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33 Cards in this Set
- Front
- Back
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S&S of LV CHF are
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exertional dyspnea, fatigue, orthopnea, PND,cardiac enlargement, rales, gallop, and pulmonary venous congestion
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S&S of RV CHF are
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> venous pressure, hepatomegaly, dependent edema, usually due to LV failure
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What is the prevalence of CHF in the US
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<1% in individuals below 60, and nearly 10% in those over 80
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What are the 4 determinants
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contractile state of the myocardium, preload, afterload, and heart rate
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What is the most common cause of CHF
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depression of contractility (due to MI, or other processes effecting the myocardium
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What is high output heart failure
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cardiac function may be supranormal, but none the less inadequate when metabolic demands or requirement for blood flow are excessive
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how does diastolic dysfunction effect CHF
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filling of the LV or RV is abnormal, either because of relaxation is impaired or the chamber is stiff
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what are some examples of high output heart failure
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thyrotoxicosis, severe enemia, AV shunting(dialysis fistulas), Pagets, and beriberi
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What are some adaptations that occour with CHF
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ventriculer hypertrophy, vasconstriction, activation of the renin A-A mechanism, increased contractility, HR, and fluid retention.
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what is the predominant feature of LF HF
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Dyspnea, due to low cardiac output and elevated venous pressure
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what are the predominant feature of RV HF
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signs of fluid retention, with the patient exibiting edema, hepatic congestion, and, on occasion asites
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how does left sided heart failure often present
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surprisingly some individuals with secere LVHF will present with symptoms of RVHF and be clinically indistinguishable from corpulmonale
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what is the most frequent cause of diastolic HF
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LVH, commonly resulting from Hypertension, but hypertropic cardiomyopathy, diabetes, and pericardial disease can produce the same clinical picture
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What is the most important treatment option for CHF
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prevention, the processes leading to CHF are of long standing and progress gradually. it is often preventable.
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Describe stage A CHF
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at high risk for CHF but without structural heart disease or symptoms. HT,DM, artery dise,obesity,met syn
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stage B CHF
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structural disease but without symptoms of HF. MI,LVH,<EF, asymptomatic valve disease
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Stage C CHF
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structural disease with prior or current symptoms of HF. SOB, fatigue, <exercise tolerance
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Stage D CHF
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refractory heart failur requiring specialized interventions.
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what is the prognosis of CHF
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5 year <50% overall. <5% per year with those with few or no symptoms. >30% per year in those with severe symptoms
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who is at higer risk, men or women
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men have a poorer prognosis due to the likely hood to have CAD
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what has improved the prognosis over the past 5 years
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the widespread use of ACEI and B blockers
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what is the most overlookes symptom of CHF
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chronic nonproductive coagh that is worse in the recumbent position
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what are the classifications catoragized by the New York Heart Association
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I - asymptomatic, II - symptomatic with mild activity, III - symptomatic with moderate activity, IV - symptomatic at rest
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What are some important peripheral signs of CHF
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JVP, thyroid exam, crakles, dullness from pleural effusions, hepatojugular reflux, asites, pitting edema
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Lab findings in CHF
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anemia, renal insufficiency, hypo or hyperkalemia,hyponatremia,thyroid function, BNP
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When is cardiac cath needed
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when CAD or valvular disease is suspected
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what are the reversible causes of CHF
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valvular lessions, myocardial ischemia, uncontrolled hypertension, arrhythmias, alcohol or drugs, intracardiac shunts,
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what are some drugs that worsen HF
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calcium channel blockers, antiarrhythmics, nsaid
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What is the most effective means of providing symptomatic relief of CHF
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Diuretics for patients with S&S of fluid retention, however excessive diuresis can cause electrolyte imbalance. a combination of diuretics and ACEI should be the initial treatment in symptomatic patients
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What is important to monitor in patients on ACEI
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ACEI may induse significant hypotension following the initial dose and is most prominent in patients with already low BP (systolic <100)
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What is the thinking on B blockers in CHF
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traditionally a contraindication, but there is now strong evidence that these agents have important beneficial effect.
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When should digitalis be used in CHF
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in patients who remain symptomatic when treated with B blockers and ACEI, and patients who are in A Fib and require rate control.
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when should calcium channel blockers be used to treat CHF
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first generation calcium channel blockers may accelerate the progression of CHF
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