ICM-Cardio > Heart failure > Flashcards

Heart failure Flashcards

(45 cards)

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1
Q

another name for heart failure

A

congestive heart failure

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2
Q

what is heart failure

A

complex clinical syndrome resulting from structural or functional cardiac disorders

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3
Q

pumping difficulties

A

systolic heart failure

-depressed EF

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4
Q

difficulty filling

A

diastolic heart failure

-preserved EF

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5
Q

normal venrticular pumping

A

SVC/IVC->RA-RV-Pulmonary artery-> lungs-> pulmonary veins-> LA-> LV-> systemic circulation

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6
Q

symptoms of heart failure

A
  • fatigue
  • poor stamina
  • dyspnea: on exertion
  • paroxysmal nocturnal dyspnea: in bed at night
  • nocturnal cough (orthopnea)
  • abdominal fullness, bloating, nausea
  • edema
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7
Q

signs of heart failure

A
  • resting tachycardia
  • low systolic BP and narrow pulse pressure
  • volume overload
  • elevated BP
  • hepatojugular reflex: press on abdomen
  • pulmonary rales
  • S3, S4 or summation gallop
  • displaced PMI
  • murmurs: mitral or tricuspid regurgitation
  • hepatomegaly
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8
Q

why have shortness of breath: left side

A

difficulty of pumping/filling-> back pressure goes into pulmonary circulation-> liquid seeps into alveoli-> alveolar edema (pulmonary edema)

  • high pulmonary venous pressure
  • see narrow pulse pressure
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9
Q

why have shortness of breath: what happens on right side

A

back pressure goes-> pulmonary artery

  • high pulmonary artery pressure
  • get jugular-venous distention
  • can go to liver-> ascites
  • edema
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10
Q

what is seen on X-ray

A

pulmonary infiltrates

-enlarged heart (maybe)

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11
Q

what is heard on auscultation of lungs?

A

crackles or rales on lung bases

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12
Q

symptoms of right CHF

A

ankles swelling
weight gain
fatigue
muscle atrophy

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13
Q

heart failure pathophysiology

A
  • decreased CO
  • poor circulation to organs
  • low circulation to musculoskeletal system
  • low circulation to kidneys
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14
Q

low circulation to kidneys results in

A

increase RAA-> salt and water retention, plasma volume expansion, and increased preload

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15
Q

what happens to heart in CHF: systolic heart failure

A

in systolic heart failure: heart muscle walls thin, cavity sites get bigger

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16
Q

Etiology of heart falire

A 
coronary artery disease=atherosclerosis
hypertension
diabetes
alcohol
valvular heart disease
viral
familial
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17
Q

what happens to heart in CHF: diastolic heart failure

A

in diastolic heart failure: heart muscle thickens, and cavity site gets smaller

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18
Q

how to we stage heart failure

A
  • Stage A: at risk of CHF (have diabetes, alcoholics)
  • Stage B: asymptomatic structural disease (thinning wall or thickening wall)
  • StageC: previous/current symptoms
  • Stage D: refractory symptoms
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19
Q

class I classifications

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A

no symptoms and no limitations to ordinary physical activity

20
Q

class II

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A

mild symptoms to ordinary physical activities

21
Q

class III

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A

marked symptoms with less than usual activity, comfortable at rest

22
Q

class IV

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A

severe limitations and symptoms at rest. Bed bound patient

23
Q

steps in diagnosis of CHF

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A
  1. clinical exam
  2. ECG
  3. chest film
  4. BNP
  5. echocardiography
24
Q

what to look for on CXR

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A
  • enlargement of heart base

- congested lungs

25
big heart is
inefficient heart
26
BNP
comes from heart - released from wall tension - enlarged heart-> if increased pressure or volume overload----> release BNP - normal BNP <100
27
what can you see on echo
``` chamber sizes presence and severity of LV systolic dysfunction valve lesions regional LV function assessment LV diastolic function Valvular abnormalities Pericardial diseases RV abnormalities ```
28
normal EF
55-65% | LV EDV- LV ESV)/ (LV EDV
29
hyperdynamic circulation
70-90% EF
30
what happens when someone is diagnosed with CHF
-natural progression
31
treatment of CHF
- diet: low sodium restriction, 2gm or less - daily weight: check everyday (morning) - vaccinations (drugs): influenza and pneumococcus) - limit how much fluid they drink in a day: 1-1.5 liters
32
drugs that improve symptoms for CHF
improve symptoms: diuretics digoxin: to strengthen heart contractility
33
most common drugs to treat CHF
diuretics, beta-blockers and ACE inhibitors Spironolactone Devices
34
drugs that improve symptoms/prognosis
improve symptoms and prognosis - ACE inhibitors/ARB's - beta-blockers - hydralazine/isosorbide - spironolactone - devices
35
cardiac resynchronization
improves LV EF improves symptoms Reduces function MR Indications: EF 120ms
36
advanced therapies
1. chronic inotropic support (first option, if fails, go to 2) - dobutamine - milrinone 2. LV assist devices (LVAD): helps heart to squeeze - Bridge therapy - destination therapy 3. Heart transplantation (last option)
37
acute decompensated CHF
1. don't follow diet - drink too much fluid - get volume overload 2. don't take medicine 3. progression of disease itself: chronic hypertension
38
treatment of acute CHF
1. Diuretics: reduced volume overload 2. Vasodilators: decrease preload and afterload, ACE inhibitors, beta-blockers 3. Inotropes: augment contractility (stage D patients)
39
reasons for acute CHF and treatment
1. address precipitating causes - correct myocardial ischemia - remove offending medications - treat arrhythmias - control elevated BP 2. Patient education
40
heart failure with preserved LV EF (diastolic heart failure)
increased LV filling pressure due to abnormalities in LV relaxation and compliance -elderly, history of HTN, CAD common
41
treatment heart failure with preserved LV EF
``` control BP diet drugs maintain sinus rhythm Diuretics Relieve MI ```
42
larger heart is
NOT stronger heart | -weak
43
chest pain is symptoms of
MI or heart attack
44
first line drugs to improve symptoms in CHF
diuretics
45
What is seen on Chest radiograph
``` Cardiomegaly Vascular engorgement Cephalization Kerley B lines Pleural effusion Enlarged main PA ``` Many may be absent in chronic compensated CHF
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