Cardio Lecture 21--Clinical Overview Of Hf

Front 1

When does HF occur? (2 scenarios)

Back 1

When the heart fails to pump blood at a rate required by the metabolizing tissues or when the heart can do so, but only under the condition of elevated filling pressures

Front 2

True/False: HF is a diagnosis resulting from various cardiac diseases.

Back 2

FALSE--HF is a clinical syndrome characterized by interstitial volume overload and/or inadequate tissue perfusion

Front 3

Is HF a syndrome or a diagnosis?

Back 3

SYNDROME

Front 4

What does a patient having cardiomyopathy tell us about the cause?

Back 4

NOTHING

Front 5

What are the two most common causes of HF?

Back 5

Ischemic heart disease and Hypertension

Front 6

What are the two major parts of the HF syndrome?

Back 6

Inadequate CO and tissue congestion

Front 7

What are the common symptoms of congestion?

Back 7

SOB with exertion or orthopnea(SOB while laying flat)--this includes Paroxysmal Nocturnal Dyspnea--sleep apnea, abdominal distention with RUQ pain and capsular swelling if liver failure, and lower extremity edema

Front 8

What is one important indication of poor heart output?

Back 8

Poor urine output due to insufficient end organ blood flow

Front 9

What are some vital sign indications of HF?

Back 9

High OR low BP, tachycardia, bradycardia, and low O2 saturation

Front 10

What is a precordium?

Back 10

Abnormality in musculoskeletal structure of chest that can be indicators of heart failure

Front 11

What are some auscultative indicators of HF?

Back 11

Presence of S3 or S4 heart sounds

Front 12

If you listen to a patient's lungs and discover no crackles, can you conclude that there is no pulmonary edema?

Back 12

NO--it might be really bad edema because there is no air, only fluid

Front 13

What are some lab indicators of HF?

Back 13

Renal or liver insufficiency, hyponaturemia, ELEVATION IN URIC ACID, B-type natiuritic peptide

Front 14

What does elevated B type natiuritic peptide indicate?

Back 14

Decompensation

Front 15

What imaging study must you AWLAYS do on a patient suspected of HF? What procedure is typically employed as well?

Back 15

Echo--right heart catheterization

Front 16

Describe the New York Heart Association classifications of HF.

Back 16

Class I: mild HF with no physical limitations on activity
Class II: mild HF, fine at rest, can do ADL's, develop symptoms with energetic exertions
Class III: Moderate--comfortable at rest but develop symptoms with less than ordinary activity
Class IV: Unable to carry out any physical activity with SOB

Front 17

True/False: You cannot move back and forth in the classifications of the New York system, but you can in the ACC staging system.

Back 17

FALSE--Move back and forth in New York--can't move back and forth in ACC

Front 18

Describe the ACC/AHA classification system of HF.

Back 18

A--no HF but at risk
B--developed structural HF but asymptomatic
C--structural HD and manifesting symptoms
D--advanced in symptoms to a point where refractory to usual medication and treatment

Front 19

What are the three main mechanisms for adaptation to HF?

Back 19

Increasing preload(see F-S Curve)

Front 20

What are the three compensatory methods for heart failure?

Back 20

1. Try to increase the preload and create a new F-S curve 2. Increase Norepi release to circulation to increase HR and contractility 3. Alter RAAS

Front 21

What does the sympathetic nervous system alteration do to the CV structures?

Back 21

Encourages heart to work harder and directs blood volume away from non-essential sites to central circulation through vasoconstriction

Front 22

What is heart remodeling?

Back 22

Enlargement and thickening of the heart along with scarring and fibrosis

Front 23

How do the kidneys respond in the face of decreased renal perfusion?

Back 23

They release Aldosterone in the face of increased angiotensin II and this causes Na+ and water retention

Front 24

What is the 1st medication anybody with heart failure is put on?

Back 24

Diuretics then ACE inhibitors

Front 25

When should beta blockers definitely NOT be used?

Back 25

A person who is decompensated and with a volume overload should not start them

Front 26

Should Angiotensin receptor blockers ever be used?

Back 26

Yes if ACE inhibitors can't be taken

Front 27

Describe the angiotensin system.

Back 27

Angiotensinogen is converted to angiotensin I by renin which is released by the kidneys in response to low blood perfusion--the angiotensin I is converted to angiotensin II by a converting enzyme--AII stimulates constriction of vascular smooth muscle and also stimulates aldosterone release, which increases water and sodium retention and causes increased preload and ALSO activates the symp and inhibits the parasymp and induces myocardial and vascular fibrosis

Front 28

What do beta blockers do and what are three effects of their use?

Back 28

They upregulate beta receptor expression and so improve calcium transport, inhibit the RA system, and inhibit endothelin and cytokine release

Front 29

What drug has a benefit in african americans in advanced stage HF?

Back 29

Hydralazine and ISDN

Front 30

What drugs should be used in the scenario of acute decompensation?

Back 30

Inotropes(dobutamine), intravenous vasodilators, and natriuritic peptides

Front 31

What HF patients have been shown to have beneficial effects from ICD's?

Back 31

MI survivors, Sustained and inducible VT patients, low EF with ischemic cardiomyopathy, non-ischemic cardiomyopathy

Front 32

Who should get cardiac resync. therapy? What is used?

Back 32

LBBB with a wide QRS--use ICD with three leads

Front 33

True/False: Diastolic HF is heart failure with reduced ejection fraction.

Back 33

FALSE--ejection fraction is conserved. The problem is in filling the heart

Front 34

Who gets diastolic HF the most? How should you treat it?

Back 34

Old female patients with high hypertension--treat underlying condition(ischemia, hypertension, etc...) and modify lifestyle

Front 35

How should you treat decompensated HF?

Back 35

Hurry--no time for studies--take history and do an exam but then start loop or thiazide diuretics or do ultrafiltration--give vasodilators and inotropes or mechanical support

Front 36

What is the most common cause of decompensated HF?

Back 36

Inappropriate reduction of therapy

Front 37

Arrhythmias can cause severe complications in HF patients how?

Back 37

Giving drugs can cause severe repercussions--if drugs must be given then apply in the hospital

Front 38

What do you do for people with catastrophic HF?

Back 38

Consider transplantation(most effective), mechanical circulatory support devices, put patients on IV inotropes

Front 39

What are indicators for MCS's?

Back 39

Bridge to transplant or Destination therapy