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SPR2015 > Heart Failure Diagnosis > Flashcards

Heart Failure Diagnosis Flashcards

1
Q

3 Major Symptoms of Heart Failure

A

1) decr cardiac output due to decr organ perfusion
2) incr pulm venous pressure (left sided) –> breathlessness
3) incr central venous pressure (right sided) –> edema

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2
Q

Symptoms of Low Flow

A

1) decr cerebral perfusion (confusion)
2) decr muscle perfusion (fatigue)
3) decr gut perfusion (anorexia/wasting)
4) decr kidney perfusion (decr urine output and renal dysfunction)

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3
Q

Effect of low flow on Starling Curve

A

Shift curve downward due to decr SV for a given pressure

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4
Q

Symptoms of Left sided pressure/increased pulm venous pressure

A

1) breathlessness (dyspnea)
2) dyspnea on exertion
3) orthopnea
4) paroxysmal noctural dyspnea
5) acute pulm edema due to fluid retention/incr LA pressure so fluid from pulm vasculature enters interstitial space and then alveoli (hypoxia)

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5
Q

Effect of incr left sided pressure on Starling curve

A

given point shifts right due to incr pressure

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6
Q

Difference between orthopnea and paroxysmal noctural dyspnea

A

Orthopnea = immediate SOB lying flat

Paroxysmal Nocturnal dyspnea= delayed SOB wake from sleep and walk around

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7
Q

Why does walking around improve paroxysmal nocturnal dyspnea

A

Mobilizing edema from tissue through lymph back into blood stream

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8
Q

Why does orthopnea occur?

A

lost venous pooling of blood in the legs

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9
Q

Symptoms of incr right sided pressure/incr central venous pressure

A

1) peripheral edema in lower extrem (older)
2) ascites (younger)
3) Hepatic congestion
4) intestinal congestion

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10
Q

Right sided failure = Effect of Edema in HF on Starling forces

A

Increased central venous pressure upsets balance between Starling forces

now increase oncotic P so pump more fluid into interstitum

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11
Q

Factors that lead to worse symptoms

A

1) incr circulating volume (preload) with sodium
2) increased pressure (afterload)
3) decr inotropy
4) arrhythmia
5) incr metabolic demands (fever, infection)
6) non-adherence with HF meds

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12
Q

examples of increased pressure (afterload) that can worsen symptoms

A

1) uncontrolled HTN
2) worse aortic stenosis
3) pulm embolism

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13
Q

examples of decr inotropy that can worsen symptoms

A

1) MI

2) beta blocker or Ca2+ channel blocker

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14
Q 
NYHA class 
1
2
3
4
A

1) asymptomatic
2) symptomatic with mod exertion
3) symptomatic with minimal exertion
4) symptomatic at rest

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15
Q

AHA/ACC HF stage 1

A

at risk for HF but not structural heart disease or symptoms

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16
Q

AHA/ACC HF stage 2

A

structural heart disease (prior MI, LVH and low EF) but no signs/symptoms of HF

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17
Q

AHA/ACC HF stage 3

A

structural heart disease with prior/current signs and symptoms (HFpEF) and (HFrEF)

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18
Q

AHA/ACC HF stage 4

A

Refractory HF

marked symptoms at rest

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19
Q

What is important about HF course?

A

variable course

episodic exacerbations and rarely single NYHA over time

but usually progressive decline over time

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20
Q

Physical exam

Signs of low flow

A

1) cool extremities - peripheral vasocosntriction to redirect flow to vital organs
2) tachycardia- compensate for low SV
3) low pulse pressure - low output

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21
Q

Physical Exam

Signs of elevated left sided pressure

A

1) rales due to wet alveoli opening
2) hypoxia
3) tachypnea
4) bolting upright

22
Q

PHysical exam

signs of elevated right sided pressures

A

1) edema - follows gravity (legs, sacrum, scrotum)
2) hepatic congestion
3) JVD = central venous pressure

23
Q

what does JVD measure

A

RA filling pressure

24
Q

What is JVD a sign of

A

increased central venous pressure

right heart failure

25
Q

how many Waves in JVD

A

Triphasic= 3

26
Q

A wave

A

atrial contraction

27
Q

C wave

A

closing of the tricuspid valve early in systole

28
Q

v wave

A

movement of RV annulus and tricuspid valve backward at the end of systole (before the valve opens)!

29
Q

S4 heart sound

A

before S1

atria contract forcefully to overcome stiff/hypertrophic LV

30
Q

S4 present in AFIB

A

NO NOT IN AFIB

31
Q

S4 normal or abnormal?

A

abnormal

32
Q

S3 heart sound cause

A

rapid expansion of vnetricular walls in early diastole

sudden stop in LA filling

heart vibrates during passive filling

33
Q

S3 normal or abnormal?

A

normal in young

abnormal after 40 y/o

34
Q

S3 sign of?

A

HFrEF or dilated heart

35
Q

what is summation gallop?

A

all 4 heart sounds

36
Q

Preexisting conditions to HF

A

Coronary, valve disease, HTN

Diabetes, Renal failure

37
Q

How can CXR help in HF

A

Enlarged heart in HFrEF

increased upper lobe vascular markings with acute decompensation

38
Q

What does acute pulm edema look like on CXR

A

fluffy infiltrate due to LA pressure overwhelming lymph return

39
Q

What is BNP secreted in response to?

A

Ventricular stretch (measure of preload)

Hyperadrenergic state, RAAS, ischemia

40
Q

What are assays of BNP

A

BNP- Normal <100

NT-proBNP= N terminus breakdown of BNP (inactive)
~ 6x BNP

41
Q

BNP relationship with age

A

incr age, incr BNP

42
Q

How is BNP used?

A

low BNP makes HF unlikely

in chronic HF, elev BNP not as useful

43
Q

Signs of HF in EKG

A

no direct diagnosis

1) prior MI (Q waves)
2) LVH (incr voltage)
3) diffuse disease from fibrosis or myocardial damage (LBBB)
4) arrhythmia (AFib, ventricular ectopy)

44
Q

Equation for EF

A

EF= (end diastolic volume - end systolic volume) / end diastolic volume

HFrEF = dilated + decr SV

45
Q

Advantages of echocardiogram

A

real-time
non-invasive
no radiation
cheap

46
Q

Right heart cath using Swan-Ganz

A

1) cath insert into major vein and floated to right heart into pulm artery
2) blocks branch of pulm artery to measure downstream pressure (wedge pressure = LA pressure)

47
Q

what is wedge pressure equal to?

A

LA pressure/left sided filling pressure

48
Q

PA Catheter measures what 2 things?

A

Pressures

Flow

  • fick CO
  • thermodilution CO
49
Q

In HF, what is the Fick CO and what is Thermodilution CO

A

Oxy sat aorta - oxy sat vein

Fick: In HF, lower oxy sat in vein because lower CO

Thermodilution: Longer time fo cold water to reach pulm artery because lower CO

50
Q

How to calculate resistance based on pressures and flow

A

dP = CO * R

Calculate resistance in pulm bed based on Difference between PA pressure and Wedge pressure

Calculate resistance in systemic based on difference between aortic pressure and central venous pressure

SPR2015 (23 decks)

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