Heart Failure I Flashcards
Risk factors for HF
CAD and Atherosclerosis
DM
HTN
Obesity/Metabolic syndrome
High output output HF
Heart can’t put out enough blood to meet bodies needs
HFrEF
Systolic failure
Under 40% EF
Non-contractile HF
HFpEF
Diastolic failure
EF over 50%
Stiff ventricles
HFpEF borderline
41-49% EF
HFpEF improved
Had HFrEF but now have EF over 40
MCC of right sided heart failure
Left sided HF
NYHA functional scale and change over time
CAN change over time
I - Heart disease but no limitations
II - Slight limitation, symptoms with ordinary activity
III - Marked limitation and symptoms with less than physical activity
IV - HF symptoms at rest
AHA Heart Failure Stages and change over time
CANNOT change over time
A - At risk but no structural disease
B - Have disease but have NEVER had symptoms
C - Structural disease and have or have had symptoms
D - Advanced, refractory disease s/t structural changes
Heart Rate of HF
Tachycardia
Kidneys in HF
RAAS system
-Vasoconstrict and retain fluid and sodium
Use an ACEI/ARB, Aldosterone antagonist
SNS in HF
Pump out epinephrine:
Vasoconstriction
Sodium resorption and water retention
Increase HR and Contractility
Use Vasodilators and BBs
Vasodilator for HF
Hydralazine
Antidiuretic hormone and HF
Promotes retention of fluid - signaled by baroreceptors
Increased thirst
Natriuretic peptides and which is better for labs
ANP and BNP
BNP is BETTER
Symptoms of pulmonary congestion
Cough, crackles, rales, increased afterload
Preload
How much blood is going IN to the LV
Afterload
Resistance from the rest of body to cardiac contraction
PE signs of HF
Lower pulse pressure (SBP-DBP)
Pulmonary congestion - dullness and crackles
Pitting edema, ascites
JVD
Precordial palpitations
Displaced PMI
S3 and S4 heart sounds
Weak pulses
Edema grade
Depth in mm divided by two
Pathognomic sign for LV failure
Pulsus alternans
Purpose of lab tests in HF
Determine CAUSE of HF
HF EKG
May show an arrhythmia
CXR in HF
Cardiomegaly, Pulmonary congestion (moves around, not sick = not infective etiology), Kerley B Lines
BNP predictive value
Extremely high negative predictive value - if its not up they don’t have HF
Use to look at exacerbations
BNP levels
Under 100 - Very unlikely
100-500 - Possible depending on LV dysfunction
Over 500 - Very likely
NT-proBNP levels
Under 300 - Very unlikely
300-1800 - Possible depending on LV dysfunction
Over 1800 - Very likely
Other things that can elevate BNP/NT-proBNP
ACS, LVH, A fib, Anemia, Renal failure, Burns, Sepsis
Take in the whole clinical picture
Troponin and CHF
Suggests an ongoing myocardial necrosis, may see even w/o ischemic disease process
ECHO and CHF
MUST HAVE to visualize ventricles
Detection of CAD in CHF
May need to stress testing
May not have chest pain - may consider angiography in some cases
