Lecture 6 Heart Failure Flashcards
HF is due to impairment of the ability of the heart to _____ _____ or to ____ blood
fill with; eject
HFrEF stands for ?
What dysfunction is it due to?
also called ___ HF
Heart Failure with reduced Ejection Fraction;
systolic,
Left
What does HFpEF stand for?
What dysfunction is it due to?
also called _____ HF
HF with preserved Ejection Fraction;
diastolic;
right
HFrEF is usually caused by ____ with antecedent ____
coronary artery disease;
MI
HFpEF is usually seen in what population of people?
older women with HTN
Stage A of the new HF classification is defined as:
Stage B = _____
Stage C = _______
Stage D =
at risk for CHF;
asymptomatic structural disease (ie previous MI)
previous/current symptoms,
refractory symptoms
what group has the highest risk for HF?
blacks
what pulmonary signs are seen in patients with HF?
diffuse wet rales/crackles
Where is the PMI displaced in HF?
lateral, due to enlarged heart
in HFrEF, there is high _____ venous pressure
pulmonary
pulmonary edema is seen as edema located in the ____ on CXR. The _____ ____ vessels in the lung fill up first. This is called ____
bases;
super apical;
cephalization
3 special symptoms of L HF
orthopnea, paroxysmal nocturnal dyspnea, rales (due to edema)
There may be a ____ ____ and dilated ____ veins due to high hepatic venous pressure in patients with L Hf
nutmeg liver;
hepatic
In HF, there is often increased ____ _____ pressure
jugular venous (seen as JVD)
Orthopnea and paroxysmal nocturnal dyspnea is due to increased ____ _____ from redistribution of blood
increased venous return
3 classic signs of HFpEF (according to FA)
hepatomegaly (nutmeg liver), JVD, peripheral pitting edema
other symptoms of right sided HF include _____ swelling, _____ gain, fatigue, and ______
ankle, weight;
cyanosis/ascites
HF:
decreased blood flow to the _____ causes an increase in firing of the _____ ____ Cells. this causes increased produciton of renin
kidney;
Juxta-glomerular apparatus
In addition to renin activation, decreased cardiac output activates the ____, leading to vaso____, ____ afterload, and ____ contractility
Sympathetic NS; constriction, increased, increased
combined action of the SNS and renin system leads to an increase in ____ end _____ pressure
LV end diastolic
A failing heart _____ _____ the frank starling curve due to inabaility to respond to an increased _____
falls off;
EDV
HF can lead to ______ remodeling, causing dilatation and ____ regurgitation
LV;
mitral
_____ lines are seen on CXR, indicating ____ pulmonary ____
kerley B (horizontal); interstitial pulmonary edema
many signs of HF on CXR may be absent in ____ ____ CHF
chronic compensated
Pressure = _____ * _____ / _____
thus, a big heart is an ______ heart
tension * thickness / radius;
ineffecient
_____ is generated by cardiomyocytes in the context of numerous triggers, such as myocardial stretch. it ____ in patients with CHF
BNP;
increases (ie greater than 100)
_____ can evaluate chamber size, severity of LV or RV dysfunction, valve abnormalities, and more
Echocardiography
Equation for ejection fraction:
what is it normally?
(LV EDV - LV ESV) / LV EDV;
normally 55-65%
_____ training and cardiac _____ are supported by class A evidence in treatment of CHF
exercise; rehabilitation
1st line treatment in chronic HF
ACE inhibitors or ARBs
Diuretics and digoxin improve _____ but not ___________
symptoms, prognosis
other treatments of CHF that improve symptoms and prognosis include ____/isorbide (vasodilator), beta blockers, _____ (Aldosterone antagonist), and implanted devices
hydralazine;
spirinolactone
a flat starling curve represents decreased ____ _____ sensitivity patients with HFrEF
LV preload
implanted devices include cardiac _____ and an implanted _____ _____
resynchronization;
cardioverter defibrillator
_____ and milrinone are used for chronic ionotropic support in patients with severely chronic HF
dobutamine
Acute decompensated CHF:
‘cold’ represents a decreased ______ (aka ________)
‘wet’ represents an elevated ______
cardiac index (Vasoconstriction/low perfusion)
pulmonary capillary wedge pressure (ie edema/congestion)
acute CHF treatment:
____ Reduce fluid volume; vasodilators such as nitroglyerin reduce _____ and ____; and _____ augment contractility
diuretics;
preload, afterload;
inotropes
