HF Flashcards
Hear Failure definition?
any structural or fxnl disorder that impairs heart’s ability to pump needed blood
HF underlying causes?
ºCAD
Ischemic cardiomyopathy
HTN
HF precipitating causes?
Infection Anemia Arrhyth Fluid overload HTN MI PE endo/myocarditis
HF: Left-Sided
Systolic Dysfxn definition?
inability to contract and expel blood
HF: Left-Sided
Systolic Dysfxn etiology?
CAD impaired contractility (cardiomyopathy) high afterload (high pressure)
HF: Left-Sided
Diastolic Dysfxn definition?
inability to relax/fill
HF: Left-Sided
Diastolic Dysfxn etiology?
Ischemia
Fibrosis
Sarcoids
Left HF Hemodynamic changes due to?
Pulmonary Edema caused by ↑ pressure in:
LA
pulmonary veins
pulmonary capillaries
↑ in Pulmonary arterial P causes what?
↑ after load on RV
(P) Right HF
Right side of heart is what type of system?
low P
high compliance
Increase in what leads to Right-Sided issues?
afterload
e.g. (P) caused by pulmonary embolism, chronic pulmonary disease
Right HF Hemodynamic changes due to?
↑ RA pressure ↑ venous P ↑ capillary P ↑ tissue fluid ↑ PERIPHERAL EDEMA
HF effect on:
EF? Vent dilation? Resting SV? Cardiac Index? Rest HR? Exercise Intolerance?
EF 5.6cm @ ED
Rest SV <2.5L/min/m2
Rest HR 75-105/min
EI: CO ↓ 40%, SV ↓ 50%
NYHA HF classification system:
Class 1
No limit on physical activity
NYHA HF classification system:
Class 2
Sxs cause slightly ↓ physical activity
NYHA HF classification system:
Class 3
DOE (sxs w/ ADL)
Marked ↓ physical activity
Asympt at rest
NYHA HF classification system:
Class 4
Severe ↓ phy activity
Sxs at rest
ACC/AHA HF classification system:
Stage A
No structural abnorm but high risk for developing HF
ACC/AHA HF classification system:
Stage B
Structural disorder but no HF sxs
ACC/AHA HF classification system:
Stage C
Past or current sxs and structural dx
ACC/AHA HF classification system:
Stage D
end-stage HF
HF signs? (4)
Edema (2º to vol overload)
Rales @ bases
JVD
S3/4 (early)
HF sxs? (5)
Dyspnea Fatigue (2º to low perfusion) Cough (nocturnal, non-productive) Early satiety (2º to hepatic congestion) Nocturia (2º to ↑ renal perfusion when supine)
Left HF presentation?
Dyspnea (fluid in lungs) Diaphoresis (sweat) Tachypnea (fluid in lungs) Tachycardia Rales S3/4
Right HF presentation?
Peripheral edema
RUQ pain
JVD
Ascites (serous fluid in peritoneum)
Systolic dysfxn presentation?
Hx valve dx, DM, CAD S3/4 Mitral regurge Rales Cardiomegaly JVD
Diastolic dysfxn presentation?
Hx HTN, DM
S4
Rales
LVH
HF ddx
PUD Asthma COPD PNA PE ARDS
HF tests: ECG?
= Ischemia, arrhythmia
HF tests: Echo?
Syst dysfxn = EF < 40%, dilated LV
Diast dysfxn = EF >45% (normal), LVH
HF tests: CXR?
= cardiomegaly, r/o pulmonary etiology
Transudative vs exudative?
Trans = fluid move in to tissue/capillary (HF) Exud = fluid moved out of tissue/capillary
HF tests: CBC?
look for anemia (can exacerbate HF)
HF tests: CMP?
(Ca2+, Mg, PO4)
liver fxn
r/o DM
HF tests: Thyroid panel?
hypothyroidism can exacerbate HF or present as HF
HF tests: BNP
(brain-type natriuretic peptide)
= ↑ levels
use to differentiate pulmonary dz from HF
Brain-type Natriuretic Peptide released in response to?
vent wall stretching
HF management?
cause
risk factors
sxs
review meds for for adverse rxn
HF goals of tx?
↓ preload -> ↓ congestive sxs
↓ afterload -> ↑ cardiac fxn
HF tx:
Stage A/Class 1-3
ACE inhibitor
HF tx:
Stage B-C/Class 1-3
ACE inhib
β block
diuretics
HF tx:
Initial therapy for ALL pts
ACE inhibitor
Digoxin
diuretics
Systolic/Diastolic dysfxn tx?
Treat systolic
Diastolic dysfxn U found in who?
old F w/ HTN, DM
ACE inhibitor benefits?
↓ morbidity and mortality
in sympt and asympt pts
Angiotensin-receptor blockers (ARBs) benefits?
Use when?
Monitor what?
↓ morbidity and mortality
↓ sxs
use if can’t use ACE inhib
BP, renal fxn, electrolytes
β blockers benefits?
↓ mortality
not for unstable pts
Diuretics benefits?
Loop-type prefered
manage fluid overload
unproven
Spironolactone is?
Aldosterone antagonist (K+ sparing diuretic)
Spironolactone indicated for?
dyspnea at rest
post-MI w/ syst dys
Spironolactone benefits?
↓ mortality
Spironolactone side-effect?
(P) hyperkalemia
Digoxin is?
Inotropic (contractility) agent
Digitoxin benefits?
↓ sxs
↑ exercise tolerance
Drugs that worsen HF? (6)
NSAIDS Glucophage (DM) boner meds TCAs (tricyclic) Sporanox (antifung) Tegretol (seizures, nerve pain)
Pulmonary edema results from?
↑ venous P
a/w HF, MI, ischemia, mitral stenosis
Pulmonary edema (from HF) presentation?
dyspnea
PRODUCTIVE cough
diaphoresis (sweat)
Pulmonary edema exam findings?
rales
wheeze
rhonchi
Pulmonary edema CXR findings?
Kerley B lines
edema
cardiomegaly
Pulmonary edema Pulmonary Capillary Wedge test findings?
pressure elevated >25mmHg
Pulmonary edema management?
“MOND”
Morphine (↓ anxiety, ↓ work of breathing)
O2 (goal >90%)
Nitrates (↓ preload, cap wedge pressure)
Diuretics (↓ fluid, congestion)
Decompensation is?
worsening of HF sxs due to progression beyond tx
Most common cause of Decompensation?
inadequate reduction of therapy
Decompensation evaluation?
Eval for Δ in personal life
Focused cardiac exam
If no finding, labs (look for K+ Δs)
Decompensation management?
“MOND tro”
Same as pulmonary except nitro instead of nitrate
Nitroglycerin (reduce preload and capillary wedge pressure)
Most common causes of death w/ HF?
Decompensation (pump failure)
Malignant arrythemias
Statins use in HF?
(lowers cholesterol)
2º prevention of CVD
Most common cause of HF?
LV systolic dysfxn
