Heart Failure clinical

Question 1

how does preload relate to PCWP

Answer 1

preload=LVEDP=LA pressure= PCWP

Question 2

what determines right ventricular preload

Answer 2

central venous pressure, roughly the same as jugular venous pressure

Question 3

most common presenting sx of HF

Answer 3

dyspnea on exertion

Question 4

cause of HFpEF

Answer 4

diastolic dysfn- improper filling causes congestion and HF sx

normal contractility w/ elevated stiffness/less compliance

Question 5

Dx of left heart failure- physical exam

Answer 5

results from increased SNS: diaphoresis, sinus tachy

from pulmonary edema: rales and tachypnea

cool extremities from peripheral vasoconstriction

Question 6

Dx of right heart failure- physical exam

Answer 6

all from increased RV preload- JVD, hepatomegaly, ascites, lower extremity edema

Question 7

differentiate S3 and S4

Answer 7

S3 is early diastole- filling a volume-overloaded ventricle

S4 is late diastole, filling stiff ventricle from atrial contraction, never present w/ a fib (no atrial contraction)

Question 8

imaging HF dx

Answer 8

echo can determine EF and/or etiology

CXR shows pulmonary edema, cardiomegaly, Kerley B lines, vessel redistribution

Question 9

BNP and HF

Answer 9

BNP released from cardiomyocytes in response to strain, strong negative predictive value (ie w/ normal BNP, dyspnea is not from HF)

Question 10

4 main drugs for HF

Answer 10

ACEi, ARBs, Aldosterone antagonists, Beta blockers

Question 11

nuerohormonal effects of ACEi and ARBs

Answer 11

reverse remodeling (lower wall stress and O2 demand), decrease fibrosis, decrease Na and water retention, decrease SNS

Question 12

hemodynamic effects of ACEi and ARBs

Answer 12

reduce afterload and SVR, decrease BP- lower O2 demand and increase SV

Question 13

contra for ACEi and ARBs

Answer 13

angioedema, renal artery stenosis, renal dysfn

Question 14

what are some effects of aldosterone excess realted to HF

Answer 14

cardiac fibrosis, vascular fibrosis, LVH, Na/water retention

Question 15

what happens w/ chronic Beta receptor activation, as occurs in HF

Answer 15

receptors are down regulated, dysfn signalling, cell death, fibrosis, arrhythmias

Question 16

beta blockers used for HF

Answer 16

metoprolol and carvedilol

Question 17

digoxin mechanism

Answer 17

inhibits Na/K ATPase and Na export, this promotes Ca retention and inotropy

Question 18

downside of digoxin

Answer 18

narrow therapeutic range- quickly becomes toxic w/ arrhythmias, confusion, nausea, visual problem

Question 19

purpose of loop diuretics w/ HF

Answer 19

maintain euvolemia to help Sx, does not prolong life and can hurt renal fn

Question 20

when to use cardiac resynchronization therapy

Answer 20

when the ventricles do not synchronously contract, can pace both when the QRS is wider than 120 msec

Question 21

how do LVADs direct flow

Answer 21

from the apex to the ascending aorta, bypassing normal outflow

Question 22

Tx for HFpEF

Answer 22

no proven mortality beneficial drugs- treat comorbid or other conditions

Question 23

what kinds of things can trigger acute decompensated HF

Answer 23

increased metabolic demands, increased preload or afterload, decreased CTY, excessive bradycardia, medical/dietary nonocompliance

Question 24

what does it mean to be cold or wet during ADHF

Answer 24

cold- cardiogenic shock, low flow state, treated w/ inotropes and or vasodilators

wet- pulmonary edema, dyspnea, orthopnea, peripheral edema, JVD, hepatomegaly
-Tx w/ diuretics

can be deompensated and both!! tx both

Question 25

IV inotrope options and drawbacks

Answer 25

dobutamine (beta agonist) and milrinone (PDE 3 antagonist), do not prolong life maybe even shorten it

Question 26

drugs w/ proven mortality benefit in HF

Answer 26

ACEi/ARBs, beta blockers, BiDil (in AA), aldosterone inibts, ICDs, CRT

Question 27

drugs only or Sx

Answer 27

diuretics, digoxin, inotropes, nitro, nitroprusside