HYOH HPS Flashcards
What EF (ejection fraction) value is categorized as heart failure with reduced EF?
EF 40% or less
What EF value is categorized as heart failure with preserved EF?
EF greater than or equal to 50%
Main cause of heart failure with preserved EF; what’s the resulting effect on the left ventricle?
Hypertension - left ventricular hypertrophy
Main cause of heart failure with reduced EF; what’s the resulting effect on the left ventricle?
Coronary artery disease - left ventricular dilation
AHA/ACC stages of HF A-D
Stage A: High risk for HF but w/o structural HD; no sxs of HF
Stage B: Structural HD; w/o sxs of HF
Stage C: Structural HD AND prior/current sxs of HF
Stage D: Refractory HF (meaning regular treatments aren’t effective anymore) requiring specialized interventions
NYHA class for functional status of someone w/HF
I: No limitation of physical activity; normal activity doesn’t cause undue breathlessness, fatigue, or palpitations
II: SLIGHT limitation of physical activity; no sxs at rest but ordinary physical activities cause breathlessness, fatigue, palpitations
III: MARKED limitation of physical activity; no sxs at rest but LESS THAN ORDINARY activity causes breathlessness..ect.
IV: CAN’T DO ANY physical activity w/o discomfort; SXS AT REST can be present; any physical activity causes increased discomfort
What is the expected finding of JVD?
Reflects RIGHT ATRIAL pressure, which in turn equals CENTRAL VENOUS pressure and RIGHT VENTRICULAR end-diastolic pressure
Basically right heart failure
CBC, CMP, Cardiac Enzymes, UA, B-natriuretic peptide (BUN) —> what would you expect with these values in a pt with HF?
CBC --> low RBC showing anemia CMP --> check for electrolyte imbalance Cardiac Enzymes --> generally elevated d/t progressive injury caused by HF (i'm not entirely sure about this b/c I can't find a clear answer anywhere) UA --> Proteinuria if kidneys affected BNP --> increased
XRAY findings that might be seen in pt with HF? (5)
- Alveolar edema (Bat’s wing patter)
- Prominent upper lobe vessels
- Cardiomegaly
- Kerley B lines (interstitial edema)
- Pleural effusion
*seem image on page 4 of HYHO
Things to do during initial evaluation of HF
- History
- Physical examination
- Labs and BNP testing
- Chest radiography
- Electrocardiography
- Apply Framingham criteria (2 major criteria met or 1 major + 2 minor)
The Framingham Criteria for HF have two categories -Major Criteria and Minor Criteria. What falls under MAJOR criteria for HF?
MAJOR CRITERIA:
- Praoxysmal nocturnal dyspnea
- Orthopnea
- Elevated jugular venous pressure (JVP)
- Crepitations (like hearing rales during lung ascultations)
- 3rd heart sound
- Cardiomegaly
- Pulmonary edema
**Diagnosis of HF requires presence of 2 major criteria or 1 major and 2 minor
The Framingham Criteria for HF have two categories -Major Criteria and Minor Criteria. What falls under MINOR criteria for HF?
MINOR Criteria
- Extremity edema
- Night cough
- Exertional dyspnea
- Hepatomegaly
- Pleural effusion
- Heart rate >120
- Loss of >4.5 kg in 5 days following diuretic treatment
**Diagnosis of HF requires presence of 2 major criteria or 1 major and 2 minor
If the Framingham criteria were NOT met (so pt didn’t have 2 major or 1 major + 2 minor) OR if BNP levels were normal, what can you rule OUT and what do you suspect pt has?
Rule OUT = systolic HF
Suspected = diastolic HF
If pt did meet the Framingham criteria and you suspected HF what is the next step?
Echocardiography - to figure out which coronary artery; but you do an echo either way (for both systolic and diastolic)
Once you conducted the echo and determined an EF of <50% what dx can you conclude? After you’ve treated the condition what should you consider next?
Systolic heart failure
After tx consider evaluating for coronary artery dz
Once you conducted the echo and determined an EF >50%, what dx can you conclude? After you’ve treated the condition what should you consider next?
Diastolic heart failure
After tx consider evaluating for coronary artery dz
Pt presents with acute onset of dyspnea and it progressed rapidly over a few minutes, what are your ddxs?
- Pulmonary thromboembolism
- Pneumothorax
- Left ventricular failure
- Asthma
- Inhaled foreign body
Pt presents with gradual onset of dyspnea that has progressed rapidly over hours to days, what are your ddxs?
- Pneumonia
- Asthma
- Exacerbation of COPD
Pt presents with gradually on set dyspnea that’s progressed relentlessly over weeks to months, what are your ddxs?
- Anemia
- Pleural effusion
- Respiratory neuromuscular disorders
Pt presents w/ gradually onset dyspnea that’s progressed relentlessly over months to years, what are your ddxs?
- COPD
- Pulmonary fibrosis
- Pulomonary tb
You’ve diagnosed pt with HF, what’s the next theraputic step?
Give diuretics to relieve congestive sxs and fluid retention (IV loop diuretics = furosemide, torsemide, or bumetanide; higher doses for pts taking diuretics chronically)
After giving diuretics, what’s the next step in treating HFpEF (HF w/ preserved EF = systolic HF)?
Manage comorbid conditions - HTN, Afib, IHD, and DM
After giving diuretics what’s the next step in treating HFrEF (HF w/ reduced EF = systolic HF)?
First line: ACE inhibitors and BBs, MRA (Mineralocorticoid receptor antagonist = aldosterone recept. antagonist –> spironolactone; eplerenone)
If pt with HFrEF is intolerant to ACEIs what tx should you offer?
Give ARBs instead (“-sartans”)
If pt with HFrEF is intolerant to ARBs what tx should you offer?
Hydralazine and nitrate
All heart failure pts should be offered what therapy?
Personalized, exercise-based cardiac rehab program unless condition is unstable
Parasympathetic physiological effects of HF and associated somatic dxfn (tender points)
Parasymps:
- Increased tone = bradycardia
- Vagus n.
- OA, AA, C2
Assoc. tender points:
- TTAs over cervical pillars
- Rotated vertebrae
- Compression of occipitomastoid sutures and OA joint
Sympathetic physioloigcal effects of HF and assoc tender points
Symps:
- Increased tone = tachycardia
- T1-T5
Tender points:
- TTAs over transverse processes
- rotated vertebrae
Motor nerve physiological effects of HF and assoc tender points
Motor:
1. C3 - C5 (keep the diaphragm alive!) = phrenic n. to diaphragm irritated b/c of lung proximity
Tender points
- TTAs over cervical pillars
- rotated vertebrae
What are other somatic dxfns assoc with HF?
- Dependent extremity edema
- Rib dysfunction
- Flattened diaphragm
- Scalene hypertonicity and tender points
- Pectoralis minor hypertonicity and tender points
2 minute OMM tx modality for HF
lower extremity pedal pump
5 min OMM tx modality for HF
rib raising
Ddxs for acute decompensated HF
- Pulmonary embolism
- Acute asthma
- Pneumonia
- Noncardiogenic pulmonary edema (e.g. adult RDS)
- Pericardial tamponade or constriction
General s/s of acute decompensated HF
Acute dyspnea, orthopnea, tachypnea, tachycardia, HTN
Hypotension reflects what in a pt with acute decompensated HF and what should you assess in this patient?
Hypotension = severe disease; arrest is imminent, assess for inadequate peripheral or end-organ perfusion
Pt has ADHF (actue decom. HF) and AF, what do you treat with?
Drugs like digoxin to slow heart rate
Pt has ADHF and acute aortic or mitral regurg or ascending aortic dissection - what’s the next step to treatment?
Cardiac surgery consult
