Lecture 12: Heart Failure - Part 1 Flashcards

1
Q

What are the 3 most common causes of HF?

A
  • CAD - ischemic heart disease
  • Idiopathic, dilated cardiomyopathy
  • Valvular heart disease
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2
Q

What are 4 causes of restriction/obstruction to ventricular filling which can lead to HF?

A
  • RV infarct
  • Constrictive pericarditis
  • Mitral stenosis
  • Atrial myxoma
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3
Q

Using the AHA/ACC heart failure staging guidelines, what does stage A represent?

A

Pts at high risk for HF but WITHOUT structural heart disease or sx’s of HF

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4
Q

Using the AHA/ACC heart failure staging guidelines, what does stage B represent?

A

Asymptomatic pts WITH structural heart disease (i.e., LVH and/or impaired LV function (low EF), valvular dz, but hemodynamically stable

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5
Q

Using the AHA/ACC heart failure staging guidelines, what does stage C represent?

A

Pts WITH current or prior sx’s of HF WITH structural heart disease; SOB, fatigure, reduced exercise tolerance

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6
Q

Using the AHA/ACC heart failure staging guidelines, what does stage D represent?

A

Pts w/ refractory HF requiring specialized treatment/interventions

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7
Q

Using the NYHA functional classification for HF, what does class I-class IV represent?

A
  • Class I = asymptomatic; no physical activity limitations
  • Class II = no sx’s at rest; exertional sx’s w/ ordinary activity
  • Class III = no sx’s at rest; sx’s with minimal activity
  • Class IV = sx’s AT rest
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8
Q

Which imaging modality is essential in the evaluation of heart disease and for distinguishing systolic HF from diastolic HF?

A

Echocardiogram

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9
Q

List 5 causes of acute HF

A
  • Acute MI
  • Ruptured papillary muscle
  • MR
  • AI
  • Toxins
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10
Q

What are some distinguishing sx’s of systolic HF vs. diastolic HF?

A
  • Systolic HF = DOE, orthopnea, paroxysmal nocturnal dyspnea
  • Diastolic HF = SOB, DOE, and pulmonary edema
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11
Q

Which type of HF (diastolic/systolic) is associated with HTN, obesity, DM, CAD, and aging?

A

Diastolic HF

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12
Q

What are 3 common underlying causes of imparired ventricular relaxation leading to diastolic HF?

A
  • Acute ischemia
  • Myocardial fibrosis
  • Amyloidosis
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13
Q

List 6 causes of high-output HF?

A
  • Hyperthyroidisim
  • Anemia
  • Pregnancy
  • A-V fistula
  • Beriberi
  • Paget’s
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14
Q

What are the CO and EF like in high output HF?

A
  • High CO
  • Low EF
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15
Q

Which hormones released as a compensatory mechanism for HF causes an increased preload and which causes inceased afterload?

A
  • Aldosterone —> Na and H2O retention = ↑ preload, congestive sx’s and volume expansion
  • Angiotensin II –> vasoconstrictor –> ↑PVR (↑ afterload)
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16
Q

What is the effect of increased ADH released during compensatory phase of HF?

A
  • Stimulates thirst –> ↑ TBW and hyponatremia (dilutional)
  • preload (Na and H2O retention)
17
Q

What are 2 major non-compliance issues which precipitate HF?

A
  • Non-compliance with diet = too much Na+, too many kcals, too many stimulants
  • Non-complance with meds = AE’s and cost
18
Q

What are 4 medication classes which can worsen/precipitate HF?

A
  • Antiarrhythmics
  • Beta-blockers
  • CCBs
  • NSAIDs
19
Q

How can anemia precipitate HF?

A

↑ O2 needs of tissues –> ↑ CO

20
Q

By which mechanism do tachyarrhythmias lead to ischemia?

A

↓ diastolic filling time

21
Q

What is the most common sx of HF?

A

Dyspnea –> ↓ arterial perfusion to organs and venous congestion

22
Q

Presence of which sx ↑ the likelihood of HF by 2-fold?

A

Paroxysmal nocturnal dyspnea

23
Q

Which PE of the lung is common with HF?

A

Crackles in lung due to pulmonary edema; may wheeze or cough (frothy- pink fluid)

24
Q

What are 4 signs/sx’s of RV failure?

A
  • Peripheral/sacral edema
  • Hepatomegalia
  • Ascites
  • ↑ JVD, hepatojugular reflex
25
Q

When measuring JVP, how many cm’s is considered above normal?

A
  • >3 cm above the sternal angle
  • 8-9 cm in total distance above the RA
26
Q

What are findings on a CXR associated with HF?

A
  • Cardiomgalia
  • Pulmonary edema w/ central peripheral infiltrates
  • ↑ size of vessels in upper portions of lungs
  • Pleural effusions
27
Q

What is the usefulness of ordering a CBC, CMP, and UA when assessing possible HF?

A
  • CBC looking for anemia 2’ to chronic disease
  • CMP looking for electrolyte imbalance; pre-renal azotemia (BUN:Cr)
  • UA looking for protein in urine
28
Q

Which lab must always be ordered in pt with HF who is >65 yo with Afib?

A

Thyroid

29
Q

What is the significance of a BNP <100 pg/mL in terms of HF?

A

97% chance of NO HF

30
Q

BNP is a neurohormone made in the ventricle that is sensitive to what (i.e., what are the stimuli)?

A
  • Sensitive to ventricle stretching and volume overload.
  • Preload/afterload are the stimuli
31
Q

What are pulmonary and liver problems which may mimic HF?

A
  • Pulmonary = PE, asthma, and pneumonia
  • Liver = cirrhosis –> ascites + edema