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33 Cards in this Set

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