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26 Cards in this Set
- Front
- Back
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What are the top four and most common etiologies of Heart failure?
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1. 60% CAD- ischmic heart disease
2. 18% idiopathic dilated cardiomyopathy 3. 12% valvular heart disease 4. 10% HTN heart disease |
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In clinic what is the most commonly seen type of heart failure?
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chronic, systolic, low LV function (ejection fraction)
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What are common signs and symptoms of heart disease?
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a. weakness/fatigue
b. dyspnea c. hepatomegalia- Increased LFT levels due to congestion d. JVD e. crackles in lungs f. s3, s4 |
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Describe the NYHA's functional classifcation of class of HF...
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Classes
1.No limitation of physical activity – No symptoms with ordinary exertion 2. – Slight limitation of physical activity – Ordinary activity causes symptoms 3. – Marked limitation of physical activity – Less than ordinary activity causes symptoms – Asymptomatic at rest 4. – Inability to carry out physical activity without discomfort – Symptoms at rest |
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When recommending treatment what are the classes and what does each mean for evidence?
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Class I – evidence and/or agreement that therapy/procedure is beneficial, useful and/or effective
Class II – conflicting evidence and/or divergence of opinion II(a) – Weight of evidence/opinion in favor II(b) – Less established evidence/opinion Class III – Evidence and/or agreement that therapy/procedure is NOT effective; may be harmful |
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Describe the a,b,c level of evidences...
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A – Data from meta-analysis or multiple randomized clinical trials
B – Data fro single randomized trial or nonrandomized studies C – Only consensus opinion of experts, case studies, or standard of care |
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What is the most common cause of LV systolic dysfunction?
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ischemic heart disease
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Name causes of heart failure associated with ventricular overload
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1. Pressure
2. HTN 3. aortic stenosis 4. pulmonary htn 5. coarct of aorta 6. aortic insufficiency 7. VSD- ventricular septal defect 8. ASD- atrial septal defect 9. MR- mitral regurg |
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What are the basic causes (non disease) of heart failure?
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1. myocardial damage- (CAD/IHD)
2. ventricular overload- (stenosis, regurg, shunts or leaks) 3. Restriction/ obstruction to ventricular filling- (stenosis, myxoma, fistula, infarct) |
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What are the mechanisms of heart failure for... start with a LV dysfuntion, then go into detail about SNS effects
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1. LV dysfunction causes C.O. to decrease and activate SNS, RAAS, arginine- vasopressin for compensation
2. SNS- increase sends NE out 3. NE causes vasoconstriction which increases afterload, BP, and decreases C.O. 4. This increases HR and contractility, which leads to higher release of ADH, which leads to Na reabsorption and more fluid retention 5. Eventual myocardial remodeling 6. Further bad things including reduced diastolic filling time, Breceptors become less efficeint |
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Describe briefly the effect of the RAAS in causing heart failure.
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a. decreases renal perfusion leads to increased renin, which creates A1 which creates A2 which causes ADH release
b. ADH causes kidney reabsorption of Na/H20 (increases preload) c. A2 also causes vasoconstriction increases pulmonary ventricular resistance (after load) |
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What is the bad effect related to heart failure of an increase in ADH
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causes reabsorption of Na/Water which cause peripheral edema but it also could stimulate thirst glands and more water you drive the more likely you may get hyponatremia
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What are the groups used to classify what type of Heart failure it is?
What is the most common? |
Most common is Systolic, low, chronic
Groups 1. systolic/diastolic 2. high/low 3. acute chronic 4. right/left 5. forward/backward |
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What is going on with systolic heart failure and what are clinical symptoms?
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Ejection Faction (EF) is less than 40% hypofusion with impaired ventricular emptying (usually 60%)
- will show weak, fatigued, reduced exercise tolerance, Breathing- DOE (dyspnea on exertion), orthopnea, paroxysmal nocturnal dyspnea |
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Compare Diastolic vs Systolic heart failure
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Diastolic- "preserved systolic" has normal ejection fraction (EF) and systolic has thoroughly reduced EF. Diastolic more likely in woman without other causes
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How would you treat diastolic heart failure
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Beta blocker- allows more time for ventricle to fill
CCB- decrease BP and slow HR avoid inotropic agents (vassopressors) |
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Distinguish acute vs. chronic heart failure
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Acute- presents with Hypotension, and peripheral edema
quick and possibly due to some MI, ruptured papillary muscle, MR, Al, toxin - usually systolic HF Chronic- many valves or dilated cardiomyopathy slow progression/ edema |
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What does right sided heart failure cause?
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If not cause by left side heart usually due to cor pulmonale
RV failure- increase venous pressure, JVD, hepatomegaly often stems from left heart failure |
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Name the type of heart failure by the following descriptions...
a. venous engorgement, hepatic enlargement, and pitting edema. b. |
a. right sided heart failure
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If patient is in HF and greater than 65, has A. fib what should be focused in addition to other cardiac exam?
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check thyroid
Free T4 and TSH |
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Explain the significance of BNP?
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brain natriuretic peptide
higher levels = worse performing heart Increase BNP = lower EF levels > 100 but around 300 to get excited |
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Name the medicine that should be used for the particular problem...
a. use indicated in all levels of heart failure (contraindications/side affect) b. Used in all classes except IV could feel worse at first c. most efficient way to reduce pulmonary congestion quickly (name and use) d. used in addition to other HF drugs mostly used on class III and IV (other name) |
a. ACE inhibitors- watch for hyperkalemia (angioedema, pregnancy, cough)
b. beta blockers c. diuretic (lasix drip for pulmonary congestion) d. spironolactone (aldactone) |
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Name the medicine that should be used for the particular problem...
a. aldosterone blocker b. useful for afib to slow ventricular rate (name) 4th or 5th line drug for HF c. needed for decompensated patient or potential transplant d. better response to this druge in Afro-Americans when added to ACE and ARBs |
a. eplerenon "inspar"
b. digitalis- lanoxin- c. inotropes (vasopressor) d. hydralazine and nitrates |
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Name the medicine that should be used for the particular problem...
a. 2nd generation prefered over first and useful in HTN and angina b. no cough side affect and block AT1 receptor |
a. Ca calcium channel (amlodipine)
b. ARB (Candesartan, Valsartan, Losartan) |
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What is proper time of use and OMM in HF lymph treatment?
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Only in chronic hemodynamically stable
1. open thoracic duct 2. Rib raising 3. Diaphragm doming 4. efflourage/pettrisage 5. cervical stroking |
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What are devices for therapy for HF that has evidence?
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resynchronization using ICD- implantable cardioverter defribllator
- stop gap between getting a new heart |
