Heart Failure – Part 2:Clinical Manifestations and Diagnosis Flashcards

1
Q

3 major symptoms of Cardiac Failure

A

↓ Cardiac output

↑ Pulmonary venous pressure (Left-sided)

↑ Central venous pressure (Right-sided)

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2
Q

↑ Central venous pressure (Right-sided) causes

A

edema

  • symptoms of Cardiac Failure
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3
Q

↑ Pulmonary venous pressure (Left-sided) causes

A

breathlessness

  • symptoms of Cardiac Failure
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4
Q

↓ Cardiac output causes

A

Symptoms of decreased organ perfusion

  • symptoms of Cardiac Failure
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5
Q

Symptoms of low flow

A

↓ cerebral perfusion
↓ muscle perfusion
↓ gut perfusion
↓ kidney perfusion

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6
Q

↓ cerebral perfusion (low flow) causes

A

Sleepiness, confusion

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7
Q

↓ muscle perfusion (low flow) causes

A

Fatigue, weakness

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8
Q

↓ gut perfusion (low flow) causes

A

Anorexia, Wasting (cachexia)

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9
Q

↓ kidney perfusion (low flow) causes

A

Reduced urine output

Progressive renal dysfunction

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10
Q

Symptoms of ↑ left-sided pressure

A

↑ Pulmonary venous pressure=

Breathlessness (dyspnea)
Dyspnea on exertion
Orthopnea
Paroxysmal nocturnal dyspnea
Acute pulmonary edema
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11
Q

Orthopnea or orthopnoea is shortness of breath (dyspnea) which occurs when _______

A

lying flat, immediate

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12
Q

Delayed SOB, waking patients from sleep
Classically patient gets out of bed and ambulates to relieve symptoms
Relates to mobilization of edema from tissue through lymphatics back into blood stream

A

Paroxysmal nocturnal dyspnea (PND)

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13
Q

Symptoms of ↑ right-sided pressure

A
↑ Central venous pressure (RV failure)= 
Peripheral swelling / dependent edema
Ascites
Hepatic congestion
Intestinal congestion (protein-losing enteropathy)
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14
Q

Precipitating factors producing acute or worsening symptoms

A

**Increased circulating volume (preload)= Sodium load in diet

Increased pressure (afterload)

Worsened contractility (inotropy)

Arrhythmia (rate)

Increased metabolic demands

**Non-adherence with HF medications

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15
Q

Paroxysmal nocturnal dyspnea (PND)

A

Delayed SOB, waking patients from sleep
Classically patient gets out of bed and ambulates to relieve symptoms
Relates to mobilization of edema from tissue through lymphatics back into blood stream

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16
Q

Symptoms generally define the severity of the disease, ex?

A

Disease severity is one of the strongest predictors of death in heart failure.

17
Q

Symptoms are often determine therapy e.g.

A

more aggressive therapies are indicated for more advanced disease)

18
Q

Signs of low flow

A

Cool extremities
Tachycardia
Low pulse pressure (difference between systolic and diastolic pressure)

19
Q

Tachycardia in HF is

A

Compensate for low stroke volume

20
Q

Signs of ↑ left-sided pressure

A

Rales (pulmonary crackles)
Hypoxia
Tachypnea
Sitting bolt upright

21
Q

Signs of ↑ right-sided pressure

A

Edema
Follow gravity (legs, sacrum, scrotum)
Hepatic congestion / hepatomegaly
Jugular venous distention (JVD)

22
Q

S3 is thought to be caused by rapid expansion of the?

A

ventricular walls in early diastole

23
Q

S4 is caused by atria contracting forcefully in an effort to?

A

overcome an abnormally stiff or hypertrophic LV

24
Q

Co-existing conditions which predispose to HF

A

HEART DISEASE:
CARDIAC RISK DISORDERS:
ABSENCE OF NON-HF CAUSES OF DYSPNEA

25
Q

Differential diagnosis for HF Signs and Symptoms

A
Pulmonary disease 
Sleep apnea
Obesity
Deconditioning
Anemia
Renal failure
Hepatic failure
Venous stasis / lymphedema
Depression
26
Q

Natriuretic Peptides (BNP)

A

B-type natriuretic is secreted by the myocardium in response to;
Primary: ventricular stretch (measure of preload)

Secondary: hyperadrenergic state, RAAS activation, ischemia

27
Q

Diagnostic use of BNP

A

Elevations are most often due to HF

28
Q

negative predictive value of BNP is more useful meaning

A

a low BNP makes HF unlikely as the cause of symptoms, + does not help when HF is already known

29
Q

EKG in HF

A

No direct diagnosis of HF

30
Q

Echocardiography Provides

A
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)
31
Q

catheter introduced thru veins &then “floated” through the r. heart to pulmonary a

Has a balloon on the end of it to help blood flow carry it into the lungs

The balloon also allows a branch of the pulmonary artery to be occluded so that the downstream pressure can be measured, which is equivalent to the ______________

A

(Procedure: Swan-Ganz catheter)

left atrial pressure / left-sided filling pressure.