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
