PMT, Johnston - Heart Failure Flashcards
Definition of HF
Inability of heart to meet metabolic demands of the body.
4 main causes of LV filling insufficiency, leading to HF.
Restriction/obstruction to vent filling: RV infarct Constrictive pericarditis MS Atrial myxoma
Goal of ACC/AHA
ID patients at risk for developing HF.
**ACC/AHA Stages of evolution of HF
A) High risk. Without structural heart disease and s/s of HF - i.e. HTN, DM, CAD, etc.
B) Asymptomatic, but has structural disease (LV-dysf) - i.e. prior event/MI, LVH, etc.
C) Currently or prior symptoms of HF. Has structural disease - i.e. structural dz and dyspnea, fatigue, reduced exercise.
D) Pts with REFRATORY HF requiring specialized interventions - i.e. s/s at rest despite max therapy.
NYHA Functional Classification
Class 1 - Asymptomatic
Class 2 - No s/s at rest. Exertional s/s with ordinary activity.
Class 3 - No s/s at rest. S/s with minimal activity
Class 4 - Rest s/s
What do 60-75% of people with HF have?
Have CAD - IHD. Most common cause of LV systolic dysfunction.
What five specific causes of HF can be seen with echo?
1) Hypertensive HD (concentric)
2) IHD
3) Hypertrophic HD (septal thickening)
4) Infiltrative HD (amyloid etc.)
5) Primary valvular disease
Acute v. chronic HF
Acute - MR, AI, toxins, rupture papillary m., acute MI
Chronic - slowly progresses, edema/wt gain, multivalvular dilated cardiomyopathy
s/s of Systolic HF
weak, fatigued, reduced exercise tolerance
PULM problems - DOE, orthopnea, paroxysmal nocturnal dyspnea
s/s of Diastolic HF
SOB, DOE, pulmonary edema
Diastolic dysfunction (impaired vent relaxation) can propagate/contribute to what three things?
Acute ischemia
Myocardial fibrosis
Amyloidosis
What is Low Output HF?
IHD, HTN
Dilated cardiomyopathy, valvular, pericardial disease.
Low CO.
What is High Output HF?
hyperthyroid, anemia, preg, AV fistula, beriberi
High CO, low EF.
What is Right Sided HF v. Left Sided HF?
- Right = RV affected. Pulmonary HTN dt pulm embolus, edema, hepatomegaly, venous distention.
- Left = LV overload. AS, MI. Dyspnea, orthopnea due to pulmonary congestion.
What are the compensatory neurohumoral responses to HF?
SNS upreg, RAS upreg, Cytokine activation, altered renal physiology, LV remodeling.
Seven precipitating causes of HF?
- Noncompliance with diet (Na, calories, caffeine).
- Noncompliance with meds ($$, AE)
- Taking meds that worsen decompensated HF
- Infection
- Anemia
- Thyroxicosis/Pregnancy
- Arrhythmia
What meds worsen decompensated HF?
What is the only AV block you can give BB?
- CCB, BB, NSAID, antiarrhythmics
- DO NOT give if more than 1st degree AV block
Why does a tachy arrhythmia provoke chest pain?
- Tachy shortens diastole, leading to ischemia.
What three things indicate AS?
Angina, syncope, dyspnea
S/s of HF
- Most common: dysnpea
- ***S3 gallop = 11-fold inc. likelihood of HF
- ***crackles
- ***new murmur
- ***JVD
- Pulmonary symptoms
- Paroxysmal Nocturnal Dyspnea = 2-fold inc. likelihood of HF
- Orthopnea
- Pulm edema, wheezing, dec. breath sounds
- Percussion pleural effusions
- Hematomegalia
- LV Failure
- RV Failure*
S/s of RV failure
Peripheral/sacral edema, heaptomegalia, asictes, increased JVD, HJR
How much below the sternal angle is the R atrium?
R atrium is 4 cm below sternal angle
Is unilateral or bilateral edema associated with HF? What else?
Bilateral edema!
Caused by heart, liver, lung, or venous stasis/insufficiency until proven otherwise.
What do presence of S3 gallop and Paroxysmal Nocturnal Dyspnea indicate - how much to they increase likelihood of this?
- *S3 gallop = 11-fold inc. likelihood of HF
* *PND = 2-fold inc. likelihood of HF
