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16 Cards in this Set
- Front
- Back
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What is most common cause of heart
failure? |
Ischemic cardiomyopathy in industrialized countries, in others, infectious diseases.
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What are the risks for heart failure?
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HTN, DM, cardiotoxic substance use (smoking, cocaine, chemos s.a. anthracycline, trastuzumab), HLD, thyroid Dz, tachycarida, CAD
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What are some symptoms and signs for heart failure?
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dyspnea, fatigue, exercise-intolerance, fluid retention, SOB
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What tests should you get in evaluating heart failure?
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ACC/AHA recommends, EKG, Echo, exercise testing, cardiac cath, endomyocardial bx, BNP, TSH. CXR
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What are the types of heart failure?
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Systolic heart failure
Diastolic heart failure |
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What is the distinction between systolic and diastolic heart failure?
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In systolic heart failure, the EF < 50%.
In diastolic heart failure, the EF is normal. |
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How should you evaluate functional capacity in patients with heart failure?
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Use the NYHA, 6 min walk test.
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What is the NYHA?
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Functional classification of heart failure.
class I; asymptomatic with normal activity. class II; fatigue, SOB with normal activity. class III; symptomatic with minimal activity. class IV; symptomatic at rest. |
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What dietary restriction in the management of heart failure?
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Despite paucity of evidence, the ACC/AHA, sodium restriction < 2gm
and fluid < 2 quarts per day. |
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What pharmacotherapies use for tx of heart failure?
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ACEi,(ARB in pt intolerable of SE of ACEi) Endpoint is SBP to 90mm Hg
BB, who are stable on ACEi. (multiple studies to back this up, CAPRICORN, COPERNICUS studies) |
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What med you use if pt is intolerant of ACEi or BB?
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Use Hydralazine and long acting Nitrates.
In AA who are symptomatic, use it in combination with ACEi or ARB increased survival. (The A-HeFT trial) |
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When is Aldosterone Antagonists appropriate for heart failure?
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NYHA class III to IV despite ACEi and BB. (The Randomized Aldosterone Evaluation Study). Eplenerone is newer, more selective aldosterone antagonist with fewer SE.
Combo of ACEi/ARB and spiroondactone should be avoided d/t increased risk of hyperK+ |
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What is the role of loop diuretics in heart failure?
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Use in combination with Low sodium diet to control volume overload, maintain stable wt and improve functional capacity. NEVER be use alone in patient with heart failure.
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What is the role of digoxin in heart failure?
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Digoxin can alleviate symptoms and decrease hospitalization. No survival difference when compared to placebo.
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What are the treatment goals for diastolic heart failure?
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control
1. HR to allow adequate filling 2. SR 3. control volume to decrease diastolic pressure 4, control BP 5, minimized ischemia |
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When is an intracardiac device (ICD) indicated in heart failure?
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patients with EF of <30% in NYHA I, II, or III and an overall life expectancy of > 6 months.
Class IV do no benefit from ICD placement. (DEFINITE study) |
