of rate and rhythm - chronic bradyarrhythmias and tachyarrhythmias

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4
Q

Preserved Ejection fraction (>40 - 50%)

A

pathologic hypertrophy - HCOM, HPN

aging

endomyocardial disorders
restrictive cardiomyopathy - infiltrative disorders, storage disorders

fibrosis

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5
Q

High Output States

A

metabolic disorders - thyrotoxicosis

nutritional disorders (beriberi)

excessive blood flow requirements - systemic AV shunting, chronic anemia

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6
Q

Conditions that can lead w/ a depressed EF or preserved EF

A 
myocardial infarction
myocardial ischemia
hypertension
obstructive valvular disease
infiltrative disorder
metabolic disorder
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7
Q

NYHA Classification

A

Class I - px w/ cardiac disease but w/o resulting limitation of physical activity

Class II - px w/ cardiac disease w/ slight limitation of physical activity

Class III - px w/ cardiac disease w/ marked limitation of physical activity

Class IV - px w/ cardiac disease resulting in inability to carry on any physical activity w/o discomfort

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8
Q

Orthopnea

A

Results from redistribution of fluid from the splanchnic circulation and lower extremities into the central circulation during recumbency with a resultant ↑ in pulmonary capillary pressure

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9
Q

Paroxysmal Nocturnal Dyspnea

A

Refers to acute episodes of severe shortness of breath and coughing that generally occur at night d.t. INCREASED PRESSURE in BRONCHIAL ARTERIES

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10
Q

Cheyne-Stokes Respiration

A

Periodic respiration or cyclic respiration: series of APNEA, HYPERVENTILATION and HYPOCAPNIA

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11
Q

Pulmonary crackles (rales or crepitations)

A

Result from the transudation of fluid from the intravascular space into the alveoli

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12
Q

Pleural effusion

A

Result from the elevation of pleural capillary pressure and the resulting transudation of fluid into the pleural cavities

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13
Q

Hepatomegaly

A

An important sign in px with HF and may pulsate during systole if tricuspid regurgitation is present

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14
Q

Assess cardiac rhythm and determine the presence of LV hypertrophy or prior MI (absence or presence of Q-waves)

A

ECG

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15
Q

Classic Chest X-Ray Pattern In Patients with PULMONARY EDEMA

A

“butterfly” pattern of interstitial and alveolar opacities

Kerley B lines

peribronchial cuffing

evidence of prominent UPPER lobe vasculature

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16
Q

Classic Chest X-Ray Pattern In Patients with PULMONARY EDEMA

A

“butterfly” pattern of interstitial and alveolar opacities

Kerley B lines

peribronchial cuffing

evidence of prominent UPPER lobe vasculature

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17
Q

The most useful test that can provide semiquantitative assessment of LV size and function, presence or absence of valvular and/or regional wall motion abnormalities

A

2D Echo/Doppler

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18
Q

The gold standard for assessing LV mass and volumes

A

Magnetic Resonance Imaging (MRI)

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19
Q

Most useful index of LV function

A

EF (stroke volume divided by end-diastolic volume)

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20
Q

Released from the failing heart and sensitive markers for the presence of HF with depressed EF

A

B-type natriuretic peptide (BNP)

N-terminal pro-BNP (NT-proBNP)

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21
Q

Newer biomarkers that can be used for determining the prognosis of HF patients

A

soluble ST-2 and galectin-3

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22
Q

NOT routinely advocated for patients with HF but useful for assessing the need for cardiac transplantation in patients with advanced HF

A

Exercise Testing

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23
Q

Form the cornerstone of pharmacotherapy lead to attenuation of decline and improvement in cardiac structure

A

RAAS blockers

β-blockers

24
Q

• Interferes with RAAS by inhibiting conversion of angiotensin I to angiotensin II

A

ACE - I

25
Q

Used if the px is ACE-intolerant

A

Angiotensin Receptor Blockers

26
Q

Interferes with sustained activation of the adrenergic nervous system particularly B1 activation

A

Beta-blockers

27
Q

Inhibits action of aldosterone on the collecting duct

A

Aldosterone Antagonist

28
Q

Reduces the HR by inhibition of “funny channels” in the SA node

A

Ivabradine

29
Q

Recommended to replace ACE-I in ambulatory HFrEF patients who remain symptomatic despite optimal therapy

A

Angiotensin Receptor Neprilysin Inhibitor (ARNI)

ARB - valsartan
neprilysin inhibitor - sacubitril

30
Q

Asymptomatic LV Dysfunction (NYHA I)

A

ACE I or ARB
B-blocker (if post MI)
Aldosterone antagonist (if recent MI)

31
Q

Symptomatic HF (NYHA II)

A

ACE I or ARB
Diuretic (if with fluid retention)
B-blocker
Aldosterone antagonist

32
Q

Worsening HF (NYHA III-IV)

A 
ACE I or ARB
Diuretic
B-blocker
Aldosterone antagonist
Digoxin
33
Q

End stage HF (NYHA IV)

A 
ACE I or ARB
Diuretic
B-blocker
Aldosterone antagonist
Digoxin
34
Q

Rapid onset or worsening symptoms/signs of HF

Life threatening

A

Acute Decompensated Heart Failure (ADHF)

35
Q

Acute Decompensated Heart Failure (ADHF)

A

peripheral edema
orthopnea
dyspnea on exertion
usually no/minimal volume overload

36
Q

Acute Hypertensive HF

A

severe dyspnea
tachypnea
tachycardia
frank pulmonary edema

37
Q

Cardiogenic Shock

A

end-organ hypoperfusion
oliguria
confusion
cool extremities

38
Q

First line therapy in volume overloaded patients w/ pulmonary congestion

A

Diuretics

furosemide
bumetanide

39
Q

Initial therapy for hypertensive AHF (hypertensive emergency)

decreases venous tone to optimize preload

decreases arterial tone (or afterload)

A

Vasodilators

nitroglycerin
isosorbide dinitrate

40
Q

Used for patients w/ hypotension, end-organ hypoperfusion or shock sec to myocardial pump failure

A

Inotropic Agents

dobutamine
dopamine

41
Q

Considered for cardiogenic shock despite inotropic support

A

NE

high dose dopamine

42
Q

Good perfusion and no congestion

A

Warm and Dry

adjust oral therapy

43
Q

Good perfusion but with congestion

A

Warm and Wet

if HPN predominates: vasodilators and diuretics

if congestion predominates: diuretics, vasodilators

44
Q

With hypoperfusion but no congestion

A

Cold and Dry

fluid challenge then inotropic support if still hypoperfused

45
Q

With hypoperfusion and w/ congestion

A

Cold and Wet

SBP >90 mmHg: vasodilators, diuretics consider inotropic agents if refractory

SBP <90 mmHg: inotropic agents, consider vasopressors, diuretics when perfusion is corrected and consider mechanical circulatory support

46
Q

Framingham Diagnostic Criteria for HF

A 
MAJOR
PND or orthopnea
neck vein distention
rales
cardiomegaly
acute pulmonary edema
S3 gallop
increased venous pressure >16 cmH20
hepatojugular reflux
MINOR
ankle edema
night cough
dyspnea on exertion
hepatomegaly
pleural effusion
vital capacity decreased by 1/3 from maximal capacity
tachycardia .>120 bpm

MAJOR or MINOR - weight loss >4.5 kg in 5 days in response to treatment

2 MAJOR or
1 MAJOR + 2 MINOR

47
Q

MC cause of systolic dysfunction –> L sided HF

A

CAD

48
Q

MC cause of diastolic dysfunction –> L sided HF

A

concentric LVH d.t. HPN

49
Q

MC cause of R sided HF

A

L sided HF

50
Q

Earliest cardinal symptom of L sided HF

A

dyspnea

51
Q

Earliest cardinal sign of L sided HF

A

L sided S3

52
Q

Most sensitive index of cardiac function

A

ejection fraction

53
Q

Single most important bedside measurement to estimate volume status

A

JVP

54
Q

Most important mechanism of dyspnea in HF

A

pulmonary congestion w/ accumulation of interstitial or intraalveolar fluid –> activates juxtacapillary J receptors

55
Q

Cornersyone of modern therapy for HF w/ depressed EF

A

ACE-I/ARBS and Beta Blockers

56
Q

Gold standard in assessing anatomy and physiology of the heart and associated vasculature

A

cardiac catheterization and coronary angiography

IM (66 decks)

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