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Flashcards in Heart Failure Continuum of Care Deck (100)
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1

Co-morbidities with Heart Failure in WOMEN

HTN
Valvular disease
Thyroid function
Less obstructive CAD
DM
LVH (increased mortality)

2

Define Heart Failure

Complex, heterogeneous & progressive syndrome characterized by structural and/or functional abnormalities in cardiac contraction, consequent adverse euro-hormonal adaptations & remodeling & co-morbidities that collectively alter myocardial function, fluid regulation, respiration, & perfusion & overall hemodynamic stability

3

Unusual Causes of Cardiomyopathy

Hypertrophic obstructive cardiomyopathy (HCM)
AL amyloid cardiomyopathy
Myocarditis
Tachycardia-induced cardiomyopathy (TIC)
Takotsubo cardiomyopathy (TTC)
Peripartum cardiomyopathy (PPCM)

4

Co-Morbid Conditions in Heart Failure

Anemia: of chronic disease
Gout: thiazides contribute
HTN
Renal dysfunction: murderous marriage with the heart
Lung disease; sleep-disordered breathing
Rapid or irregular dysrhythmias
DM
Thyroid disorders

5

Types of Remodeling in Heart Failure

Hypertrophy (preserved EF HF)
Dilation (reduced EF HF)

6

Clinical Features of Heart Failure with Preserved Ejection Fraction

Volume overload
Decreased activity tolerance
QOL similar to low EF patients

7

Heart failure with preserved ejection fraction is associated with what kind of dysfunction?

Diastolic dysfunction

8

Signs/Symptoms of Diastolic Dysfunction

Increased LV wall stiffness
Decreased compliance/impaired relaxation
Decreased cardiac output

9

3 Stages of Diastole

Isovolemic (active) relaxation & rapid early filling
Diastasis (passive) filling
Active filling during atrial contraction

10

Define Grade 1 Diastolic Heart Failure

Impaired relaxation

11

Define Grade 2 Diastolic Heart Failure

Pseudonormal
Concomitant LA enlargement, LV hypertrophy and/or decreased LV ejection fraction

12

Define Grade 3 Diastolic Heart Failure

Restrictive/constrictive
Difference is reversibility
Impaired LV relaxation
Increased LV stiffness
Increased LA pressures

13

Define Dilation

Compensate for poor cardiac output, ventricle dilates, becomes thinned & weakened

14

Heart failure with reduced ejection fraction is associated with what kind of dysfunction?

Systolic dysfunction

15

Clinical Features of Reduced Ejection Fraction Heart Failure

Impairment of LV contraction
EF less than 40%
Decreased stroke volume
Decreased cardiac output
Engorgement of systemic veins
Decreased perfusion to vital organs

16

Atrial Fibrillation in Heart Failure

Lead to an acute decompensated state

17

Common Symptoms of A-fib in Heart Failure

Fatigue
Dyspnea
Especially in preserved HF

18

Factors that Contribute to HF

Cardiac chamber enlargement
Conduction system & anatomical heart abnormalities
Adaptations of SNS
Adverse responses to medications
Electrolyte abnormalities

19

Functional Classification of HF

Class 1 (Minimal): no limitations
Class 2 (Mild): no strenuous activity
Class 3 (Moderate): activity limited to ADLs
Class 4 (Severe): symptoms with any physical activity

20

2 Parts of a Cardiovascular Assessment

Wet or dry: assessing fluid status & congestion
Warm or cold: assessing indicators of perfusion

21

No Low Perfusion or Congestion at Rest

Warm & dry

22

Congestion at Rest but No Low Perfusion at Rest

Warm & wet

23

Low Perfusion at Rest & No Congestion at Rest

Cold & dry

24

Lower Perfusion & Congestion at Rest

Cold & wet

25

Possible Evidence of Low Perfusion

Narrow pulse pressure
Sleepy/obtunded
Low serum sodium
Cool extremities
Hypotension with ACE inhibitor
Renal dysfunction

26

Signs/Symptoms of Congestion

Orthopnea/PND
JV distension
Ascites
Edema
Rales (rare)
S3
Hepato-jugular reflex

27

Follow Up Questions with SOB

Occurring at rest or with exertion
Awaken patient from sleep
Occur when walking on a flat surface; worse with stairs/carrying items
Increasing with daily activities now as opposed to 1 & 6 months ago
Ask family if patient looks more SOB than normal

28

Follow Up Questions with Cough

Productive, non-productive, blood tinged sputum
Worse with exertion or when lying down
Patient taking any new medication

29

Follow Up Questions with Chest Pain

Description
Accompanied by diaphoresis, SOB, N/V
Alleviating or aggravation factors
With or without exertion
Awaken patient from sleep

30

Follow Up Questions with Palpitations

Circumstances when symptoms occur
Duration & description
Accompanied by dizziness, loss of consciousness, shock from ICD