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14 Cards in this Set
- Front
- Back
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What causes CHF?
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Anything that impairs heart from beating: CAD (loss of muscle from MI, can be resolved if hibernating only), DCM (from HTN, infections, infiltrative, idiopathic, toxins, pregnancy, familial), valvular dysfunction, HCM, RCM, Constrictive pericarditis, High output failure (anemia, thyrotoxicosis...)
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What is meant by neurohormonal balance?
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Vasoconstriction and sodium retention (Ang II, NE, aldosterone and endothelin) balances vasodilation and Na excretion (bradykinin, prostaglandins, NO, natriuretic peptides)
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What happens to the neurohormonal balance in CHF?
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incr serum concentrations of hormones that cause Na retention, vasoconstriction and further compromise the heart. May also trigger myocyte apopotosis and ventricular remodeling (dilation, fibrosis and reduced contractility).
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What is meant by heart failure being a systemic disease?
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1) endothelium-derived vasodilation through whole CV system
2) intrinsic muscle abnormality diminish exercise capacity 3) impaired sk muscle--> ergoreflex activation--> breathlessness and fatigue |
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What are the stages of heart failure?
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Stage A: risk (CAD, smoking) w/o sympts or structural heart dz.
Stage B: structural heart dz w/o sympts (post MI, valv heart dz, fam) Stage C: structural heart disease w/ prior or current sympts of HF. Stage D: Refractory HF, end-stage |
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What are the NYHA classes of heart failure?
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Class I: V dysfxn without limitation.
Class II: slight limitation Class III: marked limitation Class IV: breathlessness and fatigue at rest. |
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What do you look for in a phys exam for CHF?
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increased weight and volume overload, reduced CO, S3 gallop, loud P2, murmurs, cardiomegaly.
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How do you treat Stage A and B CHF?
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trate HTN, control risk factors. b-blockers, ACEI/ARB. ICD if post-MI.
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What b-blockers are used in CHF? Why?
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metaprolol and carvedilol, because they decrease mortality. ACEi + ARB would also work.
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What natriuretic peptides are used in CHF? Why?
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nesiritide, for balanced vasodilation and volume management while sparing the kidneyes. May affect remodeling and pulm HTN.
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What inotropic support do you give for CHF? Why?
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dobutamine and milrinone are used for short-term improvement but worsen mortality when used long-term. Don't use chronically or intermittently.
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How would you treat more advanced CHF?
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cardiac resynchronization therapy (biV pacing), nesiritide (if acutely decompensating w/o hypotension), avoid chronic inotropic support
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How do you treat stage D CHF?
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heart transplant (if no comorbidities, heart availability, etc)
ventricular assis device (waiting for transplant) mechanical heart (trials) |
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What is CHF characterized by symptomatically?
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R-sided --> periph edema, hep congestion, increased intravasc volume, wt gain.
L-sided --> pulmonary edema decreased cardiac output --> loss of reserve, dyspnea on exertion then chronically and with acute exacerbations of decompensated heart failure. |
