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
