Miller Heart Failure Flashcards
Cardiinal clinical symptoms of HF?
- dyspnea
- fatigue
Cardinal signs of HF?
- Edema
- Rales
What constitutes HF with preserved ejection fraction? (HFpEF)
- LVEF >50%
WHat is the reduced ejection fraction HF cut off?
LVEF <40%
What is Cor Pulmonale?
- altered RV structure and or function in context of chronic lung disease
- R. sided HF
Outcomes of CHF?
- Progressive pump failure
- symptoms of HF
- Sudden death
Pathophysiology of HFrEF?
What are the CV etiologies of HFrEF?
- CAD
- Cardiomyopathy
- Myocarditis
- Valvular disease
- Cardiac infections
Extracardiac causes of HFrEF?
- Endocrine disorder
- Systemic diseases (AI)
- High intake of EtOH and illicit drugs
- Chemo
Risk for HFrEF?
- Males
- LV H
- Bundle Branch Blocks
- Previous MI
- Smoiking
Risks for HFpEF?
- Older age
- Female
- Hypertension
- A. fib
Shared risk factors for HFpEF and HFrEF?
- Age
- DM2
- Smoking
- Htn
- Atherosclerosis
- Obesity
- Metabolic syndrome
Clinical presentation of heart fasilure?
- Congestion symptoms:
- DOE
- Paroxysmal nocturnal dyspnea
- Orthopnea
- Nocturnal cough
- Weight fluctuations and or edema
- Hypoperfusion symptoms:
- Exercise intolerance
- Fatigue
- Decrease mentation and cold intolerance
What labs/imaging would be ordered to help diagnose HF?
- EKG:
- shows ischemia, rhythm and conduction abnormalities
- CXR:
- low sensitivity and specificity but detects cardiac enlargement
- BNP is most helpful, if they have normal BNP rule out HF
What could cause an elevated BNP other than HF?
- Advanced age
- Renal insufficiency
- Anemia
- COPD
- Pulm Htn
What imaging is recommended in someone with suspected HF or known HF with worsening symptoms?
- Echocardiography
- In HFrEF you will see reduced LVEF, atrial and ventricular chamber dilation or hypertrophy, valvular dysfunction, pericardial pathology and elevated ventricular filling pressures
What do you order to help rule out intracardiac thrombus?
TEE
What is ordered to rule out ischemia as a precipitating factor of HF?
- Stress echo/cardiac CT
What is the take home from the staging for ACC/AHA?
- progressive increasing mortality
- Stages are ABCD
- A being high risk but without heart disease or sx
- D being refractory HF needing special interventions
Take home of NYHA staging?
- Functional classification, it is a snapshot in time
- class I physical activity not limited
- Stage IV can’t carry on with physical activity w/o symptoms of HF
- You can move back and forth with this classification
What are the objectives in treatment of patients wit HF?
- Improve sx
- Improve quality/duration of life
- Prevent hospital admission
What treatment offers the best quality of life and longest survival?
Cardiac transplantation
In HF what medication is used to relieve sx and signs of congestion?
Diuretics
In the absence of HTN, evidence does NOT support treating HFpEF with any medication except _____.
In the absence of HTN, evidence does NOT support treating HFpEF with any medication except Diuretics.
After diuretics are given in a patient with HFrEF and if the patient is still symptomatic, what do you give next?
Therapy with ACEi and Beta blocker
After diuretics, ACEi and beta blockers are given in a patient with HFrEF, if the patient is still symptomatic what do you do?
Add MR antagonist
What do you treat in a patient with HFpEF?
- Treat comorbidities
- Diurese if congested
- Improve perfusion if hypoperfused
Complications of HF?
- substantial morbidity/mortality
- anxiety sleep disturbance
- dyspnea
- fatigue
- orthopnea
- cough/chest pain/palpitation
- edema neuropathy
*
Clinical presentation of Cor Pulmonale?
- Symptoms:
- LE swelling
- Increased abdominal girth from ascites
- Signs:
- elevated JVP
- Tricuspid murmur
- S3
- wheezing rales
- Hepatomegaly, pulsatile liver, ascites, hepatojugular reflex (press liver and see JVP rise)
- LE Edema cyanosis
EKG cor pulmonale signs?
Right axis deviation and RV hypertrophy
Cor pulmonale treatment?
- Maintain ox delivery
- Optimize volume status with diuretics fluid and Na restrictions
- Manage arrhythmias
- Activity restriction when sx
- Provide hemodynamic support
How do you prevent HF?
- Treat conditions that lead to HF
