Path phys of HF Puri Flashcards
What is heart failure
inability for heart to meet requirements of the periphery without excessive filling pressure
Who has the highest incidence of heart failure at a younger age
Black men and women
What is the number one risk factor of Heart failure
Poor management of hypertension
Systolic dysfunction
Can’t pump enough
Diastolic dysfunction
Can’t fill enough
HF reduced EF is characterized by
LV dilation with EF < 40%
HF preserved EF
concentric LV hypertrophy with EF > 50%
What changes in Systolic dysfunction? EF ?
Ejection Fraction is reduced due to loss of contractility
What changes in diastolic dysfunction? EF?
reduced compliance
This has a preserved EF
What causes HF Red EF
Infarction
Dialated Cadiomyopathy
Volume overload
What causes HF Preserved EF
Hypertension
Restrictive Cardiomyopathy (Sarcoidosis/Amyloidosis/HOCM)
What is the sign that is indicitave of very poor outcome of heart failure
Audible S3 w/ backwards heart failure
What are the cardinal signs of heart failure
Worsening dyspnea
Paroxysmal nocturnal dyspnea
weight gain
dec exercise capacity
Sleep disordered breathing
Audible S3 indicates
Backward failure /Systolic dysfunction
Audible S4 indicates
Diastolic dysfunciton
Gold standard for heart failure workup
Echocardiogram to get EF
What is a biomarker for heart failure
BNP
copeptin
cystatin C
What does Ang II activate
AVP and SNS
What way does the AVP line graph shift in heart failure
To the left mimicing a loss of blood volume even though there isn’t a loss
What do you measure to check on AVP level
Copeptin bc it has a longer halflife
How can you help ANP and BNP support heart failure more
Give ernesto to block neprilysin and AT1R
What does long activation of ATII cause
oxidative stress
What do dying hearts have more of inside them
Calcium. lesser ATP reduces SERCA. The heart cannot relax
Failing hearts on EKG
reduced slope phase 0
ERP is shorter (reentry arrythmias)
HF red EF present with what type of hypertrophy
eccentric (volume) hypertrophy (series)
HF pres EF present with what type of hypertrophy
concentric (pressure) hypertrophy (parallel)
Why are ACE inhibitors venodilators and vasodilators
bradykinin is a venodilator
Why are ARBs vasodilators
ARBs only prevent ATII which is a vasoconstictor
What is BNP
vaso/veno dilator
What can provide symptomatic relief in HF
diuretics
What diuretic helps in a kidney with a lower filtration rate
Loops
What should you use in HF with EF < 35%
Spironolactione
Eplerenone
What to give when dealing with cardiac remodeling
B blocker (carvedilol)
ACE inhibitor
Spironolactinone
How to give B blockers?
Small amount then work up
MONITOR WEIGHT
What should you never increase digoxin above
1ng/mL
Digoxin side effects
PVCs
bradycardia-> tachycardia
Yellow vision
Treat digoxin
Digibind- Fab fragments
What should you always start with in heart failure
ACE inhibitors regardless of Race
What do you give if someone doesn’t respond to an ACE inhibitor
hydralazine and isosorbide dinitrate (Bidil)
What does Ivabradine block
HCN channel to reduce HR
Which increases the chance of survival most in sudden cardiac death
Implantable defibrillator
Best treatment for preserved ejection fraction HF?
Prevention (only treatment is transplant)
