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CHF Flashcards

(26 cards)

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1
Q

NYHA Classes of Heart Failure

A
  1. No symptoms with normal activity
  2. Symptoms with normal activity
  3. Symptoms with less than normal activity
  4. Symptoms at rest
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2
Q

Definition of HFrEF vs. HFpEF

A

HFpEF: LVEF > 50%
HFrEF: LVEF <40%

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3
Q

List 6 symptoms of Heart Failure

A
  • Fatigue w/ less exertion
  • Weight Gain (>2 kg in 2d or 3 kg in 7 days)
  • Exertional Dyspnea
  • Orthopnea
  • PND
  • Ankle Edema
  • Weakness
  • Angina / Chest Pain / Palpitations
  • Cough
  • Abdominal Distension
  • Dizziness / Syncope
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4
Q

List 5 lifestyle risk factors for Heart Failure

A
  • Cigarette Smoke
  • Heavy Alcohol Use
  • Amphetamines
  • Cocaine
  • Physical Inactivity
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5
Q

List 6 Cardiac risk factors for Heart Failure

A 
Ischemic Heart Disease 
HTN / LVH 
Valvular Disease 
Cardiomyopathy 
Myocarditis 
Pericarditis 
Endocarditis 
OSA
Diabetes
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6
Q

List 6 Non-Cardiac risk factors for Heart Disease

A 
Anemia 
Hemochromatosis 
Hypertrophic Cardiomyopathy 
Sarcoidosis 
Amyloidosis 
Auto-immune 
HIV 
Hyper/Hypothyroid 
Adrenal insufficiency 
Pheochromocytoma 
Thiamine deficiency
Selenium deficiency
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7
Q

DDX

A
  • Pulmonary Embolism
  • MI
  • COPD
  • Atrial Fibrillation
  • Anemia
  • Renal Failure
  • Hypoalbuminemia
  • Obesity
  • Dependent Edema
  • Fluid Retention due to CCB or NSAIDs
  • Depression / Anxiety
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8
Q

Specific Measurements

A
  • Heart Rate - Tachycardia
  • Blood Pressure – HoTN
  • Sp02 - Hypoxia
  • Weight
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9
Q

Specific cardiac exam findings

A
  • 3rd Heart Sound
  • 4th Heart Sound
  • Displaced + sustained apex beat
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10
Q

Specific Pulmonary Exam Findings

A
  • Pulmonary Crackles
  • Rale
  • Pleural Effusion
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11
Q

Specific Volume Status Exam findings

A
  • Edema
  • Abdominojugular Reflux
  • Elevated JVP
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12
Q

Specific Abdominal Exam Findings

A

• Enlarged Liver

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13
Q

Initial labs

A
  • CBC, lytes, FBG, lipids, renal function, TSH, urinalysis, troponin
  • If available a proBNP
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14
Q

ECG findings

A

• tachy, afib, LVH, inverted t waves, Q waves, LBBB, ST elevation

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15
Q

CXR findings

A

• Vascular Markings, interstitial edema, kerley B lines, cardiomegaly, pleural effusion

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16
Q

When is an echo done, and what are the findings?

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A
  • within 72 hours UNLESS done within the last 12 months
  • ↓LVEF, ↑LV end-systolic + diastolic function, LVH, wall motion abnormalities, diastolic function, valve dysfunction, elevated pulmonary arterial pressure
17
Q

Indications for angiography

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A

• If suspecting CAD

18
Q

Acute Heart Failure exacerbation management

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A

Lasix:
• 20 – 80 mg IV OR double the home dose. Urine catheter IN. Monitor Urine output. Reassess patient’s O2 requirements in 1-2 hours.
Morphine:
• Use cautiously, may help with sensation of dyspnea and anxiety, may be harmful
NTG:
• patch (0.4-0.8 mg/hr) OR IV infusion (50 mg in 250 ml D5W, start at 10 mcg/min)
• C/I if HoTN OR Aortic Stenosis (pre-load dependent)
Oxygen:
• Target O2 >/ 92% (02, CPAP / BiPAP), intubation with persistent hypoxia and continue work of breathing despite these interventions
Position:
• Upright

19
Q

When is hospital admission considered in an acute exacerbation?

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A
  • NYHA III-IV
  • Persistent hypoxia, hypotension, tachycardia, tachypnea despite intervention
  • ECG evidence of ischemia, ventricular arrythmia, atrial arrythmia NOT under control
  • Worsening renal function
  • New diagnosis of heart failure
20
Q

What are criteria for hospital discharge

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A
  • Symptoms resolved
  • Vital Signs Stable / resolved x 24 hrs
  • Returned to dry weight + stable for 24 hrs
21
Q

HF follow up frequency

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A
  • Acute change -> follow up in 1-2 days
  • Med change + unstable -> follow up in 7 days
  • Med change + stable -> follow up in 2 weeks
  • Stable + on optimized therapy -> 3-6 months
22
Q

List the 10 management steps of acute MI

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A
  1. Pain relief only if severe (opioids can increase mortality if NSTEMI)
  2. ASA (27% mortality benefit)
  3. O2 if SpO2<90
  4. Nitrates only for analgesia
  5. Reperfusion with antithrombolic therapy or PCI
  6. B BLocker
  7. ACE
  8. Statin
  9. Do Code status
  10. use HEART score for disposition
    (History concerning, ECG concerning, Age >45, >65, Risk factors, initial trop)
23
Q

What is the H2FPEF score

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A

Liklihood of HF

Heavy=BMI>30
HTN 
Fibrilation 
Pulmonary Hypertension 
Elderly (>60)
Filing pressure >9
24
Q

When can you use SGLT2 inhibitors

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A

HFpEF >40%
DM and CVD
DM and >30 and Renal disease
DM and >50 and risks for CVD

Anyone with EF <40%
Except type 1!!!!

25
Treatment for HrEF long term
``` ACE or ARB BB Mineralcorticoid receptor antagnoist SGLT2 inhibitor even if no diabetes Diruectic ```
26
Referals to consider to EF<35%
Palliative Transplant Cardio surgery for ICD
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