Heart Failure - Dr. Miller

Question 1

sx of HF

Answer 1

1. SOB
2. fatigue
3. edema + rales

Question 2

HF 2 types

Answer 2

1. normal Ejection Fraction (LV ejects 50% or more of blood that filled it) (HFPEF)
2. reduced EJ : LV can eject 40% or less of blood that filled it (HFrEF)

Question 3

preserved EF HF what happens

Answer 3

wall of LV concentric thickening = unable to relax (ejects normal onlt doesnt fill to its capacity)

Question 4

reduced EF HF what happens

Answer 4

wall thinning = dilation of LV (can fill normally only cant eject all blood)

Question 5

HF reduced EF usually from what event and what 2 things happen right after

Answer 5

MI, lowering CO
1. sympathetic NS
2. RAAS
= vasoconstriction, increase HR

Question 6

disease not associated with heart that can cause HF reduced EF

Answer 6

1. thyroid problem
2. SLE, Sarcoidosis
3. alcohol high consumption, drugs
4. chemotherapy

Question 7

what has been easier to tx HF reduced or preserved EF

Answer 7

HF with reduced EF

Question 8

HF EF reduced risk

Answer 8

= male
= LV hypertrophy (dilating)
= smoking
= MI 
= bundle block

Question 9

HF EF preserved risk

Answer 9

= old age
= F
= HTN
= atrial Fib

Question 10

HF SX

Answer 10

1. CONGESTION : sob, paroxysmal nocturnal dyspnea, orthopnea, edema, weight (2-3lb a dat fluctuation, or 6lb a week)
2. HYPOFERFUSION : exercise intolorance, fatigue, cold intolorance,

Question 11

how to assess congestion

Answer 11

1. S3 gallop
2. orthopnea
3. edema
4. ascites
5. JVP
   (DRY OR WET)

Question 12

how to assess for perfusion

Answer 12

= cool extr
= renal dysfunction 
= narrow pulse
= hypotension
= altered mental status
(WARM OR COLD)

Question 13

cardiac biomarker most helpful to see HF in a pt

Answer 13

BNP : brain natriuretic peptide (rules out HF only)

= can be elevated in (COPD, anemia, renal insuff, old age, pul htn)

Question 14

imaging fo HF *

Answer 14

Echocardiography :2D TTE (transthoracic)

LV EF is low

Question 15

cardiomyopahty imaging

Answer 15

MRI

Question 16

ACC/ AHA staging for HF and % in population (PROGRESSIVE)

Answer 16

A : no sx or HD, however high risk HF (22%)
B : HD only no sx HF (34%)
C : HD with prior or current sx HF (12%)
D : HF require intervention (0.2%)

Question 17

NYHA stage classification of HF

Answer 17

I : no limitation in activity
II : slight limitation in activity
III: moderate limitation in activity
IV : cant do activities without sxs (unable to converse either)

Question 18

TX HF EF reduced

Answer 18

1. improve sx : diuretics*****
2. prevent heart remodeling : (ACE Inh. and BB) + minerocoritcoroids antagonist (MR) needed if needed *****
3. prevent hosp.

Question 19

TX HF EF preserved

Answer 19

no improvement in meds
= only tx htn + diuretics *****
= tx other comorbidities

Question 20

tx hypoperfusion

Answer 20

fluid and inotropic agent

Question 21

congestion tx

Answer 21

diuretics and help to tx renal replacement therapy

vasodilators

Question 22

Cor Pulmonale is from what

Answer 22

pulmonary disease (COPD, pulm htn, chronic bronchitis) = RV hypertrophy

Question 23

Cor pulmonale SX

Answer 23

1. SOB
2. LOWER Extr edema
3. abd girth increases = ascites
4. elevated JVP
5. S3 gallop, Tricuspid murmur
6. hepatosplenomegally, pulsatile liver

Question 24

Cor pulmonale EKG

Answer 24

right axis deviation , RV hypertrophy

Question 25

Cor pulmonale CXR

Answer 25

enlarged main pulmonary As and hilar As

Question 26

Cor pulmonale 2D TTE (echocardiogram)

Answer 26

hard to see , use MRI and cardiac catheterization with this

Question 27

Cor pulmonale TX

Answer 27

1. maintain O2 : give O2
2. Diuretics and lower fluid and Na
3. IV inotropes (hemodynamic support)
4. manage arrhythmia
5. restrict activity while sx, then improve it

Question 28

prevent HF

Answer 28

htn, hyper lipids, DM, obesity, smoking = PREVENT + control

= diet, exercise and counseling my patients