Heart Failure - Johnston Flashcards
Most common cause of sudden death in HF
Ventricular arrhythmias
Most common cause of HF
CAD - ischemic heart disease
Other causes of HF besides CAD (3)
- Idiopathic, dilated cardiomyopathy
- Valvular heart disease (calcific aortic stenosis, other)
- HTN heart disease
Possible reasonings for insufficient LV filling –> HF
- RV infarction
- Constrictive pericarditis
- Mitral stenosis
- Atrial myxoma
4 AHA stages in evolution of HF
A. AT RISK (CAD, HTN, DM, obese, etc.), asymptomatic
B. Asymptomatic, but LVH or impaired EF for some reason
C. Symptomatic of HF, structural heart disease
D. Refractory HF (does not respond to treatments)
If S3 is heard…
11x increased likelihood for current or future HF
4 NYHA classes of HF
- Asymptomatic
- Exertional symptoms w/ normal activity
- Exertional symptoms w/ minimal activity
- Rest symptoms
Things that can be seen on echo for causes of HF
- HTN disease
- Ischemic disease
- Hypertrophy
- Infiltrative (amyloidosis, etc.)
- Valvular disease
Symptoms of systolic HF
Weak, fatigued, reduced exercise tolerance, dyspnea, orthopnea, nocturnal dyspnea
Symptoms of diastolic HF
Shortness of breath, dyspnea, pulmonary edema
Causes of HIGH OUTPUT HF (high C.O., low E.F.)
- Hyperthyroid
- Anemia
- Pregnancy
- AV fistula
- Beriberi
Causes of LOW OUTPUT HF (low C.O.)
- Ischemic heart disease
- HTN
- Dilated cardiomyopathy
- Valvular disease
Symptoms of right HF
- Edema
- Hepatomegaly
- Venous distention
Symptoms of left HF
- Dyspnea
- Orthopnea
- Pulmonary congestion
Compensatory responses to HF
- SNS upregulated
- RAAS upregulated
- ADH upregulated
- Cytokines
- LV hypertrophy/dilation
Things that can worsen HF (tons)
- Diet non-compliance
- Meds non-compliance
- HF-worsening meds (CCB, BB, NSAID, antiarrhythmics)
- Infection
- Anemia
- Arrhythmias
- Over-exertion
- Fluid excess
- STRESS
- HTN worsening
- MI
- PE
- Hypothyroid
- Alcohol
- Valvular heart disease worsening
3 major symptoms of increased HF probability
- New murmur
- S3 gallop
- Dyspnea (PND)
Timelines for Troponins and CK-MB
Troponins – 3-12 hrs –> 24-48 hrs –> 5-14 days
CK-MB – 3-12 hrs –> 24 hours –> 1-3 days
Differential Dx for PULMONARY symptoms of HF
- P.E.
- Asthma
- Pneumonia
Differential Dx for SYSTEMIC FLUID symptoms of HF
- Cirrhosis
- Renal disease
- Venous insufficiency
5 steps to correctly treat HF
- Diagnose correctly
- Determine etiology
- Determine precipitating factors
- Understand pathophysiology
- Understand MOA of pharmacologic therapy
Major non-pharmacologic treatments of HF
- Quit smoking
- Lose weight
- Salt restriction (2 grams per day)
- Fluid restriction (
Uses for ACE inhibitor
- Systolic HF (all stages) - prevent further fluid retention
- Preventing HF in high-risk patients
- Symptoms of HF unless contraindicated
Contraindications for ACE inhibitors
- Previous angioedema (face, tongue, upper airway, etc.)
- Pregnancy
When do you give an ARB?
Side effects from ACEI (cough)
When do you give a BB?
All stable patients with HF or reduced EF unless contraindicated
When do you give diuretics?
Volume overload
When do you give Digitalis (Lanolin)?
A. fib –> slow ventricular rate
Best positive inotrope to increase contractility
Dobutamine (beta 1 and beta 2 stimulation)
How to use hydrazine and nitrates/isosorbide?
In combo w/ diuretics and dig. to increase EF and exercise tolerance
Better response to hydralazine + isosorbide in ______
African americans
