Heart Failure Continuum of Care Flashcards
Co-morbidities with Heart Failure in WOMEN
HTN Valvular disease Thyroid function Less obstructive CAD DM LVH (increased mortality)
Define Heart Failure
Complex, heterogeneous & progressive syndrome characterized by structural and/or functional abnormalities in cardiac contraction, consequent adverse euro-hormonal adaptations & remodeling & co-morbidities that collectively alter myocardial function, fluid regulation, respiration, & perfusion & overall hemodynamic stability
Unusual Causes of Cardiomyopathy
Hypertrophic obstructive cardiomyopathy (HCM) AL amyloid cardiomyopathy Myocarditis Tachycardia-induced cardiomyopathy (TIC) Takotsubo cardiomyopathy (TTC) Peripartum cardiomyopathy (PPCM)
Co-Morbid Conditions in Heart Failure
Anemia: of chronic disease Gout: thiazides contribute HTN Renal dysfunction: murderous marriage with the heart Lung disease; sleep-disordered breathing Rapid or irregular dysrhythmias DM Thyroid disorders
Types of Remodeling in Heart Failure
Hypertrophy (preserved EF HF)
Dilation (reduced EF HF)
Clinical Features of Heart Failure with Preserved Ejection Fraction
Volume overload
Decreased activity tolerance
QOL similar to low EF patients
Heart failure with preserved ejection fraction is associated with what kind of dysfunction?
Diastolic dysfunction
Signs/Symptoms of Diastolic Dysfunction
Increased LV wall stiffness
Decreased compliance/impaired relaxation
Decreased cardiac output
3 Stages of Diastole
Isovolemic (active) relaxation & rapid early filling
Diastasis (passive) filling
Active filling during atrial contraction
Define Grade 1 Diastolic Heart Failure
Impaired relaxation
Define Grade 2 Diastolic Heart Failure
Pseudonormal
Concomitant LA enlargement, LV hypertrophy and/or decreased LV ejection fraction
Define Grade 3 Diastolic Heart Failure
Restrictive/constrictive Difference is reversibility Impaired LV relaxation Increased LV stiffness Increased LA pressures
Define Dilation
Compensate for poor cardiac output, ventricle dilates, becomes thinned & weakened
Heart failure with reduced ejection fraction is associated with what kind of dysfunction?
Systolic dysfunction
Clinical Features of Reduced Ejection Fraction Heart Failure
Impairment of LV contraction EF less than 40% Decreased stroke volume Decreased cardiac output Engorgement of systemic veins Decreased perfusion to vital organs
Atrial Fibrillation in Heart Failure
Lead to an acute decompensated state
Common Symptoms of A-fib in Heart Failure
Fatigue
Dyspnea
Especially in preserved HF
Factors that Contribute to HF
Cardiac chamber enlargement Conduction system & anatomical heart abnormalities Adaptations of SNS Adverse responses to medications Electrolyte abnormalities
Functional Classification of HF
Class 1 (Minimal): no limitations Class 2 (Mild): no strenuous activity Class 3 (Moderate): activity limited to ADLs Class 4 (Severe): symptoms with any physical activity
2 Parts of a Cardiovascular Assessment
Wet or dry: assessing fluid status & congestion
Warm or cold: assessing indicators of perfusion
No Low Perfusion or Congestion at Rest
Warm & dry
Congestion at Rest but No Low Perfusion at Rest
Warm & wet
Low Perfusion at Rest & No Congestion at Rest
Cold & dry
Lower Perfusion & Congestion at Rest
Cold & wet
Possible Evidence of Low Perfusion
Narrow pulse pressure Sleepy/obtunded Low serum sodium Cool extremities Hypotension with ACE inhibitor Renal dysfunction
Signs/Symptoms of Congestion
Orthopnea/PND JV distension Ascites Edema Rales (rare) S3 Hepato-jugular reflex
Follow Up Questions with SOB
Occurring at rest or with exertion
Awaken patient from sleep
Occur when walking on a flat surface; worse with stairs/carrying items
Increasing with daily activities now as opposed to 1 & 6 months ago
Ask family if patient looks more SOB than normal
Follow Up Questions with Cough
Productive, non-productive, blood tinged sputum
Worse with exertion or when lying down
Patient taking any new medication
Follow Up Questions with Chest Pain
Description Accompanied by diaphoresis, SOB, N/V Alleviating or aggravation factors With or without exertion Awaken patient from sleep
Follow Up Questions with Palpitations
Circumstances when symptoms occur
Duration & description
Accompanied by dizziness, loss of consciousness, shock from ICD
Follow Up Questions with Dizziness, Lightheadedness, Syncope
Occur with position changes, while bending over
Accompanied by palpitations
Loss of consciousness (alone or witnessed)
Follow Up Questions with Abdominal Fullness
Weight change in the past week, month
Presence of nausea, early satiety, abdominal bloating
Clothes feel tight (pants, belt)
Experiencing RUQ tenderness, feelings of pressure in abdomen
Follow Up Questions with Dietary Habits
Table salt added while cooking or eating
Consuming frozen processed meals, canned foods, eating in restaurants
Foods high in fat/cholesterol
Follow Up Questions with Edema
Presence in feet, ankles, calf, knees, back
Resolve overnight
Skin painful or seeping
Follow Up Questions with Sleep
Awaken during the night with SOB
Able to lay flat, sleep propped up in bed, on a sofa, recliner, or sit at the edge of the bed
Follow Up Questions with Mentation
Difficulty thinking, staying awake, concentrating or understanding written/verbal communication
Does family notice whether patient’s mind drifts or not paying attention
Falling asleep while talking to someone in person or on the phone
Follow Up Questions with Substance Abuse
Smoking
Illicit drugs
Alcohol
Follow Up Questions with Past Disease/Treatment
Recent infections Symptoms Treatment Rheumatic fever Chemo: type & year
Clues for Identifying Patients with Advanced HF
Repeated hospitalizations or ED visits for HF in past year
Progressive deterioration in renal function
Weight loss without other cause
Intolerance to ACE inhibitors due to hypotension and/or worsening renal function
Intolerance to beta blockers due to worsening HF or hypotension
Frequent systolic blood pressure
Diagnostic Testing for HF
CXR Lab: include biomarkers ECG ECHO, MUGA, MRI Risk stratification for CAD Risk stratification for HF
