PC in heart failure Flashcards
What is the most common cause of heart failure
Ischemic cardiomyopathy
Outline the NYHA classification scheme
Categorizes patients based on physical limitations.
What does the NYHA classification assess?
The SEVERITY of the heart failure.
True or False. Patients are able to transition to higher or lower classes and vice versa in the NYHA classification system.
TRUE.
It is not static.
If a patient is having symptoms at rest, this would place them at what NYHA class?
NYHA IV
Complete limitation of physical activity. Unable to carry out any physical activity without symptoms of HF at REST.
Other than dyspnea, fatigue and edema (the classic sx of HF), list 6 other symptoms that HF patients experience.
1) Nausea
2) Constipation
3) Abdominal fullness/distension
4) Depression
5) Anxiety
6) Sleep disturbance
7) Pain
What variable has been consistently associated with poor prognosis in HF patients?
Number of heart failure hospitalizations.
What would trigger a referral to a palliative care consultant in HF patient?
Potential triggers for specialist palliative care consultaiton in heart failure.
Any one of the following:
Two or more hospital adx for Hf in the prior 6 months
Two or more ER visits for HF in the prior 6 months
Substantial worsening of prognosis or progressing disease
NYHA class III or IV symptoms
Substantial worsening or difficulty in controlling other physical or psychological symptoms from HF
AND AT LEAST ONE OF the following:
Consideration for, or ineligible; or not interested in advanced HF therapies (outpatient inotropic infusion, left ventricular assist device, cardiac transplantation)
Consideration of high risk procedure (cardiac surgery, thoracic surgery)
Consideration for ICD
Consideration for feeding tube placement, tracheostomy, or initiation of renal replacement therapy
Comorbidity (chronic renal failure, diabetes, , stroke, cancer, HIV, Pulmonary fibrosis, oxygen dependent COPD)
Previous/current ICU admission or CPR within last year
Negative response to the ‘surprise’ question
Significant worsenig of a comorbidity
Disagreements, uncertainty, or ethical concerns concerning treatment decisions or resuscitation preferences
Perceived emotional, spiritual, or relational distress to patient, family or surrogate
Functional or cognitive decline, loss of independence, complex care requirements
Page 260 case based manual
Define dyspnea.
An uncomfortable sensation of breathing.
Opioids reduce dyspnea in a similar manner to pain relief, nambely by modulating the ____ of dyspnea
Perception
Describe the trajectory of heart failure.
HF is a chronic illness characterized by periods of relative stability punctuated by exacerbations that may require hospitalization.
An exacerbation is a risk of death.
What is heart failure based upon?
According to left ventricular function.
What causes the symptoms of heart failure (fatigue and dyspnea)?
Volume overload
Reduced cardiac output
Sarcopenia in skeletal, respiratory and cardiac muscles
Name 4 common etiologies of heart failure
1) Tachyarrhythmia
2) Valvular disease
3) Risk factors for CAD
4) Left ventricular hypertrophy from long standing untreated HTN
List 6 complications that can occur as a result of heart failure.
1) Hospitalization
2) Death
3) Decreased QOL
4) Arrhythmias
5) Renal failure
6) Liver failure
