HF pt 1 Flashcards
sowinski 1-37
what are the common pathways that could lead to HF?
CAD
HTN
valvular Dz
cardiomyopathies
what is the pathogenesis of HF?
Left ventricular dysfunction –> remodeling –> reduced EF which can lead to death or also –> non-cardiac factors –> symptoms –> chronic HF –> pump failure/death
what is the definition of HF?
failure of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissues
what is impaired in HFrEF?
systolic dysfunction due to decreased contractility
what is impaired in HFpEF?
diastolic dysfunction due to impairment in ventricular relaxation/filing
what classifies as HFrEF?
HF symptoms with EF under 40%
what classifies as HFpEF?
HF symptoms with EF over 50%
what classifies as HFmrEF?
HF symptoms with EF between 41-49%
what classifies as HFimpEF?
HF symptoms with EF over 40% but previously had HFrEF
what are the causes of HFrEF?
ischemic dilated CM (around 70% of cases)
non-ischemic dilated CM
(HTN, Thyroid disease, obesity, stress, cardiotoxins, myocardities, idiopathic, tachycardiac, peripartum)
what are the causes of HFpEF?
recognized as the primary disturbances in many pts with HF
many pts have a combination of systolic and diastolic dysfunction
HTN most common cause
how does preload affect left ventricular performance?
venous return
LV end-diastolic volume
how does myocardial affect left ventricular performance?
force generated at any given LVEDV
how does afterload affect left ventricular performance?
aortic impedance
wall stress
how is preload different in HF
more fluid usually means more pumpout, but in HF the fluid stays in the heart
a diuretic is needed to reduce pulmonary congestion
what is the pressure-volume relationship in severe dysfunction HF?
stroke volume/CO starts out high but as afterload/SVR increases, CO decreases
how does treating HF with a positive inotrope show on the graph?
it increases the CO to relieve some of the symptoms associated with low CO
move only up on the line
how does treating HF with an ACE inhibitor show on the graph?
reduction in afterload leads to a decrease in symptoms of low CO and decrease in symptoms of high end-diastolic pressure
move up and back on line
what are the types of drugs that induce HF?
drugs that reduce contractility
direct cardiac toxins
drugs that contain sodium or lead to retention of sodium
what are examples of drugs that reduce contactility?
antiarrhythmics (disopyramide, flecainide)
B-blockers
CCBs
itraconazole
what drugs are direct cardiac toxins?
doxorubicin, epirubicin, daunomycin, CYP
trastuzumab, bevacizumab, 5-FU, blue cohosh
imatinib, lapatinib, sunitinib
ethanol, cocaine, amphetamines
what are drugs that contain Na/retention of Na?
glucocorticoids, androgens, estrogens
NSAIDs and COX-2i
rosiglitazone and pioglitazones (TZDs)
carbenicillin DiNa+, ticarcillin DiNa+
what are the symptoms of right ventricular failure?
abdominal pain
anorexia
nausea
bloating
constipation
what are the signs of right ventricular failure?
peripheral edema
JVD
HJR
hepatomegaly
ascites
how does right ventricular failure mainfest?
primarily systemic venous congestion
how does left ventricular failure mainfest?
primarily pulmonary congestion
what are the symptoms of left ventricular failure?
DOE
orthopnea
PND
tachypnea
bendopnea
cough
hemoptysis
what are the signs of left ventricular failure?
rales
S3 gallop
pulmonary edema
pleural effusion
cheyne-stokes respiration
what are non-specific symptom findings?
exercise intolerance
fatigue
weakness
nocturia
CNS symptoms
what are non-specific sign findings?
tachycardia
pallor cyanosis
cardiomegaly
what is DOE
exertional dyspnea (so SOB on exertion)
major symptom of pulmonary congestion (LV failure)
what is orthopnea?
quantified sign of pulmonary congestion
pt needs x amount of pillows to breath at night
what is PND?
paroxysmal nocturnal dyspnea
sudden night SOB/ pt feels like drowning
what is JVD?
major sign of systemic venous congestion (right ventricular failure)
jugular venous distension where the jugular vein is full of fluid from the right side of the heart and you can visibly see it and measure in cm for congestion
what is HJR?
hepatojugular reflux
major sign of right ventricular failure
if pressure on liver, fluid can be seen going up the jugular
what is measured in a clinical assessment of HF?
HPI
medication history
signs and symptoms
cardiac risk factors
what is measured in an initial laboratory assessment?
CBC, serum electrolytes (Na/K/Mg), BUN, Cr, TFTs
electrocardiogram
chest x-ray
why is a TFT taken for HF?
thyroid function test to see if an increased thyroid is causing an increase sympathetic nervous system response and causing high output HF
what natriuretic peptides are measured?
BNP (over 35 pg/mL)
NT-proBNP (over 125 pg/mL)
what evaluates LV function and measures the EF?
electrocardiogram
nuclear testing (single-photon emission computed tomograph, MUGA)
cardiac catheterizations (invasive)
mRI and CT
what is the primary equation to measure EF?
EDV (end diastole volume) - ESV (end systolic volume)
divided by
EDV
multiply by 100%
what is another equation to measure EF?
SV /EDV x 100%
how are the NYHA classes sorted?
I - no symptoms
II - mild symptoms
III - moderate symptoms
IV - severe symptoms/can’t get out of bed
how is stage A classified?
pt at risk
no symptoms or biomarkers of HD
how is stage B classified?
pt has no symptoms but evidence of structural HD, abnormal cardiac function, or elevated natriuretic peptide/cardiac troponin levels
how is stage C classified?
pt with symptoms
how is stage D classified?
refractory end-stage HF
marked symptoms at rest despite maximal medial therapy
requires specialized interventions
what puts a pt at risk for HF?
HTN, CAD, DM, family history of cardiomyopathy
