Diagnosis & Treatment of Heart Failure Flashcards Preview

CVPR: CV Unit I > Diagnosis & Treatment of Heart Failure > Flashcards

Flashcards in Diagnosis & Treatment of Heart Failure Deck (25)
Loading flashcards...
1
Q

Major pathophysiological characteristics that lead to symptoms of heart failure (3)

A
  • decreased cardiac output
  • increased pulmonary venous pressure
  • increased central venous pressure
2
Q

Heart failure symptoms associated w/decreased cardiac output

A
  • FATIGUE
  • Symptoms of decreased organ perfusion
    • Muscle→fatigue, tiredness/sleepiness
    • Gut→anorexia, wasting (cachexia)
    • Kidney→↓urine output, renal dysfunction
    • Exercise intolerance→inability to augment cardiac output to meet increasing demands of stress/exercise.
3
Q

Heart failure symptoms associated w/increased pulmonary venous pressure

A
  • **DYSPNEA **(breathlessness)
  • Dyspnea on exertion
  • Orthopnea
  • Paroxysmal nocturnal dyspnea (PND)
  • Acute pulmonary edema
4
Q

Heart failure symptoms associated w/increased central venous pressure

A
  • Peripheral swelling/dependent** EDEMA**
  • Ascites
  • Hepatic congestion
  • Intestinal congestion (protein-losing enteropathy)
5
Q

Orthopnea definition

A
  • SOB when lying flat
  • 1) fluid normally accumulates in lower lobes of lungs (due to gravity) –> allows breathing from upper lobes
    • lying down –> fluid disperses throughout lungs –> dyspnea
  • 2) increased venous return b/c decreased gravity pull on returning blood –> increased congestion & SOB
6
Q

Paroxysmal nocturnal dyspnea (PND) definition

A
  • delayed SOB, waking patients from sleep
  • mobilization of edema from tissue through lymphatics back into blood stream
7
Q

Symptoms/causes of acute pulmonary edema

A
  • acute, intense shortness of breath
  • “fluffy” infiltrates on an CXR
  • occurs once fluid retention/left atrial pressure overwhelms compensatory mechanisms→fluid spills from the pulmonary vasculature into the interstitial space and then into the alveoli→hypoxia
8
Q

NY Heart Association functional classification scheme of heart failure

A
  • I: asymptomatic
  • II: symptomatic with moderate exertion
  • III: symptomatic with minimal exertion
  • IV: symptomatic at rest
9
Q

ACC/AHA Heart Failure Stage Classification system

A
  • A: At high risk for heart failure but without structural heart disease or symptoms of heart failure
  • B: Structural heart disease but without symptoms of heart failure.
  • C: Structural heart disease with prior or current symptoms of heart failure.
  • D: refractory heart failure requiring specialized interventions.
10
Q

Common precipitants of worsening heart failure/symptoms (6)

A
  • Increased circulating volume (Preload)→sodium load in diet, renal failure
  • Increased pressure (afterload)→uncontrolled hypertension (LV), worsening aortic stenosis (LV), pulmonary embolism (RV)
  • Worsened contractility (inotropy)→myocardial ischemia, initiation of negative inotrope (beta-blocker or calcium channel blocker)
  • Arrhythmia (rate)→bradycardia, atrial fibrillation
  • Increased metabolic demands→fever, infection, anemia, hyperthyroidism, pregnancy
  • NON-ADHERENCE WITH HF MEDICATIONS.
11
Q

Characteristics of clinical course of heart failrure

A
  • clinical course = variable, non-linear
  • marked by episodic exacerbations with significant symptoms (sometimes requiring hospitalization), with intervening periods of relative stability.
  • Patients rarely stay at a singly NYHA class over time; they may move between functional classes depending on a number of factors
  • usual course is an average of progressive decline over time.
12
Q

Key pathophysiological problems that lead to signs of heart failure (4)

A
  • low flow/cardiac output
  • elevated left-sided filling pressures
  • elevated right-sided pressures
  • abnormal contractions –> extra heart sounds
13
Q

Signs of low flow (3)

A
  • Cool extremities—peripheral vasoconstriction to redirect what existing blood flwo there is to vital organs.
  • Tachycardia—compensate for low stroke volume
  • Low pulse pressure—reflection of low output.
14
Q

Signs of elevated left-sided filling pressures

A
  • rales (pulmonary crackles)—fluid in the lungs, wet alveoli opening
  • Hypoxia
  • Tachypnea
  • Comfortable only when upright, tri-podding
  • Popping open of alveoli
15
Q

Signs of elevated right-sided pressures (3)

A
  • Edema—dependent=follows gravity
  • Hepatic congestion/hepatomegaly
  • Jugular venous distention (JVD) = ↑ central venous pressure
16
Q

Characteristics of Jugular Venous Pressure (JVP)

A
  • JVP = CVP = right atrial pressure
  • Normal < 5 cm H2O.
  • With a person lying flat or a person with JVD in HF, the jugular vein (internal and external) will fill with blood.
  • JVD –> visibily full neck veins on visual examination.
  • Jugular venis will transmit pressure changes in the right atrium as waves, visible fluctuations in the vein size and in the meniscus.
17
Q

Types of abnormal heart sounds encountered in HF (2)

A

Gallops

  • S3 gallop—rapid expansion of the ventricular walls in early diastole
    • HFrEF/dilated heartKen-tuc-ky (S1-S2-S3)
  • S4 gallop—atria contracting forcefully in an effort to overcome abnormally stiff or hypertrophic LV
    • Ten-ne-ssee (S4-S1-S2)
18
Q

Major types of laboratory/imaging studies & tests used in dx of HF

A
  • lab tests: natriuretic peptides
    • BNP (B-type natriuretic)
    • NT-proBNP
  • imaging studies
    • CXR
    • Electrocardiogram (EKG)
    • Echocardiography
  • Catheterization
19
Q

BNP & NT-proBNP definition

A
  • BNP=B-type natriuretic peptide –> secreted by myocardium in response to:
    • Primary: ventricular stretch
    • Secondary: hyperadrenergic state, RAAS activation, ischemia
  • BT-proBNP: n-terminus breakdown product of BNP
    • remains in blood longer and is easier to measure
20
Q

Primary dx use of BNP/pro-BNP

A
  • clincally used to rule out HF
  • used as a comparison to base BNP levels
  • multiple root causes that can lead to elevated BNP
21
Q

Dx of HF via CXR

A
  • Enlarged cardiac silhouette = HFrEF
  • ↑upper lobe vascular markings = acute decompensation
  • fluffy infiltrates = pulmonary edema
  • pleural effusions
22
Q

Dx of HF via EKG

A
  • No direct diagnosis of HF can be made w/EKG
  • Can infer possibility of HF from other findings:
    • Q waves—prior MI
    • Increased voltage—LVH
    • Arrhythmia (AF, PVCs), non-sustained ventricular tachycardia (NSVT)
23
Q

Dx of HF via Echo

A
  • Provides information on a number of different factors:
  • LVEF
  • chamber size (dilation), LV wall thickness (hypertrophy)
  • measures of relaxation (diastology)
  • valvular anatomy and function
  • filling pressures, pulmonary pressures.
  • Advantages: real time, non-invasive, no radiation, inexpensive
24
Q

Characteristics of right heart catherization

A
  • A plastic catheter is placed into a major vein and floated through the right heart and into the pulmonary artery
  • A balloon on the end helps blood flow carry it to the lungs.
    • Balloon allows a branch of the pulmonary artery to be occluded so that the downstream pressure can be measured = left atria pressure / left sided filling pressure
25
Q

Measurements that can be obtained from right heart catheterization

A
  • ​Measure pressures—CVP/RA, RV, PA, PCWP
  • Measure flow/CO
  • Resistances can be calculated from pressures and flow.