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CVPR Unit 1 > Heart Failure II -Clinical Manifestations & Dx > Flashcards

Heart Failure II -Clinical Manifestations & Dx Flashcards

1
Q

What are the 3 major Sx in HF?

A
  • Decreased cardiac output: Sx of decreased organ perfusion
  • Increased pulmonary venous pressure: breathlessness
  • increased venous pressure: edema
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2
Q

Sx of reduced cerebral perfusion?

A

Sleepiness and confusion

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3
Q

sx of reduced gut perfusion?

A

Anorexia and wasting (cachexia)

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4
Q

What Sx are observed as a result of increased pulmonary venous pressure?

A

breathlessness, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, acute pulmonary edema

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5
Q

What are the 2 forms of positional SOB?

A

Orthopnea: SOB when flat

Paroxysmal nocturnal dyspnea (PND): SOB upon waking up during the night

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6
Q

What are the Sx of increased central venous pressure (right sided pressure)?

A
  • peripheral swelling/dependent edema
  • Ascites
  • hepatic congestion
  • intestinal congestion
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7
Q

What are some of the precipitating factors producing acute or worsening symptoms?

A
  • Increased circulating volume (preload): sodium load in diet
  • Non-adherence with HF medications
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8
Q

What are the signs of low flow?

A
  • Cool extremities (peripheral vasoconstriction)
  • Tachycardia
  • low pulse pressure
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9
Q

signs of increased left sided pressure:

A
  • Rales (pulmonary crackles, sounds like velcro)
  • Hypoxia
  • tachycardia
  • Sitting bolt upright
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10
Q

Signs of increased right sided pressure:

A
  • edema
  • hepatic congestion/hepatomegaly
  • Jugular venous distention
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11
Q

Jugular distention could be a sign of what?

A

increased central venous pressure (CVP)

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12
Q

T or F: JVP=CVP=R atrial filling pressure

A

True, assumes no blockage or valve inbetween

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13
Q

T or F: triphasic wave form is found in jugular venous pressure

A

True, a wave= atrial contraction

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14
Q

What does the C wave represent?

A

closing of the tricuspid valve early in systole

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15
Q

What does the V wave represent?

A

Movement of the RV annulus and tricuspid valve backward at the very end of systole

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16
Q

What does the A wave represent?

A

atrial contraction

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17
Q

What is the cause of S3?

A

caused by rapid expansion of the ventricular walls in early diastole

18
Q

What is the cause of S4?

A

caused by atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic LV

19
Q

What is a summation gallop?

A

At high heart rates, the S3 and S4 sounds combine to make a single “third” sound.

20
Q

Characteristics of S3

A
  • Can be present in normal young people; abnormal after age 40
  • Typical of HFrEF / dilated heart
  • Cadence of “Ken-tuc-ky” (S1-S2-S3)
21
Q

Characteristics of S4

A
  • Usually abnormal
  • Cadence of “Ten-ne-ssee” (S4-S1-S2)
  • Absent in AFIB
22
Q

Basis of The New York Heart Association (NYHA) classification system

A

based largely on the assessment of symptoms.

23
Q

Basis of The new American College of Cardiology and American Heart Association (ACC/AHA)

A

focus more on underlying disease and the need to treat early in the disease process, even before overt symptoms of heart failure are present. compliment the NYHA�

24
Q

Co-existing conditions which predispose to HF:

A
  • HEART DISEASE: Coronary, Valve Disease, Hypertension, Other
  • CARDIAC RISK DISORDERS: Diabetes, Renal Failure
  • ABSENCE OF NON-HF CAUSES OF DYSPNEA
25
Q

DDx for HF S&S:

A 
Pulmonary disease (COPD, asthma, pneumonia, pulmonary embolus, primary pulmonary hypertension)
Sleep apnea
Obesity
Deconditioning
Anemia
Renal failure
Hepatic failure
Venous stasis / lymphedema
Depression
26
Q

What is the purpose of doing HF labs/studies?

A
  • Confirm the diagnosis of HF: Rule in HF, Rule out other potential causes
  • Characterize HF: Type (e.g. systolic v. diastolic), Severity
  • Assess response to therapy
27
Q

What are the CXR findings in HF?

A
  • Enlarged cardiac silhouette in HFrEF

- Increased upper lobe vascular markings with acute decompensation

28
Q

What is acute pulmonary edema?

A
  • Acute intense shortness of breath

- Occurs once fluid retention / left atrial pressure overwhelms compensatory mechanisms (e.g. lymphatic fluid return)

29
Q

B-type natriuretic is secreted by the myocardium in response to what?

A
  • Primary: ventricular stretch (measure of preload)

- Secondary: hyperadrenergic state, RAAS activation, ischemia

30
Q

What are the 2 forms of BNP assays?

A

-BNP: Normal? (<100)
-NT-proBNP:
N-terminus breakdown product of BNP
Inactive
Half life ~120 minutes (BNP 20 minutes)
~6 times the BNP
-Both decrease w/ age

31
Q

Reasons BNP is elevated

A

HF, PE, Sepsis

32
Q

Clinical use of BNP

A
  • “rule out symptomatic HF”

- negative predictive value of BNP is more useful (a low BNP makes HF unlikely as the cause of symptoms)

33
Q

Can you make a direct Dx of HF by looking at EKG?

A

No, but you can Infer possibility of HF from other findings

34
Q

What is LVEF?

A
  • L Ventricle ejection fraction, Gross measure of systolic function
  • Normal = (100 ml – 40 ml) / 100 ml = 60%
  • HFrEF = (200 ml – 150 ml) / 200 ml = 25%
35
Q

what imaging methods are available to measure LVEF?

A

Ultrasound (echocardiography)
Nuclear (MUGA or SPECT)
MRI
CT

36
Q

List uses of Echocardiography

A

Provides:

  • LVEF (systolic function)
  • Chamber size (dilation)
  • LV wall thickness (hypertrophy)
  • Measures of relaxation (diastology)
  • Valvular anatomy and function
  • Estimated filling pressures (LA, CVP)
  • Estimated pulmonary pressures (pulmonary hypertension)
37
Q

Advantages of Echocardiography

A

Real time
Non-invasive
No radiation
Relatively “inexpensive”

38
Q

What is Right heart catheterization (Swan-Ganz catheter)?

A

A plastic catheter introduced into one of the major veins and then “floated” through the right heart into the pulmonary artery. Has a balloon on the end of it to help blood flow carry it into the lungs

39
Q

Use of right heart catheterization (Swan-Ganz catheter)

A

The balloon also allows a branch of the pulmonary artery to be occluded so that the downstream pressure (post-capillary wedge pressure [PCWP]) can be measured, which is equivalent to the left atrial pressure / left-sided filling pressure.

40
Q

What hemodynamic measure can be obtained from a PA catheter?

A
  • Pressures (CVP/RA, RV, PA, PCWP)
  • Flow = cardiac output
  • Fick CO (oxygen consumption measure)
  • Thermodilution CO (timed flow measure)
41
Q

What is the pressure across a body capillary bed?

A

ΔP = CO x R
ΔP = mean arterial BP – central venous pressure
Systemic vascular resistance = ΔP / cardiac output (in woods units)

CVPR Unit 1 (27 decks)

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