Pathophysiology and Patient Assessment

Question 1

What is the #1 reason for hospital readmission?

Answer 1

Heart Failure
25% within 30 days, 50% within 6 months

Question 2

What is Heart Failure?

Answer 2

a decrease in cardiac output (heart can’t meet demands of the body)

Question 3

What is Cardiac Output?

Answer 3

the amount of blood leaving your heart
important- tissues and organs require oxygen to function, and blood is the carrier

Question 4

Equation for Cardiac Output

Answer 4

CO= SV x HR

Question 5

What is Systolic Dysfunction?

Answer 5

Problem with PUMPING
Also called HFrEF. Ventricle can fill, but cannot pump (squeeze)

Question 6

What is Diastolic Dysfunction?

Answer 6

Problem with FILLING
Also called HFpEF

Question 7

What is an Ejection Fraction?

Answer 7

The % of blood that leaves your left ventricle when it contracts

Question 8

What is a normal ejection fraction? How much blood normally remains?

Answer 8

Normal- 50-70%, remaining is 30-50%

Question 9

What is the equation for EF?

Answer 9

EF= Stroke Volume/End Diastolic Volume

Question 10

What is HFrEF and what %?

Answer 10

Heart Failure with REDUCED ejection fraction
Less than 40% of the blood in your ventricle leaves when it contracts

Question 11

What is HFmrEF and what %?

Answer 11

Heart failure with MILDLY REDUCED ejection fraction
HFpEF getting worse or HFrEF getting. better
EF= 40-50%

Question 12

What is HFpEF and what %?

Answer 12

Heart failure with PRESERVED ejection fraction
The LV doesn’t fill properly, but does contract, so the same % of blood leaves the ventricle, but from a smaller starting volume
EF= > 50%

Question 13

What does an echocardiogram evaluate?

Answer 13

Ejection Fraction/Wall Motion abnormalities, chambers of the heart, valves

Question 13

What is hypoperfusion?

Answer 13

Not enough oxygenated blood moving forward from the heart to perfuse the vital organs

Question 14

What is congestion?

Answer 14

Blood backs up from the LV to the lungs, possible RV, and beyond

Question 15

What are the symptoms of hypoperfusion?

Answer 15

Tachycardia, fatigue, cyanosis, cold extremities, organ dysfunction, Increased: serum creatinine and LFTs, confusion AMS

Question 16

What are the symptoms of Congestion?

Answer 16

Weight gain, SOB, Orthopnea, Paroxysmal Nocturnal Dyspnea, Pleural effusion on CXR, crackles/rales on ausculation, S3 and S4, peripheral edema, BNP, JVD

Question 17

What does a Chest Xray test?

Answer 17

Cardiac enlargement, pulmonary edema, pleural effusions

Question 18

What does an ECG test?

Answer 18

May help you identify a cause for HF exacerbations (ACS, arrythmias)

Question 19

What does CBC/BMP test?

Answer 19

Hypoperfusion, hyponatermia, anemia

Question 20

BNP or NT-BNP values?

Answer 20

BNP > 100ng/mL
NT-pro BNP > 300ng/mL

Question 21

ACC Classification: At risk for structural heart disease, no symptoms

Answer 21

Class A

Question 22

ACC Classification: Yes structural heart disease, no symptoms

Answer 22

Class B

Question 23

ACC Classification: Yes structural heart disease, Yes symptoms

Answer 23

Class C

Question 24

ACC Classification: Yes structural heart disease, refractory symptoms

Answer 24

Class D

Question 25

NYHA Classification: No limitation of physical activity, ordinary activity does not cause any HF symptoms

Answer 25

Class I

Question 26

NYHA Classification: Slight limitation of physical activity, comfortable at rest, but ordinary activity results in HF symptoms

Answer 26

Class II

Question 27

NYHA Classification: Marked limitation of physical activity, comfortable at rest, but less than ordinary activity results in HF symptoms

Answer 27

Class III

Question 28

NYHA Classification: Symptoms at rest

Answer 28

Class IV

Question 29

What is the most common cause of HF?

Answer 29

Myocardial Infarction

Question 30

What is the #1 Cause of Death in a Patient w HF?

Answer 30

Sudden cardiac death from ventricular tachycardia/fibrillation

Question 31

What is an exacerbation or ADHF?

Answer 31

Rapid onset of symptoms causing clinic, ED, hospital admission

Question 32

What causes an acute exacerbation?

Answer 32

Non compliance (with medications or diet), NSAID use, and comorbidities (afib, MI, and infection)

Question 33

Classification of ADHF: Class I

Answer 33

Warm & Dry

Question 34

Classification of ADHF: Class II

Answer 34

Warm & Wet

Question 35

Classification of ADHF: Class III

Answer 35

Cold & Dry

Question 36

Classification of ADHF: Class IV

Answer 36

Cold & Wet