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Cardiovascular 2 > Heart Failure - Johnston > Flashcards

Heart Failure - Johnston Flashcards

1
Q

Most common cause of sudden death in HF

A

Ventricular arrhythmias

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2
Q

Most common cause of HF

A

CAD - ischemic heart disease

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3
Q

Other causes of HF besides CAD (3)

A
  • Idiopathic, dilated cardiomyopathy
  • Valvular heart disease (calcific aortic stenosis, other)
  • HTN heart disease
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4
Q

Possible reasonings for insufficient LV filling –> HF

A
  • RV infarction
  • Constrictive pericarditis
  • Mitral stenosis
  • Atrial myxoma
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5
Q

4 AHA stages in evolution of HF

A

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)

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6
Q

If S3 is heard…

A

11x increased likelihood for current or future HF

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7
Q

4 NYHA classes of HF

A
  1. Asymptomatic
  2. Exertional symptoms w/ normal activity
  3. Exertional symptoms w/ minimal activity
  4. Rest symptoms
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8
Q

Things that can be seen on echo for causes of HF

A
  • HTN disease
  • Ischemic disease
  • Hypertrophy
  • Infiltrative (amyloidosis, etc.)
  • Valvular disease
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9
Q

Symptoms of systolic HF

A

Weak, fatigued, reduced exercise tolerance, dyspnea, orthopnea, nocturnal dyspnea

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10
Q

Symptoms of diastolic HF

A

Shortness of breath, dyspnea, pulmonary edema

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11
Q

Causes of HIGH OUTPUT HF (high C.O., low E.F.)

A
  • Hyperthyroid
  • Anemia
  • Pregnancy
  • AV fistula
  • Beriberi
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12
Q

Causes of LOW OUTPUT HF (low C.O.)

A
  • Ischemic heart disease
  • HTN
  • Dilated cardiomyopathy
  • Valvular disease
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13
Q

Symptoms of right HF

A
  • Edema
  • Hepatomegaly
  • Venous distention
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14
Q

Symptoms of left HF

A
  • Dyspnea
  • Orthopnea
  • Pulmonary congestion
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15
Q

Compensatory responses to HF

A
  • SNS upregulated
  • RAAS upregulated
  • ADH upregulated
  • Cytokines
  • LV hypertrophy/dilation
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16
Q

Things that can worsen HF (tons)

A
  • 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
17
Q

3 major symptoms of increased HF probability

A
  • New murmur
  • S3 gallop
  • Dyspnea (PND)
18
Q

Timelines for Troponins and CK-MB

A

Troponins – 3-12 hrs –> 24-48 hrs –> 5-14 days

CK-MB – 3-12 hrs –> 24 hours –> 1-3 days

19
Q

Differential Dx for PULMONARY symptoms of HF

A
  • P.E.
  • Asthma
  • Pneumonia
20
Q

Differential Dx for SYSTEMIC FLUID symptoms of HF

A
  • Cirrhosis
  • Renal disease
  • Venous insufficiency
21
Q

5 steps to correctly treat HF

A
  1. Diagnose correctly
  2. Determine etiology
  3. Determine precipitating factors
  4. Understand pathophysiology
  5. Understand MOA of pharmacologic therapy
22
Q

Major non-pharmacologic treatments of HF

A
  • Quit smoking
  • Lose weight
  • Salt restriction (2 grams per day)
  • Fluid restriction (
23
Q

Uses for ACE inhibitor

A
  • Systolic HF (all stages) - prevent further fluid retention
  • Preventing HF in high-risk patients
  • Symptoms of HF unless contraindicated
24
Q

Contraindications for ACE inhibitors

A
  • Previous angioedema (face, tongue, upper airway, etc.)

- Pregnancy

25
Q

When do you give an ARB?

A

Side effects from ACEI (cough)

26
Q

When do you give a BB?

A

All stable patients with HF or reduced EF unless contraindicated

27
Q

When do you give diuretics?

A

Volume overload

28
Q

When do you give Digitalis (Lanolin)?

A

A. fib –> slow ventricular rate

29
Q

Best positive inotrope to increase contractility

A

Dobutamine (beta 1 and beta 2 stimulation)

30
Q

How to use hydrazine and nitrates/isosorbide?

A

In combo w/ diuretics and dig. to increase EF and exercise tolerance

31
Q

Better response to hydralazine + isosorbide in ______

A

African americans

Cardiovascular 2 (20 decks)

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