HF Flashcards
HF is defined as a
complex syndrome that results from any structural or functional impairment of ventricular filling or blood ejection
HF leads to
to tissue hypoperfusion, fatigue, dyspnea, weakness, edema, and weight gain
HF may be caused by
structural abnormalities of the pericardium, myocardium, endocardium, heart valves, or great vessels
ejection fraction is the main marker for determining
HF risk factors, treatment, outcomes
the LV’s ability ot fill is determined by (5)
Pulmonary venous blood flow
LA function
mitral valve dynamics
pericardial restraint
active and passive elastic properties of the LV
LV diastolic function is normal when
factors combine to provide an LVEDV (preload) sufficient cardiac output for cellular metabolism without elevating pulmonary venous and LA pressures
in HFpEF, higher LV filling pressures are required to
to achieve normal end-diastole volume
A steeper rise of the end-diastolic pressure-volume curve indicates
delayed LV relaxation and increased myocardial stiffness
Reduced LV compliance and precipitates (5)
LA hypertension
LA systolic and diastolic dysfunction
pulmonary venous congestion
and exercise intolerance
Delays in relaxation are a form of “active stiffening” caused by
failure of the actin-myosin dissociation due to inadequate perfusion or dysfunctional intracellular Ca++ homeostasis.
LV relaxation depends on ________ , which is typically elevated in ______ patients.
afterload; HTN
t/f bradycardia exacerbates the failure of LV relaxation
false, tachycardia exacerbates the failure of LV relaxation
HFpEF or HFrEF
Profound exercise intolerance is seen with _______ despite only having a modest depression in LV systolic function
HFpEF
Prolonged compression of the coronary arteries restricts diastolic coronary blood flow, which contributes to
subendocardial ischemia and a further reduction in exercise tolerance
The most common signs of HF are
fatigue
tachypnea
dyspnea
paroxysmal nocturnal dyspnea
orthopnea
S3 gallop
JVD
peripheral edema
exercise intolerance
and reduced tissue perfusion.
where on CXR is an early indicator of LV failure and pulmonary venous HTN
distention of pulmonary veins in the upper lobes of the lung
kerley lines produce what pattern and reflect what?
honeycomb pattern and reflect interlobar edema
alveolar edema produces what in what kind of pattern
homogenous densities in the lung fields, typically butterfly pattern
T/f pulm edema in radiography may lag behind clincal evidence by up to 12 hours
true
what is the ACC/AHA diagnosis criteria for LVDD
HF symptoms, EF > 50% and evidence of LVDD
HFrEF or HFpEF
BNP elevation
HFrEF! due to LV dilation and eccentric remodeling
HFrEF or HFpEF
BNP lower
HFpEF! associated with concentric hypertrophic, relatively normal LV chamber size and lower end-diastolic wall stress allowing for lower BNP
what protein represents the inflammatory component of HF
C-reactive protein (CRP) and growth differentiation factor- 15 (GDF-15)
why check trops in HF patients
systemically released due to myocardial damage and serve as a measure of risk prediction
NYHA Class I
no limitations and no symptoms with ordinary activity
NYHA Class II vs Class III
Class II - limitations with minimal activity
Class III - limitations with any activity
both comfortable/asymptomatic at rest
NYHA Class IV
symptomatic at rest
also a INTERMAC 4
ACC/AHA Class A
high risk no funcitonal or structural deficitis
ACC/AHA Class B
structural deficit but asymptomatic
ACC/AHA Class C
heart failure symptoms due to underlying structure heart deficit with medical management
ACC/AHA Class D
advanced disease requiring hospitalization, transplant, or palliative care
lifestyle treatment for CHF
aerobic fitness, weight loss, salt-restricted diet (DASH), HTN and blood glucose manage, smoking cessation
kahoot Q
HFrEF
HF with EF < 40%
systolic HF
HFpEF
HF with EF > 50%
diastolic HF
borderline HFpEF
HF symptoms with an EF 40-49%
T/F diastolic dysfunction is only present in HFrEF
false, diastolic dysfunction is present in both HFpEF and HFrEF
LV hypertrophy pattern of HFpEF
concentric hypertrophy
LV dilation pattern of HFrEF
eccentric hypertrophy
which HF is related to conditions such as HTN, DM, Afib, obestiy, metabolic syndrome, COPD, and CKD/anemia
HFpEF
which HF is associated with modifiable risk factors such as smoking and HLD
HFrEF
which HF has a higher incidence of myocardial ischemia and infarction, previous PCI, CABG, PVD
HFrEF
women are more affected by _______
men are more effected by _______
women - HFpEF
men - HFrEF
prevalence of HFrEF, HFpEF, borderline in %
HFpEF - 52%
HFrEF - 33 %
boderline - 16%
what dysfunction is the primary determinant of HFpEF
LV diastolic dysfunction
what dysfunction is the primary determinant of HFrEF
contractile dysfunction
common causes of LV diastolic dysfunction
- age > 60
- acute myocardial ischemia
- myocardial stunnning/infarction
- ventricular remodeling after infarction
- pressure-volume overload hypertrophy (aortic valve stenosis/essential HTN)
- volume overload hypertrophy (aortic/mitral valve regurg)
- hypertrophic obstructive, dilated, restrictive cardiomyopathy
- pericardial disease
symptoms most common with HFpEF
paroxysmal nocturnal dyspnea, pulmonary edema, and dependent edema
symptoms most common with HFrEF
s3 gallop
mean pulmonary capillary wedge pressure > 15 mmHg at rest or >25 mmHg with exercise provides evidence of
HFpEF and is a predictor of mortality
EKG abnormalities in HF patients
LVH, previous MI, arrhythmias, and conduction abnormalities
chronic HF treatment consisting of treat associated conditions, exercise and weight loss is assoicated with which HF
HFpEF
chronic HF treatment with beta blocker and ACE-Inhibitor therapy is assoicated with which HF
HFrEF
according to ACC/ESC what medication can reduce LV filling pressures, decrease pulmonary venous congestion, and improve HF symptoms
loop diuretics
kahoot Q
when might thiazide diuretics be useful
poorly controlled HTN to prevent onset of HFpEF
beta blocker therapy is strongly recommended for
HFrEF!
in HFpEF BB are preseribed for other indications (HTN, Afib, MI)
kahoot Q
which HF uses ACE-Inhibitors as mainstay treatment
HFrEF
ACE-I show no benefit in HFpEF unless used for HTN
what can reverse LV dysfunction following an MI
coronary revascularization via CABG or PCI
early revascularization may prevent permenant EF reductions
cardiac resynchronized therapy is used for
biventricular pacing
HF with a ventricular conduction delay (prolonged QRS)
benefits of cardiac resynchonization therapy
more synchoronous heart contractions and improves Cardiac Output
when is CRT recommended
NYHA Class III or IV with EF < 5% and QRS duration 120-150 ms
risk of CRT
infection, misplacement, device failure
implantable hemodynamic monitoring allows remote observation of intracardiac pressures to
guide treatment and prevent decompensation
cardioMEMS - noninvasive PAP monitoring
implantable cardioverting-defibrillators used to prevent
sudden death in patients with advanced HF
50% HF deaths are due to sudden cardiac dysrhymias
kahoot Q
LVAD is used for
- temporary ventricular assistance while heart is recovering
- patients awaiting heart transplant
- patients on inotropes or IABP with potentially reversible medical conditions
- advanced HF not candidates for transplant
T/F LVAD mechanical pumps can take over total or partial function of the damaged ventricle and facilitate restoration of normal hemodynamcics and perfusion
true
