Lecture 12: Heart Failure - Part 1 Flashcards
What are the 3 most common causes of HF?
- CAD - ischemic heart disease
- Idiopathic, dilated cardiomyopathy
- Valvular heart disease
What are 4 causes of restriction/obstruction to ventricular filling which can lead to HF?
- RV infarct
- Constrictive pericarditis
- Mitral stenosis
- Atrial myxoma
Using the AHA/ACC heart failure staging guidelines, what does stage A represent?
Pts at high risk for HF but WITHOUT structural heart disease or sx’s of HF
Using the AHA/ACC heart failure staging guidelines, what does stage B represent?
Asymptomatic pts WITH structural heart disease (i.e., LVH and/or impaired LV function (low EF), valvular dz, but hemodynamically stable
Using the AHA/ACC heart failure staging guidelines, what does stage C represent?
Pts WITH current or prior sx’s of HF WITH structural heart disease; SOB, fatigure, reduced exercise tolerance
Using the AHA/ACC heart failure staging guidelines, what does stage D represent?
Pts w/ refractory HF requiring specialized treatment/interventions
Using the NYHA functional classification for HF, what does class I-class IV represent?
- 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
Which imaging modality is essential in the evaluation of heart disease and for distinguishing systolic HF from diastolic HF?
Echocardiogram
List 5 causes of acute HF
- Acute MI
- Ruptured papillary muscle
- MR
- AI
- Toxins
What are some distinguishing sx’s of systolic HF vs. diastolic HF?
- Systolic HF = DOE, orthopnea, paroxysmal nocturnal dyspnea
- Diastolic HF = SOB, DOE, and pulmonary edema
Which type of HF (diastolic/systolic) is associated with HTN, obesity, DM, CAD, and aging?
Diastolic HF
What are 3 common underlying causes of imparired ventricular relaxation leading to diastolic HF?
- Acute ischemia
- Myocardial fibrosis
- Amyloidosis
List 6 causes of high-output HF?
- Hyperthyroidisim
- Anemia
- Pregnancy
- A-V fistula
- Beriberi
- Paget’s
What are the CO and EF like in high output HF?
- High CO
- Low EF
Which hormones released as a compensatory mechanism for HF causes an increased preload and which causes inceased afterload?
- Aldosterone —> Na and H2O retention = ↑ preload, congestive sx’s and volume expansion
- Angiotensin II –> vasoconstrictor –> ↑PVR (↑ afterload)
What is the effect of increased ADH released during compensatory phase of HF?
- Stimulates thirst –> ↑ TBW and hyponatremia (dilutional)
- ↑ preload (Na and H2O retention)
What are 2 major non-compliance issues which precipitate HF?
- Non-compliance with diet = too much Na+, too many kcals, too many stimulants
- Non-complance with meds = AE’s and cost
What are 4 medication classes which can worsen/precipitate HF?
- Antiarrhythmics
- Beta-blockers
- CCBs
- NSAIDs
How can anemia precipitate HF?
↑ O2 needs of tissues –> ↑ CO
By which mechanism do tachyarrhythmias lead to ischemia?
↓ diastolic filling time
What is the most common sx of HF?
Dyspnea –> ↓ arterial perfusion to organs and venous congestion
Presence of which sx ↑ the likelihood of HF by 2-fold?
Paroxysmal nocturnal dyspnea
Which PE of the lung is common with HF?
Crackles in lung due to pulmonary edema; may wheeze or cough (frothy- pink fluid)
What are 4 signs/sx’s of RV failure?
- Peripheral/sacral edema
- Hepatomegalia
- Ascites
- ↑ JVD, hepatojugular reflex
When measuring JVP, how many cm’s is considered above normal?
- >3 cm above the sternal angle
- 8-9 cm in total distance above the RA
What are findings on a CXR associated with HF?
- Cardiomgalia
- Pulmonary edema w/ central peripheral infiltrates
- ↑ size of vessels in upper portions of lungs
- Pleural effusions
What is the usefulness of ordering a CBC, CMP, and UA when assessing possible HF?
- CBC looking for anemia 2’ to chronic disease
- CMP looking for electrolyte imbalance; pre-renal azotemia (BUN:Cr)
- UA looking for protein in urine
Which lab must always be ordered in pt with HF who is >65 yo with Afib?
Thyroid
What is the significance of a BNP <100 pg/mL in terms of HF?
97% chance of NO HF
BNP is a neurohormone made in the ventricle that is sensitive to what (i.e., what are the stimuli)?
- Sensitive to ventricle stretching and volume overload.
- Preload/afterload are the stimuli
What are pulmonary and liver problems which may mimic HF?
- Pulmonary = PE, asthma, and pneumonia
- Liver = cirrhosis –> ascites + edema
