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Cardiology Part II > Heart Failure Caused by Systolic Dysfunction Lecture Powerpoint > Flashcards

Heart Failure Caused by Systolic Dysfunction Lecture Powerpoint Flashcards

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1
Q

Heart failure caused by systolic dysfunction is also known as…

A

….heart failure with reduced ejection fraction (HFREF)

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2
Q

Heart failure occurs because of problems in these 2 components of heart function

A
  • Decrease in preload (venous return and end diastolic volume in ventricles stretching myocytes
  • Decrease in myocardial contractility
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3
Q

Systolic dysfunction has a _____ and ___ventricle while diastolic has a ____ and ___ ventricle

A

dilated and floppy, stiff and inflexible

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4
Q

Ejection fraction to diagnose left heart failure must be less than…

A

Less than 40%

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5
Q

Heart failure

A

Clinical syndrome that results when abnormalities in structure or function of myocardium impair the ability of ventricle to fill with (diastolic) or eject blood (systolic)

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6
Q

Most common cause of systolic heart failure

A

Ischemic cardiomyopathy following an acute MI

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7
Q

Most common cause of diastolic heart failure

A

Longstanding uncontrolled hypertension leading to LV hypertrophy

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8
Q

Diastolic heart failure has preserved _____. But the issue is ____ volume containing ability caused by abnormal heart adaptations (despite not appearing to) that have dropped cardiac output

A

Ejection fraction, decreased

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9
Q

Heart failure diagnoses are becoming more prevalent because…

A

…patients are living longer post MI and other forms of heart disease

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10
Q

Myocyte remodeling in systolic heart failure mech of action

A
  • Portion of heart that lacks perfusion (ischemia) becomes thinned and dilated (floppy)
  • decreased CO
  • RAAS system compensates decreased CO by vasoconstricting, increasing contractility, and retaining sodium (and therefore water volume)
  • This actually worsens the cardiac functioning by increasing load placed on heart which is already weaker to begin with
  • Portions of heart muscle surrounding thicken to compensate but it ultimately cannot
  • decreased CO
  • system recycles
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11
Q

Can we have both systolic and diastolic dysfunction and how do you tell?

A

yes and thru imaging studies such as echocardiogram of the heart muscle

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12
Q

Pathways targeted in systolic dysfunction for drug therapy

A
  • B receptors

- RAAS

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13
Q

Natriuretic peptides normal functions and levels in systolic dysfunction heart failure (generally)

A

Counterbalance RAAS by causing vasodilation (BNP) and increase Na+ excretion (and therefore H2O volume as well), levels will be elevated in heart failure

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14
Q

Cardiorenal syndrome

A

Comorbidity due to the low cardiac output associated with systolic dysfunction heart failure causing renal hypoperfusion resulting in renal failure (patients with heart failure often go into renal failure)

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15
Q

2 types of cardiac remodeling

A

1) physiologic - compensatory change in dimension and function of heart in response to stimuli such as pregnancy and exercise (not necessarily chronic or a bad thing)
2) pathologic - permanent changes to the heart’s shape and function in response to stimuli such as seen in MI, cardiomyopathy, HTN, and valvular disease

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16
Q

Risk factors for systolic dysfunction (4)

A
  • CAD***
  • previous MI
  • diabetes
  • HTN
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17
Q

2 types of cardiomyopathy

A

Restricted - diastolic function impacted

Dilated - systolic function impacted

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18
Q

1 risk factor for diastolic dysfunction

A

-HTN

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19
Q

Symptoms of systolic dysfunction heart failure (5)

A
  • Dyspnea
  • Fatigue
  • Peripheral edema
  • weight gain early stage weight loss in advanced stage
  • JVDs
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20
Q

Hepatojugular reflex

A

Distension of neck veins precipitated by placing firm pressure over the liver, distension greater than 3cm is diagnostic for systolic heart failure

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21
Q

Most common type of ventricular failure is found on what side?

A

Left sided

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22
Q

Why do we see shortness of breath in left ventricular failure?

A

Back up of fluid into the lungs from the left ventricle and atrium

23
Q

Leading disease state cause of right ventricular failure

A

Left ventricular failure (fluid backs up from left ventricles to lungs to right ventricle causing increased pressure on it)

24
Q

Common cause of 2ndary** right sided only ventricular failure

A

pulmonary fibrosis from things such as COPD (cor pulmonale)

25
Q

Modified framingham diagnostic criteria for congestive heart failure

A

Presence of 2 major criteria or 1 major and 2 minor criteria

26
Q

3 ways to classify heart failure

A
  • Functional classification
  • disease state and progression
  • echocardiogram (systolic vs diastolic)
27
Q

Functional classification of heart failure and the 4 classes

A

Relates to syptoms of everyday activities and QOL
Class 1 - no limitation
Class 2 - slight limitation of physical activity
Class 3 - comfortable only at rest
Class 4 - symptomatic even at rest

28
Q

Disease state and progression classification of heart failure and the 4 classes

A

Based on pre-disease to advanced symptoms evidenced by EKGs and echos
Stage A - patient high risk of developing but no structural disease or symptoms currently
Stage B - patient with structural heart disease but no signs or symptoms
Stage C - Patient with structural heart disease and current signs of HF
Stage D - Patient with marked symptoms at rest requiring special intervention

29
Q

Echocardiogram (Systolic vs diastolic) classification of heart failure

A

Determined via echocardiogram
Systolic - LV ejection fraction <40%, eccentric, thin ventricle
Diastolic - LV ejection fraction >40%, thick ventricle wall

30
Q

Heart failure diagnosis (2)

A

Clinical H&P based from Framingham criteria, confirmed via echocardiography primarily and EKG secondarily

31
Q

Labs for heart failure (7)

A

1) CBC - possible anemia or infection
2) CHEM 7 - possible abnormal electrolytes
3) Liver function test - hepatic congestion
4) lipid profile/fasting glucose - check for risk factors
5) TSH - hypo or hyperthyroidism
6) Cardiac biomarkers - may be elevated in suspected MI
7) ***BNP - may be elevated

32
Q

BNP testing can show false positive elevation indicative of heart failure in these 3 other conditions

A
  • pulmonary disease
  • PE
  • renal impairment
33
Q

Medications that exacerbate heart failure (2)

A
  • NSAIDS

- CCBs

34
Q

S3 cause and what type of heart failure is it heard with?

A
  • Increased sloshing reverberating against dilated left ventricular wall, not always pathology
  • More common in a systolic heart failure
35
Q

S4 cause and what type of heart failure is it heard with?

A
  • Blood being forced into a stiff non-compliant ventricle, almost always pathology
  • more common in a diastolic heart failure
36
Q

Chest Xray findings for LV heart failure and what view is best for seeing it?

A
  • Cardiac silhoutte greater than .5 indicates cardiomegaly as well as pulmonary signs for effusions and edema
  • only on a PA view can see it
37
Q

Kerley B lines

A

Occur on a chest xray indicating fluid buildup in lower lobes of the lungs often in LV heart failure

38
Q

Best imaging study for heart failure and best alternative

A

Transthoracic echocardiogram, transesophageal echocardiogram is best alt (but requires sedation :( )

39
Q

If a patient has an ejection fraction between 40-50%, what do you do?

A

Treat them considering the clinical picture and use judgement (are they symptomatic? Are they high risk for progression?)

40
Q

Systolic heart failure treatment targets

A
  • preload
  • afterload
  • improved inotropy
41
Q

4 choice therapies for systolic heart failure

A
  • non pharm lifestyle mods
  • multiple drugs
  • surgical
  • electrophysiological
42
Q

Lifestyle modification therapies for heart failure (3)

A
  • quit smoking
  • decrease alcohol
  • salt and fluid restriction
43
Q

Systolic dysfunction has what contraindicated drug class?

A

non dihydropyridine ca2+ channel blockers (potential to act on heart)

44
Q

Pharmacological treatment for chronic systolic dysfunction heart failure (3)

A
  • ACE and ARB #1
  • B blocker
  • Spironolactone supplementary
45
Q

Stage A-D pharm treatment protocol for chronic systolic dysfunction heart failure

A
  • ACE
  • ACE and B blocker
  • ACE and B blocker, diuretics
  • mechanical assist devices, transplant?
46
Q

Systolic dysfunction indicates ___ in all patients and ___ in all patients without contraindications

A

ACE, B blocker

47
Q

Digoxin helps with symptoms of heart failure but is not typical to use because it does not…

A

….affect mortality rates

48
Q

Drug class often indicated for HF patients with atrial fibrillation or recent MI

A

Anticoagulants

49
Q

2 Devices indicated for patients with LV Ejection Fraction of <30%

A
  • Implantable cardioverter defibrillator
    • Biventricular pacemaker (cardiac resyncronization therapy)

- Biventricular pacemaker (cardiac resyncronization therapy)

50
Q

Patients with LV ejection fraction <30% are at high risk for these 2 conditions

A
  • Ventricular tachycardia

- ventricular fibrillation

51
Q

Implantable left ventricular assist device

A

Helps patients awaiting transplant pump blood at the ventricle

52
Q

Swan Ganz catheter

A

Right ventricle catheterization from pulmonary artery to measure CVP, right sided heart pressure, and pulmonary artery pressure

53
Q

The frank starling curve shifts in what direction in response to systolic dysfunction

A

Down and to the right (stroke volume (y axis) is reduced and preload is increased (LV EDV x axis)

54
Q

End result of myocyte remodeling in systolic heart failure

A

-end result is hypoperfusion with hypervolemia, and cardiac remodeling of ventricle to be dilated and floppy

Cardiology Part II (18 decks)

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