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S7- Cardiopulmonary > Week 2- Heart Failure > Flashcards

Week 2- Heart Failure Flashcards

1
Q

PART 1

A

PART 1

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2
Q

What are the S/Sx of Heart Failure (HF)? (4)

A
  • Exertional Dyspnea
  • Orthopnea (SOB in supine)
  • Paroxysmal Nocturnal Dyspnea (SOB at night)
  • Fatigue
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3
Q

What are some other common clinical S/Sx of HF and what are they?

A
  • Fluid retention
  • Ascites (fluid retention in abdomen)
  • Pleural effusions (fluid between lung pleura)
  • JVD (jugular venous distension)
  • Hepatomegaly (enlargement of the liver)
  • Pitting edema
  • Tachycardia
  • S3 Gallop
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4
Q

HFpEF vs HFrEF

A

HFpEF = Heart Failure w/ preserved ejection fraction

HFrEF = Heart Failure w/ reduced ejection fraction

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5
Q

Patients with Left Sided HF have compromised contractility. What is the impact of this?

A
  • Reduced SV, EF, and CO.

- Ultimately results in reduced blood flow (O2) to the body leading to exercise intolerance, fatigue, and SOB.

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6
Q

What are some causes of Left Sided HF? (4)

A
  • HTN
  • CAD (Coronary Artery Disease)
  • Arrhythmias
  • Decreased CO caused by impaired ventricular filling and decreased ventricular relaxation
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7
Q

Describe how pulmonary congestion may occur with vascular congestion.

A
  • As the LV contractility reduces, we also see a decrease in SV and EF.
  • With a decrease in SV and EF, we will see an increase in LVEDV and LVEDP (vascular congestion).
  • Atrium eventually will not be able to overcome pressure needed to push blood into LV and will have blood accumulation.
  • Eventually, we will see backing up of blood into the lungs (pulmonary congestion).
  • Results in PULMONARY EDEMA and HEMOPTYSIS (bloody sputum).
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8
Q

What are the S/Sx of Left Sided HF?

A
  • SOB, Dyspnea
  • Fatigue, exertional dyspnea
  • Waking up feeling like you are suffocating (orthopnia, paroxysmal nocturnal dyspnea)
  • Decreased urine production
  • Coughs that develop with reclining
  • Mitral valve regurgitation
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9
Q
  • Why should we expect patients with Left Sided HF to have a decrease in urine production?
  • Why should we expect patients with Left Sided HF to have mitral valve regurgitation?
A
  • Blood flow to kidneys is compromised, which is what drives kidney function.
  • Increased LV and LA diastolic volume and pressure.
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10
Q

Left Sided HF DO CHAP acronym.

A
  • Dyspnea
  • Orthopnea
  • Cough
  • Hemoptysis
  • Adventitious Breath Sounds
  • Pulmonary Congestion
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11
Q

Patients with Right Sided HF have compromised contractility. What is the impact of this?

A
  • Accumulation of blood in RV, RA, and SYSTEMIC CIRCULATION.

- Leads to systemic S/Sx.

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12
Q

What are the S/Sx of Right Sided HF?

A
  • Systemic congestion
  • Abdominal swelling/ascites/bloating
  • Kidney failure
  • JVD
  • Weight gain
  • Dependent edema (gravity dependent)
  • Increased frequency of DVT/PE
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13
Q
  • Right Sided HF = _________ S/Sx

- Left Sided HF = ________ S/Sx

A
  • Right Sided HF = systemic S/Sx

- Left Sided HF = pulmonary S/Sx

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14
Q

PART 2

A

PART 2

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15
Q

Is HF usually left or right sided?

A

Right Sided HF ultimately meets up with Left Sided HF.

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16
Q

What is CHF?

A

A clinical condition in which the heart is unable to pump enough blood to meet the metabolic needs of the body because of pathological changes in the myocardium.

17
Q

Describe the (5) AHA clinical stages of CHF.

A

Normal
-No Sx, normal exercise, normal LV fxn

Asymptomatic LV Dysfunction
-No Sx, normal exercise, abnormal LV fxn

Compensated CHF
-No Sx, decreased exercise, abnormal LV fxn

Decompensated CHF
-Sx, decreased exercise, abnormal LV fxn

Refractory Period
-Sx not controlled w/ treatment

18
Q

Describe the ABCD scheme of HF from the American Heart Association.

A

A- High-risk for CHF without structural heart disease or symptoms.
B- Diagnosed with structural heart disease, but not experiencing any CHF symptoms.
C- Structural heart disease with prior or current CHF symptoms
D- Advanced heart failure

19
Q

Describe the NYHA HF classifications.

A 
NYHA-1 = Cardiac disease, but no symptoms and no limitation in ordinary physical activity
NYHA-2 = Mild symptoms and slight limitation during ordinary activity
NYHA-3 = Significant limitation in activity due to symptoms. Comfortable only at rest.
NYHA-4 = Severe limitations. Symptoms even while at rest.
20
Q

Is CHF acute or chronic?

A

Can be either acute or chronic.

21
Q

What are some ways we can tell if someone has acute CHF?

A
  • EXACERBATION
  • Sudden dyspnea and limb swelling
  • 5 lb rule (5lb increase in BW in 24 hours)
22
Q

What is the difference between Systolic HF and Diastolic HF?

A
  • Systolic HF = Heart isn’t contracting well during heartbeats.
  • Diastolic heart failure= Heart isn’t able to relax normally between beats.
23
Q
  • Systolic HF = HF_EF

- Diastolic HF = HF_EF

A
  • Systolic HF = HFrEF

- Diastolic HF = HFpEF

24
Q

Describe the pathophysiology of Diastolic HF.

A
  • Ventricles lose ability to relax and become stiffer/less compliant.
  • Heart chambers can’t fill normally during diastole (reduced EDV).
  • Global loss of cardiac, vascular, and peripheral reserve.
  • Often patients have pulmonary HTN and exercise intolerance.
25
Q

What is the main point behind recognizing Diastolic HF?

A

HF can exist even with normal EF.

26
Q
  • Does Diastolic HF affect men or women more?
  • Does Systolic HF affect men or women more?
  • Which results in more frequent hospitilizations?
A
  • Diastolic HF = Women>Men
  • Systolic HF = Men>Women
  • Systolic HF
27
Q
  • HF is now recognized as a ___________ disease rather than simply a heart disease.
  • HF is a response to a long term hyper_______ and/or chronic hyper_________ state.
A
  • neuroendocrine

- hyperautonomic, hyperinflammatory

28
Q

What are some medications patients with HF may take?

A
  • Diuretics
  • Beta blockers
  • ACE inhibitors/ARB
  • Calcium channel blockers
  • Vasodilators
  • Positive ionotropes
29
Q

Is HF exclusively a “cardoi-centric” disease?

A

No

  • endothelial dysfunction
  • skeletal muscle damage
  • kidney dysfunction
  • decreased systemic blood flow and accompanying increased total peripheral resistance secondary to excessive sympathetic stimulation causing vasoconstriction

S7- Cardiopulmonary (24 decks)

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