Heart Failure (Johnston) Flashcards
The most common cause of LV systolic dysfunction is from ___
Ischemic heart disease
This stage of heart failure is characterized by having HF risk factors, no heart disease, and no symptoms
A
This stage of heart failure is characterized by having heart disease, no symptoms, can have LV dysfunction
B
This stage of HF is characterized by a pt who has prior or current HF symptoms with structural heart disease
C
This stage of HF is characterized by refractory HF. These pts are eligible for mechanical support, transplants and have 1 year mortality of 50-60%
D
Which NYHA class is characterized by an inability to carry out physical activity without discomfort and has a 1 year mortality of 50-60%?
IV
The only class of NYHA that has symptoms at rest
This type of HF accounts for at least 50% of cases and includes decreased SV, increased ventricle filling pressure and the EF is less than 40%. You get Hypoperfusion with impaired ventricular filling. These pts are weak, fatigued, and have reduced exercise intolerance
Systolic HF
Pts with this type of HF have a normal EF, SOB, DOE, pulmonary edema, and an inability of the LV to relax/fill. There is an increased resistance to ventricular filling and decreased compliance or increased stiffness.
Diastolic HF
I.e., restrictive/constrictive pericarditis, hypertensive/hypertrophic cardiomyopathy
Hyperthyroidism, anemia, pregnancy, AV fistula, beriberi, Pagets are associated with this type of HF
High output –> High CO but low EF
Ischemic heart disease, HTN, dilated cardiomyopathy, valvular and pericardial disease are associated with this type of HF
Low output
Pulm HTN d/t pulm embolus, edema, hepatomegaly, and venous distention are signs of ___
Right sided HF
Aortic stenosis, Mitral insufficiency, dyspnea, orthopnea are signs/symtpoms of ___
Left sided HF
What are some meds that can worsen HF?
CCB
B blockers
NSAID
Antiarrhythmics
The presence of this sign increases the likelihood of HF 11-fold:
Presence of S3 gallop
What are signs/symptoms of RV failure?
Peripheral/sacral edema
Hepatomegaly
Ascites
Increased JVD, HJR
What electrolyte imbalances will you see on CMP as well as the BUN to Cr ratio in a pt with HF?
Low Na, K
Pre-renal azotemia –> High BUN:CR
If a pt is in HF, greater than 65 years old with A FIb, what do you want to check?
Thyroid –> Free T4, TSH
What are some indications for admission to the hospital for management of HF?
Acute myocardial ischemia Severe RD Hypoxia Hypotension Cardiogenic shock Anasarca Syncope HF refractory to oral meds
This drug is useful for all NYHA functional classifications with systolic HF, lower mortality and morbidity by 20%, is useful in preventing HF in high-risk pts (ASHD, MD, HT) level of evidence=A, and recommended in pts with symptoms of HF, reduced EF, unless contraindicated with Level of Evidence=A
ACEi’s
When should you use ACEi’s cautiously and when are they contraindicated?
Use cautiously with renal insufficiency (Cr greater than 2.5 mg) or K greater than 5
Contraindicated in angioedema, pregnancy, bilateral renal a stenosis
Side effect is the ACEi cough
This drug is comparable to the ACEi but not more effective and shouldn’t be given to pt if they had angioedema from ACEi
ARBs
This drug is recommended for all stable pts with symptoms of HF, reduced EF, unless contraindicated with a level of evidence=A. Use these in pts with NYHA class II and III but not IV
B blockers
This inotropic agent improves the quality of life associated with HF but no demonstrable effect on survival. It inhibits Na/K ATPase and increases contractile state by increasing IC Ca concentration. It is useful in a fib to slow ventricular rate
Digitalis-Lanoxin
What electrolyte do you need to monitor if you give a HF pt spironolactone?
K
A systolic murmur that radiates into the left axilla is likely:
Mitral regurgitation
This intotrope increases contractility by stimulating beta 1 and beta2 receptors
Dobutamine
This drug for HF is an arterial vasodilator, reduces afterload and SVR
Hydralazine
This drug type is a veno-vasodilator and reduces preload or reduce venous return to increase CO
Nitrates
What drug combo should be considered in african americans than in whites considering HF?
Hydralazine and isosorbide di/mononitrates
This drug class is a tx for pts with HF associated with reduced EF but is not recommended as routine and provides no benefit
CCBs
What OMM techniques can be utilized in HF lymph tx?
Open thoracic inlet
Rib raising
Diaphragm doming
Effleurage/petrissage
What is the dominant etiology of heart failure?
CAD-Ischemic heart disease (60-75%)
