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34 Cards in this Set
- Front
- Back
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Primarily a clinical condition in which the heart is unable to meet the metabolic requirements of the body, typically manifested by fluid retention.
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Congestive Heart Failure
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% of Diastolic HF in total HF
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30% .. maybe 50%
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Dilated CMO:
Sys or Dia Dysfunction? |
Systolic dysfunction
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Normal systolic dysfunction
Abnormalities with diastolic relaxation and diastolic stiffness |
Diastolic Dysfunction
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High Output Failure, secondary to what extra-cardiac abnormalities?
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Sepsis, Thyrotoxicosis, anemia, AV fistula, Beriberi, High metabolic (Paget’s)
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Increased resistance to diastolic filling and reduced relaxation results in increase in ___?___ and subsequent pulmonary edema and right sided failure
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LVEDP
(Diastolic dysfunction ) |
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Elevated ___?___ resulting in increased wedge pressure, capillary leak and pulmonary edema, also right side failure
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LVEDP
(Systolic dysfunction (CMO) ) |
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_______lesions can result in increased filling pressures, volume overloaded heart
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Regurgitant valvular lesions
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________ lesions can cause reduced cardiac output, increased diastolic pressure, pulmonary edema
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Stenotic lesions
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Treatment modalities aimed towards improvement in these 4 parameters affecting Cardiac Performance
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Heart rate
Contractility (Inotropism) Preload (Filling pressure) Afterload (Increased work on the heart) |
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High output states of CHF result in ______, _______, ________ with ________
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increased C.O., subsequent fluid retention, and increased pulmonary perfusion with pulmonary edema
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Starling mechanism:
Ideal ventricular stretch (__?__) optimizes cardiac performance |
preload
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What is caused by the following:
Increased lung stiffness to breathing Interstitial water affects gas exchange |
dyspnea
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Drugs good to decrease preload?
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diuretics, lasics, morphine
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Drugs good to decrease afterload?
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lisinopril, maybe beta blockers.
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Morphine depresses the respiratory system, why is this good for HF pt?
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Give small dose (4mg) and resp sys will be fine,
causes vasodilating effects |
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Congestive Heart Failure Clinical Manifestations
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Dyspnea, Orthopnea, PND, Fatigue
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Congestive Heart Failure Physical Findings
(Right sided) |
Neck vein distention
Peripheral edema, usually lower extremity due to gravity Hepatomegaly secondary to volume congestion Pleural effusions due to volume overload, increased capillary pressure with cavity space secretions Bilateral or right side effusion, rarely if ever isolated left side effusion Ascites Anasarca Right side third heart sound, TR, RV heave |
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Congestive Heart Failure Physical Findings
(Left sided) |
Pulmonary rales secondary to edema
Left side third heart sound |
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Congestive Heart Failure Physical Findings
(Reduced C.O.) |
Pale, cool skin, peripheral cyanosis
Tachycardia, reduced blood pressure Somnolence, mental confusion Cheyne Stokes respiration |
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Why hear a Left side third heart sound in CHF?
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MR
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Lab results of CHF
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Hyponatremia -Dilutional
Pre renal azotemia -Renal hypoperfusion Elevated B natriuretic peptide -Excellent marker for acute CHF |
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BNP under 100. Is it HF?
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Probably not.
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ECG of CHF?
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Nothing specific
Tachycardia, LVH, non specific changes |
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CXR of CHF?
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Cardiomegaly
Interstitial, pulmonary edema Pleural effusions |
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Echo findings of CHF?
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No changes diagnostic of CHF but mechanism can be ascertained possibly
(Echo diagnoses cardiomyopathy) |
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Catheterization findings in CHF?
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Swan Ganz: elevated PWP, decreased cardiac output in systolic dysfunction, hemodynamically significant pericardial, congenital, or valvular disease
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Treatment of CHF
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Oxygen
Fluid restriction Bed rest Blood pressure control Upright bed position Diuretics -Reduce both volume and preload Nitrates, morphine -Preload reduction ACE-I, ARB agents -Afterload reduction Inotropes -Digitalis, less useful than previously thought Dobutrex, milrinone, epinephrine, etc(Improve cardiac output) Beta blockers Intra-aortic Balloon Counterpulsation |
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Is Digoxin a good inotropic agent?
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no
use dobutamine, primacore, or big gun epinephrine |
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probably the superior beta blocker in CHF
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Carvedilol
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What is the Beta blocker for severe acute CHF
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None.
Do not use Beta blockers for sever CHF |
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Drug class used to Improve heart’s environmental mileau in acute CHF
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Beta blockers
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Congestive Heart Failure Treatment of Chronic CHF
(Systolic Dysfunction vs. Diastolic) |
Syst dys: Salt, fluid restriction
Diastolic Dysfunction: --Blood pressure control is paramount --Salt, fluid restriction |
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Congestive Heart Failure Treatment of Chronic CHF
(pharm) |
Pharmacologic Agents
ACE-I and ARB agents Beta Blockers Diuretics, not always Digitalis, in refractory cases Aldactone Inhibitory to the affects of increased renin Consider ICD (implanted cardiac defibrillator) since cause of death is mostly arrhythmic Consider RCT (resynchronized cardiac therapy) especially in patients with LBBB to correct the dys-synergy inherent in this abnormal myocardial contractile condition |
