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Therapy year 3- sem 2 > HF - Part 1 > Flashcards

HF - Part 1 Flashcards

1
Q

what is heart failure? corroborated by what?

A

chronic progressive condition where the heart isn’t able to pump enough blood to meet to demand of the body

usualy at least one of the follwoing:
- elevated naturietics peptide levels
- evidence of cardiogenic pulomary systemic congestion

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2
Q

What is sytole

A

contraction and emptying

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3
Q

what is diastole

A

relaxation and filling

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4
Q

what kind of HF is linked to systole? Diastole

A

systole -HFrEF

diastole - HFpEF

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5
Q

Preload what is it? what happens when it increases?

A

preload what is it?
- amount of blood sitting in the ventricle at the end of diastole/filling

when we have increased preload usualying accoidng to Starling’s Law of hearts we can increase Co upto a certain point. However in HF we don’t increase Co we actually decrease it and there is more for the heart to pump

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6
Q

Afterload what is it? what happens when it increases?

A

the resistance of force against which the ventricle must work to eject blood

also called Total peripheral resistance

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7
Q

how is afterload estimated? how is it linked to BP?

A

Systemic vascular resistance (SVR)

BP = CO x SVR

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8
Q

starling’s law of the natural heart for after load

A

as afterload changes it doesn’y affect CO much

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9
Q

increased afterload?

A

the already weakened heart has to work harder and CO is decreased

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10
Q

Stroke volume depedns on what

A

preload, after load and myocardial contrcatiloty

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11
Q

cardiac output equation

A

CO = SV x HR

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12
Q

if dehydrated what happens?

A

decreased SV

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13
Q

what is ejection fraction

A

the amount of blood pumped out of left ventricle compared to amount there at the end of filling

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14
Q

what is normal EF

A

60-70%

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15
Q

what are the difererent ranges of HF

A

HFpEF - 50’s

HFmrEF - 40’ s

HFrEF - less then 40

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16
Q

what drugs can we use for HFpEf or HFmrEF

A

ARB, MRA - maybe

SGLT2i - yes

17
Q

what are the 5 cause of HF

A
  1. primary cardiac
  2. pressure overload - HTN emergency
  3. volume overload
    - bad compliance with diurtics
    - renal or haptic dysfunction
  4. high output
    - CO is normal but body need more could be due to anemaia, shunt, sepsis, thrytoxiicosis
  5. medications
    - bet blaocker, CCB and antiarrhytmics are negative inotropes (reduce cardiac contratility)
    - NSADIS - fluid retemtion
    - thalizolindines ( fluid retention)
    - doxorubicin (carditoxic)
18
Q

SX of HF

when can you expect atypical presenttaions?

A

FED (fatigue, edema, dyspepsia)

  • paroxymal nocturnal dyspepsia, orthopnea, cough, abdominal distentio, weight gain

atypical presntations in elderly, womeh and obese

19
Q

left-sided symptoms

A

cough, dyspnea, PND, orthopnea, rales

20
Q

right-sided Symtoms

A

weight gain, peripheral edema, nausea, abdominal pain, elevated jugular vein pressure (JVP), hepatomegaly

21
Q

other symptoms

A

S3 and sometimes S4 heart sounds

lab
- BNPmore then 400
- NT-pro-BNP more then 300
- Scr may be reduced due to due to hypoperusion (diverted to essential organs)
- sodium level may be low less then 130

22
Q

Classifiaction of HF

A
  1. sx only when higher then ordianry activity
  2. sx when doing some oridinary activity like longer wlaks
  3. sx when doing ordinary actity from room to room walk - short walks
    a) dyspepsi at rest
    b) no dyspepsia at rest
  4. sx at rest
23
Q

Distinguish between physiological features of preserved and reduced

A

reducesd
- large left ventrivle
- thin left ventricle wall

preserved
- small left ventricle
- thick left ventivle wall

24
Q

common risk factors and co-morbidties for preserved and reduced HF

A

reduced
- male
- obese
- HTN
- DM
- kidney disease
- volume overload
- myocardiatis and myocardial infection

presevered
- female
- older age
Lots of co-morbidties

25
Q

tretament for HFpEF?

A

SGLT2i - reducese hospitalizations and cardiovascualr death, NOT all cause death

26
Q

tretament for HFmrEF?

A

SGLT2i (defienitly), MRA (likley), ARB (inconsistently)

27
Q

trteamnet guid for preserved?

A

diuretics - SGLT2i - maybe: ARNi, ARB, MRA

28
Q

what agents are used for fluid retention in women

A

ARNI or MRA

29
Q

if a patient had reduced but imporves and is now mildrly redued what regimen should they follow?

A

reduced

30
Q

when should we consider MRA in mildrly reduced?

A

when K is below 5

31
Q

when using the clinical assessment tool for patients to diagnosis preserved what are the criteria

A
  1. BMi greter then 30 (2)
  2. HTN with 2 or more meds for it (1)
  3. paroxysmal or A fib (3)
  4. age great then 65 (1)
  5. pulmoary artery rpessure greter (1)then 35mmHg (1)
32
Q

using the tool what scores mean what

A

0 - unlikey preserved HF
1-5 CKD? BNP over 450? Nt- non-BNP over 150? if so liliely otehrwise refer to carddologisr

if 6-9 : likely

Therapy year 3- sem 2 (9 decks)

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