Hfref (Heart Failure: Refuced Ejection Fraction) Aka Systolic

Front 1

HFrEF is characterized by what?

Back 1

Dilated cardiomyopathy, the ventricles are dilated; dilatation causes thinner muscle and therefore reduced contractility.

Front 2

Causes

Back 2

CAD (80%)
HTN
DM
ETOH "alcoholic cardiomyopathy"
VIRAL INFECTIONS
CHEMOTHERAPY

Front 3

Chemotherapy Agents causing HFrEF

Back 3

Doxirubacin, Trastuzamab

Front 4

Clinical findings of HFrEF

Back 4

s3 murmur, JVD ,dyspnea
peripheral edema
parox nocturnal dyspnea
orthopnea (?how many pillows used at night)
fatigue

Front 5

Diagnosis

Back 5

Chest Xray (cardiomegaly-- nonspecific but indicative.... pulmonary edema-- nonspecific but indicative)

BNP - can be falsely low in obese pts, secreted by myocardium, also, elevated in an exacerbation

ECHOCARDIOGRAM - u/s of heart :: dilated chamber, EF percentage,

Front 6

NYHA Heart failure classifications

Back 6

class 1 : asymptomatic
class 2: SOB c ADLS
class 3: slightest activity will cause SOB
class 4: SOB at rest

Front 7

ACC/AHA stages of heart failures

Back 7

stage A: high risk, no structure or functional abnormalities
Stage B: structural abnormalities, asymptomatic
Stage C: symptoms are now present
Stage D: very severe symptoms even with medical optimization

Front 8

HFrEF Med Mgmt DIURETICS

Monitor for WHAT when on diuretics

Back 8

Diuretics

symptom relief only. they do not relieve morbidity and mortality EXCEPT FOR SPIROLACTONE

-loop diuretic (lasix)
-thiazide diuretic (metolazone)
-aldosterone blockers (aldactone)
-sequential nephron blockade

MONITOR WEIGHT & LYTES

Front 9

HFrEF ACE INHIBITORS ('PRILS)

Monitor for WHAT when on ACE Inhibitors?

Back 9

1st line therapy for reduced EF: ACE inhibitors

decrease symptoms
reduce ventricular size
increase ejection fraction
decrease risk for IM

MONITOR FOR: Cough, angioedema, hypotension, crt, K+

Front 10

ARB's (angiotensin receptor blockers) ('sartans)

Back 10

similar benefits to ACE inhibitors

alt tx to ACE inhibitors

controversy to ACE/ARB combo (inc risk of hyperK+)
risky, no proven benefits to combo

Front 11

Beta Blockers (olol's)

WARNINGS AND CONTRAINDICATIONS

MONITOR FOR??

Back 11

Improved systolic function
inc EF 5-10%
reduced symptoms
decreased risk of mortality

NEVER START OR STOP DURING AN EXACERBATION!!!
CONTRAINDICATED IN ASTHMA OR 2nd or 3rd AV BLOCK!!!! (bronchoconstriction, worsens av block)

MONITOR FOR: bradycardia, hypotenion, bronchospasm

Front 12

aldosterone blockers

Back 12

reduction in mortality, symptoms, hospitalization

def add to anyone stage 3 or 4 HF

Monitor: K+, BP, Crt

Front 13

For Afro Americans

Back 13

Hydralazine with Isosorbide Dinitrate

Reduces hospitalization but NOT mortality

Front 14

MEDS TO AVOID IN PTs WITH HFrEF !!!

Back 14

AVOID Thiazolidinediones (DM MED) (ACTOS)

ANTI-ARYTHMICS

NSAIDS

Front 15

MAKE SURE FLU AND PNA ARE UP TO DATE!!

Back 15

MAKE SURE FLU AND PNA ARE UP TO DATE

Front 16

Consider ICD therapy

Back 16

decreased risk for sudden cardiac death

INDICATIONS: EF < 35 % , survival of > 1 yr

Front 17

Consider Atrial Synchronized Biventricular Pacing

(different set of indications)

Back 17

very severe HF increased risk conduction delays

Indications:
NYHA stage 3 or 4 despite max therapies
EF < 35%
Sinus Rhythm
QRS must be wide, greater than 120msec

Front 18

CARDIAC REHABILITATION

Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems.

Rehab programs include exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life.

Back 18

improves symptoms and quality of life but does not improve mortality

Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems.

Rehab programs include exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life.