Heart Failure PP Flashcards
1 cause of heart failure…
Systemic HTN
Causes of HF
Systemic HTN
MI
Valve disease
Diabetes
Others
Dysrhythmias
Obesity, Lung Disease, Sleep disorder (breathing)
CKD
Anemia, Hyperthyroidism, Infection, Drugs
The Frank-Starling Mechanism
Heart adjusts its force of contraction based on the amount of blood filling the ventricles (preload).
Maybe impaired by these problems (2)
Dilated cardiomyopathy or severe heart failure, where excessive stretch weakens the heart’s ability to pump effectively.
Increased preload & Cardiac output Leads to increased HR & BP / Increased Cardiac workload
Leads to…
LV dysfunction
Management of HF
MEDS
ACE inhibitors
ARBs
beta-blockers
aldosterone antagonists
interventions like device therapy or surgery, aim to slow or reverse these changes.
Description: Enlargement of the ventricular chambers due to increased volume or pressure.
Causes: Chronic volume overload (e.g., valve regurgitation) or heart failure.
Effects:
Initially helps maintain cardiac output.
Over time, leads to reduced contractility and heart failure.
Ventricular Dilation
Description: Thickening of the heart muscle (myocardium) in response to increased workload.
Types:
Concentric Hypertrophy: Due to pressure overload (e.g., hypertension).
Eccentric Hypertrophy: Due to volume overload (e.g., valve regurgitation).
Effects:
Can initially improve heart function.
May lead to stiff ventricles, diastolic dysfunction, and increased oxygen demand
Muscular Hypertrophy
Signs of HF (4)
Ventricular dilation
Muscle Hypertrophy
Apoptosis
Fibrosis
Ischemic heart disease (e.g., myocardial infarction).
Chronic hypertension leading to left ventricular hypertrophy.
Dilated cardiomyopathy.
Valvular diseases (e.g., aortic stenosis).
Arrhythmias.
Causes Low output or High output HF
Low output
Ischemic heart disease (e.g., myocardial infarction).
Chronic hypertension leading to left ventricular hypertrophy.
Dilated cardiomyopathy.
Valvular diseases (e.g., aortic stenosis).
Arrhythmias.
Leads to Low or High Output HF
Low output HF
Symptoms
Fatigue, weakness.
Cool extremities (due to poor perfusion).
Pulmonary congestion (e.g., dyspnea, orthopnea).
Peripheral edema.
Low or High Output HF
Low output HF
Causes:
Severe anemia.
Thyrotoxicosis (hyperthyroidism).
Arteriovenous fistulas or malformations.
Paget’s disease of bone.
Beriberi (thiamine deficiency).
Sepsis (due to profound vasodilation).
Low or high output HF
High
The heart pumps an abnormally high volume of blood, but it still fails to meet the metabolic demands of the body due to an underlying systemic condition.
Warm extremities (due to increased blood flow).
Bounding pulses.
Pulmonary congestion and edema (in advanced stages).
Tachycardia and palpitations.
Low or High Output HF
High
HF can be acute or chronic
Describe (4) from each…
Acute:
MI
Virus
Drugs
Dysrhythmias
Chronic:
HTN
Valve Diseases
DM
Lng Trm Edema
Primary cause of left sided HF
Primary Cause: Left ventricle dysfunction (commonly due to hypertension, ischemic heart disease, or valvular disorders).
Symptoms of Left sided heart failure (4)
Dyspnea (shortness of breath), especially on exertion or when lying down (orthopnea).
Paroxysmal nocturnal dyspnea (PND).
Fatigue and weakness due to reduced cardiac output
.
Pulmonary congestion causing cough, crackles, and frothy sputum.
Pathophysiology: Blood backs up into the lungs due to poor left ventricular pumping, leading to pulmonary edema
Left sided HF
Complications: Pulmonary hypertension, hypoxia, and possible progression to right heart failure.
Problem…
Left sided HF
Primary Cause: Right ventricle dysfunction (often secondary to left heart failure, chronic lung diseases, or pulmonary hypertension
Right sided HF
Symptoms of Right sided HF (4)
Peripheral edema (swelling in legs and feet).
Ascites (abdominal swelling).
Jugular venous distention (JVD).
Hepatosplenomegaly (enlargement of the liver and spleen).
Fatigue due to impaired venous return and decreased cardiac output.
Pathophysiology: Blood backs up into the systemic circulation due to poor right ventricular pumping, leading to venous congestion.
Right sided HF
Fluid Congestion:
____ heart failure → Pulmonary congestion.
_____ heart failure → Systemic venous congestion.
Symptoms Location:
____ → Respiratory-focused symptoms (lungs).
____→ Peripheral and abdominal symptoms.
Fluid Congestion:
Left heart failure → Pulmonary congestion.
Right heart failure → Systemic venous congestion.
Symptoms Location:
Left → Respiratory-focused symptoms (lungs).
Right → Peripheral and abdominal symptoms.
Cough worse at night
Dyspnea
Crackles or wheezes
Pleural effusion
Pink, forthy sputum
Tachypnea
S3 S4
Which HF
Left
Cardiac output with Left sided HF
Decrease
Pulmonary congestion
Which HF
Left
Pulse with left HF
Thready weak
JVD
Enlarge liver & spleen
Anorexia
Nausea
Dependent edema
Swollen hands or feet
Polyuria at night
Weight gain
Increased or decreased BP
Right HF
Systemic congestion
Which HF
Right
Cor pulmonale is…
Specific type of right sided HF Always caused by pulmonary vascular condition (e.g., COPD, pulmonary embolism).
Most important lab test for determining HF
Values
BNP
<100 Normal
100 - 300 further investigation
300 mild HF
600 mod HF
900 severe HF
Name Diagnostic for HF…
H&P
ECG
2D echo (EF, Ab values, wall changes)
CXR
Describe New York Association Functional Classification
(For HF)
Class 1 - 4
1: No symptoms with ordinary activity
Class II
Description: Slight limitation of physical activity.
Symptoms: Comfortable at rest, but ordinary physical activity (e.g., walking up stairs, moderate exertion) results in fatigue, palpitation, dyspnea, or angina.
Functional Status: Mild symptoms with normal daily activities.
Class III
Description: Marked limitation of physical activity.
Symptoms: Comfortable at rest, but less than ordinary activity (e.g., light housework, short walking) causes fatigue, palpitation, dyspnea, or angina.
Functional Status: Significant symptoms even with minimal exertion.
Class IV
Description: Inability to carry on any physical activity without discomfort.
Symptoms: Symptoms of heart failure (e.g., fatigue, dyspnea, angina) are present at rest. Any physical activity increases discomfort.
Functional Status: Severe limitation; often bedridden or unable to perform daily tasks.
Description: No limitation of physical activity.
Symptoms: Ordinary physical activity does not cause fatigue, palpitation, dyspnea (shortness of breath), or angina.
Functional Status: Asymptomatic during normal activities.
Class 1
Description: Slight limitation of physical activity.
Symptoms: Comfortable at rest, but ordinary physical activity (e.g., walking up stairs, moderate exertion) results in fatigue, palpitation, dyspnea, or angina.
Functional Status: Mild symptoms with normal daily activities.
Class II
Description: Marked limitation of physical activity.
Symptoms: Comfortable at rest, but less than ordinary activity (e.g., light housework, short walking) causes fatigue, palpitation, dyspnea, or angina.
Functional Status: Significant symptoms even with minimal exertion.
Class III
Description: Inability to carry on any physical activity without discomfort.
Symptoms: Symptoms of heart failure (e.g., fatigue, dyspnea, angina) are present at rest. Any physical activity increases discomfort.
Functional Status: Severe limitation; often bedridden or unable to perform daily tasks.
Class IV
Nitroglycerin has this affect on preload & afterload
Lowers
Pregnant women have this type of precaution with cardiologist…
Go to a specialist
Why consider use of ARBS instead of ACE Inhibitors…
Less serious SE (Dry Cough & Angioedema)
ARNI (Angiotensin Receptor-Neprilysin Inhibitor) refers to a class of medications used to treat….
HF with reduced ejection fraction (HFrEF).
The most commonly used ARNI is sacubitril/valsartan
ARNI
Is a combination of Sacubitril (neprilysin inhibitor) & Valsartan (angiotensin receptor blocker - ARB)
The combination results in reduced stress on the heart and improved cardiac function.
Approved for what problem…
Approved for HFrEF (Heart Failure with Reduced Ejection Fraction) to reduce the risk of cardiovascular death and hospitalization for heart failure.
SE For ARNI (6)
Hypotension.
Hyperkalemia.
Dizziness.
Angioedema (rare but serious).
Renal impairment.
Cough (less common than with ACE inhibitors).
Basically the same as ACE & ARBS
When to hold K sparing Diuretucs
Uses
Heart failure (e.g., spironolactone in HFrEF).
Hypertension (as an adjunct to other diuretics).
Edema associated with liver cirrhosis or nephrotic syndrome.
Hyperaldosteronism (primary or secondary).
When to hold..
K >5
Creatinine >2.5
Adult males 0.7–1.3 mg/dL (62–115 µmol/L)
Adult females 0.6–1.1 mg/dL (53–97 µmol/L)
Creatinine levels norms
What do highs and lows means
High
Dehydration
CKD
MEDS: ACE / ARBS NSAIDS
HF
High protein diet
Rhabdomyolysis
Low
Liver problem
Preggers
Low muscle mass
Diuretics help with remodeling of the heart
T or F
T
Best medications to reduce afterload (3)
ACE
ARB
ARNI
Angiotensin Receptor-Neprilysin Inhibitor
Slide
SE For ACE (4)
Low BP
Worsening Kidney Function
Hyperkalemia
Chronic Cough
Angioedema
How long to be off an ACE befire starting an ARI
72 hrs
Contradictions to ARNI
(4)
Concurrent Use of ACE / ARB
DM
Preggers
Valsartan / Sacubitril
Is this type of medication…
Cost 12$ per day
ARNI
Angiotensin Receptor-Neprilysin Inhibitor
Reduce preload (3)
Diet
Diuretics
Venous Vasodilators
Traditional HF Diet
- Limit sodium to….
- Fluid restrictions (class IV patients)
- Weight self (How Often)
- Weight gain of ___ in 1 day or
____ in 1 week = contact HCP
- 2 G
- 2 L/day
- Daily weight
- 3# in 1 day or 5# in 1 week
Therapeutic level of Digoxin
0.5 - 2 ng/ml
Medication Antidote for Digoxin…
Amount….
Digi fab 0.125
Last Resort for HF
Left Ventricular Assist Device (LVAD)
Beta-Blockers have 3 effects
Adrenergic …. Primary
Cholinergic….
Glycopenic ….
Adrenergic - Decreased heart rate and contractility.
- Bronchoconstriction (non-selective).
- Vasoconstriction (in certain vascular beds).
Cholinergic - Increased parasympathetic (vagal) tone.
- Bradycardia and AV node conduction delay.
Glycopenic - Impaired glycogenolysis and glucose release.
- Masked symptoms of hypoglycemia in diabetics.
Sweating
Shakiness or tremors
Tachycardia (rapid heartbeat)
Anxiety or nervousness
Irritability or mood swings
Palpitations
Hunger
Neuroglycopenic Symptoms (due to insufficient glucose to the brain):
Confusion or disorientation
Difficulty concentrating
Slurred speech
Dizziness or lightheadedness
Weakness or fatigue
Blurred vision
Headache
Loss of coordination
Seizures (in severe cases)
Loss of consciousness or coma (severe hypoglycemia)
Other Symptoms:
Nausea
Cold, clammy skin
Hypo or hyperglycemia
Hypoglycemia
Think drunk with Tachycardia
Why are BB not a good first choice in black men.
They will refuse to take them due to ED
Diuretics alone can be given to treat HF
F
Never alone
Types of meds given to treat HF
1.ACE Inhibitors
Examples: Enalapril, Lisinopril, Ramipril
- Angiotensin Receptor Blockers (ARBs)
Examples: Losartan, Valsartan, Candesartan
- Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)
Example: Sacubitril/Valsartan (Entresto)
- Beta-Blockers
Examples: Carvedilol, Metoprolol succinate, Bisoprolol
- Mineralocorticoid Receptor Antagonists (MRAs)
Examples: Spironolactone, Eplerenone
- Diuretics
Examples: Furosemide, Bumetanide, Torsemide
Ivabradine
- Hydralazine and Nitrates (Combination Therapy)
Example: Hydralazine/Isosorbide dinitrate (BiDil)
SGLT2 Inhibitors
Examples: Dapagliflozin, Empagliflozin
Aldosterone antagonists aka potassium sparring diuretics
Give examples…
Hold…
Spironolactone
Eplerenone
Hold
K>5
Creatinine >2.5
SE of spironolactone (3)
Hyperkalemia
Gynecomastia
Impotence
Venodilators
Dilate veins to decrease blood returning to the heart
Tolerance can develop
Examples….
Nitroglycerin (Store in Dark colored Glass container)
Isosorbide
Neseritide (natrecor)
Type of med…
Action: Causes loss of NA in renal tubules and vasodilation.
Used for….
Type : BNP Type venodilator
Used for Acute severe HF
Digitalis / Digoxin
Action…
Describe in general…..
Reduces HF symptoms
Increaes exercise tolerance
Improve hemodynamics
Decrease progression of HF
Improves rate of survival….?
Improves force of heart contractions while decreasing HR
DOESN’T IMPROVE SURVIVAL RATE
SE of Digoxin OD >2ng /ml
Anorexia/ Nausea
Mental Status change
Halo around lights
Arrhythmia
IV inotropes
Exp.
Milrinone (Primacor)
Dobutamine (Dobutrex)
Dopamine
Used for…
Action…
Acute CHF
Increase contractility and dilation peripheral vessels
New order for IV furosemide & Digoxin Which lab result is most important to look at….
Why…
K
Hypokalemia increase risk of Digoxin toxicity
Intra-aortic balloon pump
Used….
Action….
Used acute MI/HF to decrease cardiac workload
Increases cardiac output and increases O2 delivery to myocardium
Impella is….
Describe…
LVAD
Pumps blood for LV to aorta 2.5 - 5 L/M
Short term upto 10 days but patients often need it longer
SE of BB
Hypotension
Bradycardia
Fluid Retention
Fatigue
Impotence
Mask hypoglycemia in Diabetics
PT goal for Congestive HF when ready…
200 - 400 ft walk
Evaluation of LVS function…
Echo or Cath
Prescribed at discharge fir LVSD left ventricle systolic dysfunction
ACE / ARB
BB
Smoking cessation
Most common cause of Mitral Stenosis
Rheumatic fever
Describe affects of Mitral Stenosis
Pulmonary congestion
Right sided HF
Preload decrease
CO Falls
Stenosis restricts blood flow through the valve due to narrowing, while regurgitation causes blood to flow backward due to improper valve closure.
Stenosis leads to increased pressure before the valve (in the chamber receiving blood), whereas regurgitation increases volume in the chamber behind the valve.
T or F
T
Chordae tendinae contract & shorten
Valve leaflets…
LA - LV Blood flow impaired
LA dilates, PAP increases, RV hypertrophic & CO DECREASES
This problem….
Fuse & become stiff
Mitral stenosis
Calcification/ muscle weakness prevent valve closure.
Blood flows back to LA during systole
Decreased CO
LA dilation
Pulmonary Congestion
RV failure
This problem…
Mitral regurgitation
Pulmonary congestion
AFIB
R HF
Anxiety
Atypical chest pain
Murmur
S3
S/S For..m
Mitral regurgitation
Valve leaflets enlarge and prolapse into LA during systole
This problem…
Mitral valve prolapse
Aortic stenosis
Starts when the aorta closes and blood backs up all the way to the Pulmonary Artery. Happens during Systole
Leads to this type of HF….
Left sided
Aortic stenosis
Backflow of blood from Aorta to ventricles during diastole
LV dilates then hypertrophies
This outcome…
LV failure
Diagnostic testing for valvular disease
…
X ray
Echocardiography
Exercise tolerance test
Cardiac Catheterization
ECG
Prosthetic valve
Mech: _____
Bio _____
IRN #
Mechanical 2.5 - 3.5
Bio 2 - 3
TAVR
Define…
TAVR is a minimally invasive surgical procedure used to treat severe aortic stenosis (narrowing of the aortic valve)
Especially in patients who are not candidates for traditional open-heart surgery.
New aortic valve is implanted through a catheter, typically inserted via the femoral artery (in the groin) or sometimes through other arteries or the chest.
The catheter delivers the new valve, which is expanded within the existing, narrowed valve to replace it.
Name of procedure…
Who its for…
TAVR
Transcatheter aortic valve replacement
Patients with severe aortic stenosis who are at high risk for complications from traditional valve surgery
Endocardial injury - vegative lesions - valve destruction
SS
Recurrent fever
Micro emboli
Petechiae
Splinter Hemorrhage
Organ Infarction
Diagnostic
Murmur
Echo
Blood culture
Name problem…
Endocarditis
Endocarditis
Endocardial injury - Vegative lesions - valve destruction
SS
Recurrent fever
Micro emboli
Petechiae
Splinter Hemorrhage
Organ Infarction
Diagnostic
Murmur
Echo
Blood culture
Treatment….
Antibiotics
Inflammation of the pericardial layers of heart.
SS
Pericardial Rub / pain
Fever
Cardiac Tamponade
Causes:
Infection
Cancer
Cardiac Surgery
Connective tissue disease
Name problem and treatment….
Pericarditis
Colchicine: Reduces symptoms and recurrence.
Steroids
Antibiotics
NSAIDS
Pt has Pericarditis
SS
Pericardial Rub / pain
Fever
Cardiac Tamponade
Pt was given
Colchiche
Steroid
Antibiotics
What is the treatment for Cardiac Tamponade….
Pericardiocentesis.
Needle drains fluid from around the heart
Rheumatic Carditis is Inflammation of all layers of the heart
SS
Heart murmurs (due to valve inflammation and damage).
Tachycardia
Signs of heart failure (dyspnea, fatigue, peripheral edema).
Systemic:
Fever
Joint pain and swelling (migratory polyarthritis)
Skin manifestations (erythema marginatum, subcutaneous nodules)
Chorea (involuntary, jerky movements)
Treatment….
Antibiotics min 10 days
Rheumatic Carditis is Inflammation of…
Give antibiotics min 10 days
Diagnostic…
All heart layers
Echocardiogram
Lab
Elevated CRP
Fluid accumulation in pericardium
Sudden decrease in cardiac output
Name problem…
Solution….
Cardiac Tamponade
Solution: Pericardiocentesis
Muscles fibers of heart are damaged causing them to be Hard, Thick, Rigid.
Causes: Etoh, infection, inflammation, poor nutrient, drugs, genetic, Unknown
Name problem…
Cardiomyopathy
Types of Cardiomyopathy
Dilated
____ wall thickness, _____ ventricle
Normal wall thickness, enlarged ventricle
Types of Cardiomyopathy
Hypertrophic
______, ________ muscle walls, _____ filling
Thick and stiff muscle walls, impaired filling
Types of Cardiomyopathy
Restrictive - rarest
_____ tissue replaces muscle tissue
Scar tissue replaces regular muscle tissue
Types of Cardiomyopathy
Arrhythmogenic Right Ventricular
______ & _______ tissue replaces muscle
Fatty & Fibrous tissue replaces muscle
Manifestions of Cardiomyopathy include (4)
Dyspnea
Fatigue
Palpation
Dysrhythmias
Hypertropic Cardiomyopathy can have chest pain at rest unrelieved by Nitroglycerin.
What can be the outcome…
Sudden Death
Cardiomyopathy
Dilated & Restrictive
Treatment…
Same as HF
Medications:
ACE inhibitors/ARBs: Reduce afterload and prevent heart remodeling.
Beta-blockers: Decrease heart rate and improve ventricular function.
Diuretics: Relieve fluid overload (edema, pulmonary congestion).
Aldosterone antagonists: (e.g., spironolactone) to manage fluid retention and reduce cardiac fibrosis.
Anticoagulants: Prevent
thromboembolism if atrial fibrillation or reduced ejection fraction is present
Digoxin: Improves contractility in select cases.
Devices/Interventions:
Implantable Cardioverter-Defibrillator (ICD): Prevent sudden cardiac death in those with a high risk of arrhythmias.
Cardiac Resynchronization Therapy (CRT): For patients with dyssynchronous ventricular contraction.
Heart transplantation: For refractory cases.
Cardiomyopathy
Obstructive
Treatment….
BB
CCB
Activity Restrictions
Cardiomyopathy
Arrhythmogenic
Treatment…
Unclear
BB
CCB
Ablation
ICD
Ivabradine is a heart rate-lowering medication used primarily to manage specific types of heart failure and angina.
Used for…
Used in patients..
Increasing EF
EF <35
Used in patients
Are in sinus rhythm.
Have a resting heart rate ≥70 beats per minute.
Are already on maximally tolerated beta-blockers or have a contraindication to beta-blockers.
Heart stretches & doesn’t come back describes in general this heart condition…
Cardiomyopathy
Prosthetic valve IRN values
Mech….
Biological….
Mechanical 2.5 - 3.5
Biological 2 - 3
