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34 Cards in this Set
- Front
- Back
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For class of heart failure, what are the different functional classes and levels?
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I-asymptomatic
II-symptomatic w/ moderate exertion III-symptomatic w/ minimal exertion IV-symptomatic at rest |
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Why does orthopnea occur?
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increase venous return
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Symptoms of heart failure
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pulmonary rales (elevated capillary pressure)
S3 or S4 gallop (inc LV pressure, dec compliance) orthopnea peripheral edema (elevated capillary bed pressure) Hepatomegaly (inv IVC pressure) distended jugular veins (elevated R atrial pressure) |
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3 signs on CXR of pulmonary edema
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bat wing (alveolar edema)
prominent upper lobe vessels (redistribution) Kerley B Lines (interstitial edema) |
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Normal CVP/JVP
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normal CVP <7mmHg
or normal JVP <9cm H2O |
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Causes of Right HF
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mainly secondary, including:
-Left HF (most common) -chronic lung disease -primary pulmonary HTN Also primary causes. |
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Primary causes of right HF
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R ventricular infarction
pulmonic stenosis tricuspid regurgitation congenital heart disease arrhythmogenic RV dysplasia |
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Most common presenting symptom of HF
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dyspnea on exertion
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6 findings in left heart failure
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diaphoresis
tachypnea sinus tach pulmonary rales auscultatory gallops cool extremities |
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PE findings in Right HF
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JVD
hepatic enlargement ascites lower extremity edema |
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Cause of S3 gallop
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early diastolic filling of volume-overloaded ventricle
(normal in children) |
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Cause of S4 gallop
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late diastolic filling/atrial contraction into stiff ventricle
(never in A-fib) |
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Staple for dx of systolic heart failure
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echocardiogram
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In addition to drugs for HF, what are the dietary adjustments needed?
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dec salt and dec water intake
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Goals of hemodynamic changes for HF?
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afterload reduction
-dec vascular tone -dec BP |
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Why use neurohormonal drugs?
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Save lives (and prolong them)
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In which class are a majority of patients killed by heart failure itself?
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Class IV
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When are defibrillators used?
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When EF <35%
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What is present on EKG with dilated cardiomyopathy?
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wide QRS
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Only cure for HF
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heart transplant
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Key difference between acute MI and Acutely decompensated heart failure
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aMI has 2% mortality after discharge (60-90d)
ADHF has 10% mortality within same period |
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Precipitating factors for decompensated HF
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inc metabolic demands
inc circulating volume conditions that inc AL or dec contractility excessive bradycardia medical or dietary non-adherence |
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If patients come in "cold", what does that indicate?
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dec cardiac output
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What are some symptoms in those that present "cold"?
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N, early satiety, altered mental status, acidosis, reduced capillary refill, cold skin, hypotension, narrow pulse pressure
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If patients come in "wet", what does that indicate?
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inc pulmonary capillary wedge pressure (preload)
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Symptoms of "wet" ADHF
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dyspnea, orthopnea, PND, morning cough, peripheral edema, rales, ascites, hepatic congestion, JVD
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What measure can be elevated during HF?
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B-type natriuretic peptide
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How to calculate cold presentation of ADHF
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pulse pressure is difference between 2, then calculate proportional pulse pressure (PP / SBP)
<25% predicts Cardiac index <2.2 |
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2 main goals of tx of ADHF
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relieve congestion (optimize preload)
assure adequate tissue perfusion (BP & CO) |
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How do diuretics help with CHF?
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dec preload (relieve pulmonary edema)
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Effect of routine use of inotropes on survival
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does not extend life, may shorten it
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movement to left on same curve on Frank-Starling curve
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tx w/ diuretics
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What tx are used to improve symptoms?
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diuretics
digoxin inotropes vasodilators |
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What tx are used to save lives?
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ACE inhibitors/ARB
BB hydralazine/nitrates aldosterone inhibitors ICDs CRT |
