[HYHO] HPS Session 1 Heart Failure

Question 1

Define:

Heart Failure

Answer 1

Complex clinical syndrome that results from:

Structural or functional impairment of ventricular filling or ejection of blood

Question 2

What are the cardinal clinical symptoms of heart failure?

Answer 2

Dyspnea

Fatigue

Edema

Rales

Question 3

Stages of HF

Describe a Stage A patient

Answer 3

At RISK for HF but is asymptomatic

No limitations in ordinary physical activity

Question 4

Give examples of patients that would be STAGE A of HF:

Answer 4

• HTN
• Atherosclerotic dz
• DM
• Obesity
• Metabolic syndrome

Question 5

Stages of HF

Describe a STAGE B patient

Answer 5

Mild symptoms

SLIGHT limitation during ordinary activity

Question 6

Give examples of patients that would be STAGE B of HF:

Answer 6

• Previous MI
• LV remodeling including LVH and low EF
• Asymptomatic valvular disease

Question 7

Stages of HF

Describe a STAGE C patient

Answer 7

Structural heart disease

Significant limitation in activity due to symptoms.

Comfortable only at rest

Question 8

Give examples of patients that would be STAGE C HF?

Answer 8

• Known structural heart disease
• Shortness of breath and fatigue
• Reduced exercise tolerance

Question 9

Stages of HF

Describe a STAGE D patient

Answer 9

SEVERE limitations

Symptoms even while at rest

Question 10

Give examples of patients that would be STAGE D HF?

Answer 10

Marked symptoms at rest despite maximal medical therapy

Question 11

What are the two types of heart failure?

Answer 11

Reduced ejection fraction heart failure - Systolic

Preserved ejection fraction heart failure - Diastolic

Question 12

Patients with values of ___% to ___% are classified as having borderline reduced ejection fraction

Answer 12

Patients with values of 41% to 49% are classified as having borderline reduced ejection fraction

Question 13

What is the most common cause of heart failure with reduced ejection fraction?

Answer 13

Coronary artery disease

Question 14

What is the most common cause of heart failure with preserved ejection fraction?

Answer 14

Hypertension

Question 15

What is the common heart archetectural change that occurs with Heart failure with reduced ejection fraction?

Answer 15

Left ventricular dilation

Question 16

What is the common heart archetectural change that occurs with Heart failure with preserved ejection fraction?

Answer 16

Left ventricular hypertrophy

Question 17

Quick and dirty steps (6) on how to measure the JVP:

Answer 17

1. Raise head to relax SCM muscles
2. Raise to 30degrees, turn pts head slightly away
3. Examine both sides of the neck, find internal jugular venous pulsations
4. (if necessary) adjust head of bed till you can see oscillation point or meniscus of the internal jugular venous pulsations
5. Focus of RIGHT internal jugular vein
6. Identify the highest point of pulsation in the right jugular vein

Question 18

What are the diagnostic tests you would order for a HF pt?

Answer 18

CBC

CMP

Cardiac enzymes

UA

Beta-natriuretic peptide

Question 19

What are some imaging tools you’d order to diagnose HF?

Answer 19

Echocardiography w/ doppler

CXR

Question 20

What is the systematic appraoch to interpreting a CXR?

Answer 20

ABCDE-F

A = Airway

B = Bone

C = Cardiac

D = Diaphragm

E= Extras

F = Fields of the lung

Question 21

What do kerley B lines represent?

Answer 21

Interstitial edema

Question 22

What is the measurement of 2mm for pitting edema documented as?

4mm?

6mm?

8mm?

Answer 22

2mm = 1+

4mm = 2+

6mm= 3+

8mm= 4+

Question 23

What are examples of major criteria for HF?

Answer 23

• Paroxysmal nocturnal dyspnea
• Orthopnea
• Elevated JVP

Question 24

What are the parasympathetic considerations you should make for OS w/ HF?

Answer 24

Parasympathetic will present with involvement with:

Increased tone –> bradycardia

Vagus nerve

OA, AA and C2

Question 25

What are your OS considerations with HF for sympathetic influences?

Answer 25

Increased tone = tachycardia

T1-T5 involvement