Week 2- Heart Failure Flashcards
PART 1
PART 1
What are the S/Sx of Heart Failure (HF)? (4)
- Exertional Dyspnea
- Orthopnea (SOB in supine)
- Paroxysmal Nocturnal Dyspnea (SOB at night)
- Fatigue
What are some other common clinical S/Sx of HF and what are they?
- 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
HFpEF vs HFrEF
HFpEF = Heart Failure w/ preserved ejection fraction
HFrEF = Heart Failure w/ reduced ejection fraction
Patients with Left Sided HF have compromised contractility. What is the impact of this?
- Reduced SV, EF, and CO.
- Ultimately results in reduced blood flow (O2) to the body leading to exercise intolerance, fatigue, and SOB.
What are some causes of Left Sided HF? (4)
- HTN
- CAD (Coronary Artery Disease)
- Arrhythmias
- Decreased CO caused by impaired ventricular filling and decreased ventricular relaxation
Describe how pulmonary congestion may occur with vascular congestion.
- 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).
What are the S/Sx of Left Sided HF?
- 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
- 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?
- Blood flow to kidneys is compromised, which is what drives kidney function.
- Increased LV and LA diastolic volume and pressure.
Left Sided HF DO CHAP acronym.
- Dyspnea
- Orthopnea
- Cough
- Hemoptysis
- Adventitious Breath Sounds
- Pulmonary Congestion
Patients with Right Sided HF have compromised contractility. What is the impact of this?
- Accumulation of blood in RV, RA, and SYSTEMIC CIRCULATION.
- Leads to systemic S/Sx.
What are the S/Sx of Right Sided HF?
- Systemic congestion
- Abdominal swelling/ascites/bloating
- Kidney failure
- JVD
- Weight gain
- Dependent edema (gravity dependent)
- Increased frequency of DVT/PE
- Right Sided HF = _________ S/Sx
- Left Sided HF = ________ S/Sx
- Right Sided HF = systemic S/Sx
- Left Sided HF = pulmonary S/Sx
PART 2
PART 2
Is HF usually left or right sided?
Right Sided HF ultimately meets up with Left Sided HF.
What is CHF?
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.
Describe the (5) AHA clinical stages of CHF.
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
Describe the ABCD scheme of HF from the American Heart Association.
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
Describe the NYHA HF classifications.
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.
Is CHF acute or chronic?
Can be either acute or chronic.
What are some ways we can tell if someone has acute CHF?
- EXACERBATION
- Sudden dyspnea and limb swelling
- 5 lb rule (5lb increase in BW in 24 hours)
What is the difference between Systolic HF and Diastolic HF?
- Systolic HF = Heart isn’t contracting well during heartbeats.
- Diastolic heart failure= Heart isn’t able to relax normally between beats.
- Systolic HF = HF_EF
- Diastolic HF = HF_EF
- Systolic HF = HFrEF
- Diastolic HF = HFpEF
Describe the pathophysiology of Diastolic HF.
- 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.
What is the main point behind recognizing Diastolic HF?
HF can exist even with normal EF.
- Does Diastolic HF affect men or women more?
- Does Systolic HF affect men or women more?
- Which results in more frequent hospitilizations?
- Diastolic HF = Women>Men
- Systolic HF = Men>Women
- Systolic HF
- 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.
- neuroendocrine
- hyperautonomic, hyperinflammatory
What are some medications patients with HF may take?
- Diuretics
- Beta blockers
- ACE inhibitors/ARB
- Calcium channel blockers
- Vasodilators
- Positive ionotropes
Is HF exclusively a “cardoi-centric” disease?
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
