Heart Failure - Johnston Flashcards
What is the most common cause of HF?
ischemic heart disease
What are the basic causes of HF?
- restrictive/obstruction to ventricular filling ( RV infarct, constrictive pericarditis, mitral stenosis, atrial myxoma)
What are the stages of heart failure according to AHA?
A. AT risk people (CAD, HTN, DM) asymptomatic
B. has LVH or impaired LV function, low EF, previous MI, valvular disease, structural heart disease, hemodynamicaly stable. - asymptomatic
C. Symptomatic of HF with structural heart disease
D. Refractory HF; does not respond to conventional tx and needs specialized tx like mechanical support, transplant.
what are the classes of HF according to NYHA?
- Asymptomatic, no limitation of activity, or symp on exertion,
- Slight limitation, ordinary activity causes symptoms
- Exertional symptoms with minimal activity.
- Inability to carry out physical activity without discomfort; symptoms at rest
what are some symptoms of systolic HF?
- Decreased SV, increased vent filling pressure
- EF less than 40%
- weak, fatigued, reduced exercise tolerance, dyspnea, orthopnea, nocturnal dyspnea
What are some symptoms of diastollic HF?
- SOB
- dyspnea
- pulmonary edema
Differentiate between acute and chronic HF.
Acute: heart failure due to acute MI, ruptured papillary muscle, MR, AI, toxins
Chronic: (most common): Multivalvular disease of dilated cardiomyopathy, progresses slowly, edema, wt gain
what are are causes of high output heart failure?
- hyperthyroidism, anemia, pregnancy, A-V fistula, beriberi, Paget’s
- High CO but low EF
What are some causes of Low Output Heart failure?
More common than High output
- ischemic heart disease, HTN ( dilated cardiomyopahty, valvular and pericardial disease)
what are signs of right sided HF
- edema
- pulmonary HTN
- hepatomegalia,
- venous distension
- increased JVD, HJR
- ascites
What are signs of left sided HF
- LV is overloaded
- AS, MI
- dyspnea, orthopnea, due to pul congestion
Due to heart failure, what neurohormonal responses are unregulated?
SNS
RAAS
ADH
cytokines
What are three major symptoms of increased HF probability?
- new murmur
- S3 gallop
- Dyspnea
what are some signs of RV failure?
- peripheral sacral edema
-
On CXR what is seen that which are diagnostic of HR?
- cardiomegalia
- pulmonary edema with central peripheral infiltrates
- increased size of vessels in upper portion of lungs
- pleural effusions
What is the timeline of levels of Troponin T and I?
increase 3-12 hrs from onset of chest pain
- peak at 24-48rs;
- return to baseline 5-14 days
what is the timeline of levels of CkMB?
- increase 3-12 hrs from onset of chest pain
- peak 24 hrs; baseline 1-3 days
- sensitivity
Explain how CBC, CMP, UA, Thyroid function, can help with diagnosis of HF
CBC: anemia secondary to chronic disease can aggregate HF
CMP: electrolyte imbalance - how Na, K ; Pre-renal azotemia
UA: protein in urine
Thyroid: function should be checked in HF pt greater than 65 with afib
what are some differential diagnosis of HF?
- Pulmonary issues (PE, asthma, pneumonia)
- Cirrhosis (ascites, edema
- Renal - edema
- Venous insufficiency - edema
What are some nonpharmacologic tx of hF?
- quit smoking
- lose weight
- Salt restriction (2g/day)
- Fluid restriction
- avoid isometric activity
- avoid alcohol
When is ACEI indicated for HF?
- systolic HF in all stages - prevent further fluid retention
- preventing HF in high risk pts
- symptoms of HF unless contraindicated
Be cautious in pts with renal insufficiency. Contrandicated if pt has angioedema, pregnant, or bilateral RAS
when is BB indicated for HF? contraindicated?
Indicated: all stable pts with systolic HF and dilated cardiomyopathy contracindicated: reduced EF, or class IV HF pts. Good to use in NYHA class II and III
when is digitalis indicated?
Afib –> sl0w ventricular rate
What positive inotrope is best to increase contractility and improve CO?
- dobutamine (beta 1 and beta 2 stimulation)
How is hydrazine and nitrates/isosorbide used?
- in combo w/diuretics and digoxin to increase EF and exercise tolerance
what patient population best responds to hydralzazine + isosorbide?
African americans
when should a HF patient be admited to the hospital?
- acute myocardial ischemia
- severe resp distress
- hypoxia
- hypotension
- cardiogenic shock
- anasarca
- syncope
- heart failure refractory to oral meds
in conventional tx of acute HF what is the goal with each of these:
A. Diuretics
B. Vasodilators
C. Inotropes
A. reduce fluid volume
B. decrease preload and/or afterload
C. augment contractility
which class of evidence based meds (EBM) classification recommendation should we ideally follow to treat HF?
Class I. ACEI and ARB falls within this class
CCB falls under what class of recommendation as tx of HF?
Class III. No benefit, not recommended as routine. it’s used for pts with HF associated with reduced EF.
