HYHO HPS #2 Flashcards
HF is described as a complex clinical syndrome that results from what 2 things?
- Structural or functional impairment of ventricular filling
or
- Ejection of blood
HF leads to the cardinal clinical symptoms of _________ and ________ and signs of heart : ______ and _____.
- dyspnea and fatigue
- edema and rales
What term is preferred and why: CHF or HF?
HF, because many patients present without symptoms of volume overload.
How can HF be categorized?
What is considered borderline reduced EF?
- HF with reduced ejection fraction (LV EF is 40% or less).
- HF with preserved EF (LV EF is 50% or more)
- Borderline reduced EF is considered: 41-49%,
_______ is the main cause of HF w/ reduced EF, which most commonly results in left ventricular _______.
- Coronary artery disease (CAD)
- Dilation
_______ is the main cause of HF w/ preserved EF, which most commonly results in left ventricular _______.
- HTN
- hypertrophy
What is a NL EF?
55-60%
Stage A in the development of HF is…
at high risk, but w/o structural damage or symptoms of HF
Stage B in the development of HF?
Structural defects but without signs or symptoms of HF.
Stage C in the development of HF?
Structural damage WITH prior/current symptoms
Stage D in the development of HF is
refractory HF that requires specialized interventions
Describe a patient in Stage A and stage B HF.
Stage A: high-risk (HTN, CAD, DB, obese, metabolic syndrome)
Stage B:
- previous MI,
- remodling of LV that includes LVH and low EF,
- asymptomatic valvular disease
Describe a patient with Stage C and stage D HF.
Stage C: [known structural damage + SOB, fatigue, decrease excercise tolerance]
Stage D: [Marked symptoms when resting, despite maximum medical therapy]
Class ___ of heart failure has no limitation of physical activity; does not cause breathlessness, fatigue or palpitations
1
Class ____ of heart failure is unable to carry on any physical activity without discomfort. Symptoms are present at rest and increase during activity
4
Class ___: marked limitation of physical activity. At rest, patient is comfortable, but less than ordinary physical activity causes sx.
3
Class ____: slight limitation of phycal activity, comofrtable at rest but ordinary physical activity causes sx.
2
________ jugular vein is used to measure jugular venous pressure
Right internal
Jugular venous pressure is measured at the ______ point of pulsation of the right jugular vein on the neck
highest
- What are the steps to measure JVP?
- Have the patient lay down; rest head on on pillow to realx SCM muscles
- Raise the exam table to 30 degrees and turn the patients head slightly away from the side you are inspecting.
- Use tangential lightening and ID external jugular vein – then find internal pulsations.
- Raise or lower the bed until you can see pulses of the IJV in the lower 1/2 of the neck.
- focus on the RIVJ, look for pulsations in the suprasternal notch, between attachments of the SCM or posterior to SCM.
- ID the highest point of pulsation of R JV, make a right angle from the point and the sternal angle. Measure vertical distance + 5cm = sum is the JVP.
why do we add 5 cm when measuring the JVP?
it is the distance from the sternal angle to the center of the right atrium
What labs do we take to exam HF?
1. CBC
2. CMP
3. Cardiac enzymes
4. UA
5. BNP
What supports the diagnosis of HF?
1. BNP.
2. 2-D echo + doppler
3. CXR
What is the ABCDE-F of CXR?
- A (airway): check to see if trachea is midline
- B (bone): look for fractures or metasis
- C (cardiac): look to see if heart is enlarged
- D (diaphragm): look for free air under diaphragm and pleural effusions
- E (extra): tubes and lines
- F (fields of lungs): look at parenchyma of lungsfor atelctasis or consolidation
What 5 findings may we see on CXR in a patient with HF?
- 1. Alveolar edema (bat wings)
- 2. Kerley B lines (interstitial edema)
- 3. Pleural effusion
- 4. Prominent vessels of upper lobe
- 5. Enlarged <3
What conditions of Framinghan criteria must be met for HF?
2 major criteria or 1 major + 2 minor
Normal BNP rules out ______ heart failure, but an echo could still show _______ heart failure
NL BNP: not systolic HF, the patient could still have diastolic HF on echo
Systolic HF will have a ejection fraction at _____.
less than 50%
Diastolic HF will have a ejection fraction at _____ and what else?
- More than 50%,
- Left atria: high pressure
- Left ventricle: Decreased compliance and impaired relaxation
what are the major criteria of framingham critera? (7)
- Parxyosmal nocturnal dyspnea
- Orthopnea
- High JVP
- Crepitations
- 3rd heart sound
- Cardiomegaly on CXR
- Pulmonary edema on CXR
what are the minor criteria of framingham critera? (7)
- Edema in extremeties
- Cough at night
- Exertional dyspnea
- Hepatomegaly
- Pleural effision
- HR >120
- Loss of 4.5kg in 5 days after diuretic treatment
What are our DDx if onset of dyspnea is acute and progressed rapidly over a few minutes?
- 1. Pulmonary thromboembolism
- 2. Pneumothorax
- 3. LV failure
- 4. Asthma
- 5. Inhaled foreing body
What are our DDx if onset of dyspnea is gradual and progressed rapidly over a hours-days?
- Pneumonia
- Asthma
- Exacerbation of COPD
What are our DDx if onset of dyspnea is gradual and progressed relentlassly over a weeks-months?
- Anemia
- Pleural effusion
- Respiratory Neuromuscular Disorder
What are our DDx if onset of dyspnea is gradual and progressed relentlassly over a months-years?
- COPD
- Pulmonary fibrosis
- TB
If a patient has HF, what should be given to relieve congestion and fluid retention?
Diuretics
First line treatment for heart failure with reduced EF is ________ and _________. What about if symptoms continue?
- ACE inhibitors
- B-Blockers
If symptoms continue, give MRA.
If intolerant to ACE-I => ARBS
If intolerance to ACE and ARBS => hydralazine and nitrate.
If a patient has HF with reduced rejection fraction is intolerant to ACE inhibitors, what can you give them?
ARBS
If a patient has HF with reduced rejection fraction is intolerant to ACE inhibitors AND ARBS, what can you give them?
Hydralazine and nitrate
What is the first line of treatment of HF with preserved ejection fraction?
-
Manage comorbid conditions, like
- HTN
- A-fib
- Ischemic heart disease
- DM
What 4 things can we do if symptoms persist despite first line
- If sinus rhythm with HR >75 and LVEF is <35%
- Esp if African/Caribbeal
- if worsening HF
- if LVEF is < 35%
- Add Ivabradine
- Add hydralazine and nitrate
- Digoxin
- Replace ACEI/ARB with sacubritil valsartin
What should all heart failure patients be offered?
Personalized, exercised-based cardiac rehabilitation programs, unless they are unstable.
Sympathetic region for the heart is _____
T1-T5
what 2 minute OMM treatment can be done for a patient with HF?
- Pedal pump
what 5 minute OMM treatment can be done for a patient with HF?
Rib raising
Increased parasympathetic tone causes ________ via the ____ nerve, with effects seen at ___, ___, ___.
bradycardia
vagus
OA, AA, C2
Motor control is controlled by the _____ nerve at ____.
phrenic
C3-5
What differentials do we have for acute decompensated HF?
- PE
- Acute asthma
- Pneumonia
- Noncardiogenic pulmonary edema
- Pericardial tamponade
what interventional considerations should you consider for HF?
- pharmacology
- procedures
- OMM/OMT
What tenderpoints are used in HF to examine parasympathetics?
- tissue texture changes over cerivcal pillars
- rotated vertebra of OA, AA and C2
- compression of occipitomastoid sutures as well as OA-joint
what the the sympathetic tenderpoints for the Heart?
1. tissue texture changes over TP
2. Rotated vertebra
What are the tenderpoints for motor function in HF patients?
- TTA over cervical pillars
- Rotated vertebra at C3-5
What other SD can HF patients have?
- 1. Dependent extremity edema
- 2. Rib dysfunction
- Flat diaphragm
- Hypertonicity of scalene muscles and TPs
- Pec minor hypertonicity and TPs
4 ways to manage HF?
1. Prevent
2. Chronic issues
3. Prognosis
4. Complications
