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Cardiology Secrets > HEART FAILURE WITH PRESERVED EJECTION FRACTION > Flashcards

HEART FAILURE WITH PRESERVED EJECTION FRACTION Flashcards

1
Q

What is diastolic dysfunction (DD)?

A

Defined as increased viscoelastic chamber stiffness, impaired ventricular relaxation, or a combination of both.

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2
Q

What conditions may accelerate the decline in left ventricular compliance associated with DD?

A

Hypertension, diabetes, and obesity.

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3
Q

Can diastolic dysfunction occur in the absence of systolic dysfunction?

A

Yes, DD can occur with or without systolic dysfunction.

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4
Q

What symptoms can diastolic dysfunction lead to?

A

Dyspnea, orthopnea, and bilateral lower extremity swelling.

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5
Q

What is heart failure with preserved ejection fraction (HFpEF)?

A

A condition where impaired relaxation leads to increased left ventricular filling pressures, promoting HF symptoms.

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6
Q

What is the prevalence of HFpEF in individuals with heart failure?

A

Approximately 50% of individuals with heart failure have HFpEF.

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7
Q

What is the projected cost of HFpEF to the U.S. healthcare system by 2030?

A

~$70 billion.

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8
Q

Who are the individuals at highest risk of HFpEF?

A

Older women.

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9
Q

What are some risk factors for HFpEF?

A

Hypertension, obesity, physical inactivity, coronary artery disease, and atrial fibrillation.

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10
Q

What is the in-hospital mortality rate for HFpEF?

A

Ranges from 2.4% to 4.9%.

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11
Q

What is the 5-year mortality rate after hospitalization for HFpEF?

A

Roughly 40%.

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12
Q

What are some pathophysiological mechanisms contributing to HFpEF?

A

Chronotropic incompetence, autonomic dysfunction, systemic and pulmonary vascular dysfunction, reduced nitric oxide availability, and RV dysfunction.

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13
Q

What can precipitate decompensated HFpEF?

A

Uncontrolled blood pressure, atrial fibrillation, nonadherence to diuretic therapy, high sodium intake, myocardial ischemia, sepsis, and acute renal dysfunction.

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14
Q

How is HFpEF diagnosed?

A

Based primarily on signs and symptoms, with criteria including LVEF ≥50% and elevated LV filling pressures.

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15
Q

What are first-line diagnostic tools for suspected HFpEF?

A

Echocardiography, natriuretic peptide levels, and objective assessment of functional capacity.

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16
Q

Which echocardiographic parameters are used to assess diastolic dysfunction?

A

Biplane LA maximum volume index, E/e9 ratio, early diastolic velocity at septal and lateral sides, and peak TR velocity.

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17
Q

What classification is used for diastolic dysfunction based on mitral velocities?

A

Grade I, Grade II, Grade III DD, and indeterminate diastolic function.

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18
Q

What is the annual death rate for HFpEF in the United States?

A

8% to 12%.

19
Q

What are some characteristics of patients with HFpEF compared to healthy individuals?

A

Lower lean total body and leg mass, higher intramuscular fat content, lower type 1 muscle fibers, and lower capillary density.

20
Q

What is the lifetime risk of developing HFpEF for non-Black individuals compared to Black individuals?

A

11.2% for non-Black vs. 7.7% for Black individuals.

21
Q

True or False: Diastolic dysfunction is necessary for the diagnosis of HFpEF.

A

False.

22
Q

What are some advanced testing methods for diagnosing HFpEF?

A

Cardiac MRI, technetium pyrophosphate scintigraphy scan, and endomyocardial biopsy.

23
Q

What is the role of cardiac MRI in assessing diastolic function?

A

To derive parameters such as LV mass, LA size and function, and myocardial deformation.

24
Q

What specific cardiac diseases require a different approach in management?

A

Atrial fibrillation, hypertrophic cardiomyopathy, group I, III, or IV pulmonary hypertension, moderate or severe mitral annular calcification, significant mitral valve disease

25
Q

What parameters can be derived from cardiac MRI to assess diastolic function?

A
  • LV mass
  • LA size and function
  • Mitral inflow and pulmonary venous velocity profiles
  • Myocardial deformation
26
Q

What is the purpose of diastolic stress testing?

A

To assess diastolic dysfunction in select clinical situations.

27
Q

What measurements are captured during right heart catheterization?

A
  • LV systolic pressure
  • Minimal LV pressure
  • LV end-diastolic pressure
  • Mean LV diastolic pressures
28
Q

What is the gold standard for assessing diastolic function?

A

Invasive assessment

29
Q

How can LV filling pressures be estimated noninvasively?

A
  • Mitral inflow (E) velocities
  • Mitral annulus (e9) velocities assessed with Doppler and tissue Doppler echocardiography
30
Q

True or False: E/e9 increases in patients with normal myocardium during exercise.

A

False

31
Q

What are the average E/e’ values and e’ velocities indicating normal diastolic function?

A
  • Average E/e’ >14
  • Septal e’ velocity <7 cm/s
  • Lateral e’ velocity <10 cm/s
  • TR velocity >2.8 m/s
  • LA volume index >34 mL/m2
32
Q

What is the primary focus of the acute management of decompensated HFpEF?

A
  • Volume management
  • Blood pressure control
  • Reversal of precipitating factors
33
Q

What is the goal of diuresis in the treatment of decompensated HFpEF?

A

To achieve euvolemic status

34
Q

What should be monitored during diuretic therapy?

A
  • Renal function (creatinine, blood urea nitrogen)
  • Electrolytes (sodium, potassium, magnesium)
  • Clinical parameters (symptoms, jugular venous pressure, daily weights)
35
Q

What is a recommended blood pressure target for patients with decompensated HFpEF?

A

Less than 130/80 mm Hg

36
Q

What are some precipitating factors that need identification in decompensated HFpEF?

A
  • Ischemia
  • Atrial fibrillation
  • Anemia
  • Infection
  • Infiltrative cardiomyopathy
37
Q

What nonpharmacological therapies are recommended for patients with chronic HFpEF?

A
  • Dietary sodium restriction (2–3 g daily)
  • Daily home weight monitoring
  • Medication compliance
  • Regular follow-up
38
Q

What risk factors are associated with greater morbidity and mortality in HFpEF?

A
  • Obesity
  • Diabetes
  • Hypertension
39
Q

What pharmacological therapies are recommended for patients with chronic HFpEF?

A
  • Beta-blockers
  • ACE inhibitors/ARBs
  • Mineralocorticoid antagonists
  • Angiotensin-neprilysin inhibitors
40
Q

What are the Class I recommendations for the treatment of HFpEF?

A
  • Systolic and diastolic blood pressure should be controlled
  • Diuretics should be used for relief of symptoms due to volume overload
41
Q

What is a potential benefit of treatment with sacubitril-valsartan in HFpEF patients?

A

Potential benefit in female participants or participants with an LVEF below 57%

42
Q

What is a common treatment for rate control in patients with atrial fibrillation and HFpEF?

A
  • Beta-blockers
  • Nondihydropyridine calcium channel blockers
  • Digoxin
43
Q

What is the recommended approach if adequate diuresis cannot be achieved?

A

Ultrafiltration

Cardiology Secrets (26 decks)

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