Term
| Heart failure is the pathophysiological ___ state in which the heart cannot pump blood efficiently enough to meet the body's needs. |
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Definition
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Term
| Heart failure definitions: |
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Definition
Syndrome caused by cardiac dysfunction generally resulting from myocardial muscle dysfunction or loss, and characterized by LV dilation or hypertrophy…Heart Failure Society of America, 2006
Characterized by elevated cardiac filling pressures or inadequate peripheral oxygen delivery at rest or during stress…HFSA, 2006 |
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Term
| DRG: way of classifying diagnoses based on length of stay, every disease entitiy has a DRG, someone comes in with HF DRG says should take 3 days to get under control, so 3 days will be payed for with X number of dollars, if patient leaves in 2 days> hospital keeps extra money, if pt stays 6 days> the hospital does not get more money, no more money from Medicare |
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Definition
DRGs have been used in the US since 1982 to determine how much Medicare pays the hospital for each "product", since patients within each category are similar clinically and are expected to use the same level of hospital resources. DRGs may be further grouped into Major Diagnostic Categories (MDCs).
Contents
[hide]
Diagnosis Related Group= DRG |
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Term
| 3 types of cardiomyopathy: |
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Definition
- Dilated
- Hypertrophic
- Restrictive |
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Term
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Definition
- increased JVP
- neck vein distention
- REDUCED LEFT VENTRICULAR EJECTION FRACTION
- left ventricular heave
- S3
- laterally diplaced PMI
- crackles
- peripheral edema
- hypertension
- hepatomegaly (later sign)
Left ventricle is too stretched out and cannot recoil back very well. |
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Term
| Hypertrophic cardiomyopathy: |
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Definition
- double apical pulse
- S4 harsh holosystolic murmur at lower left sternal border
- myofilaments look like ground glass (congenital disarray of myofilaments- autosomal dominant trait)
- septum hypertrophies obstructing the outflow tract (sudden death on the field) |
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Term
| the type of cardiomyopathy responsible for sudden death on the football field? |
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Definition
| Hypertrophic cardiomyopahty- autosomal dominant |
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Term
| Patients with hypertrophic cardiomyopathy have ejection fractions of __% and have __ ventricles, so they end of getting __ ___ like __ __ and __ __ which can lead to sudden cardiac death. Defibrillators can save these patients lives. |
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Definition
- 80-90%
- hyperdynamic ventricles
- ventricular dysarrhythmias
- ventricular tachycardia
- ventricular fibrillation |
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Term
| the cardiomyopathy that is least common of the 3: |
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Definition
| Restrictive cardiomyopathy |
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Term
| Restrictive Cardiomyopathy: |
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Definition
- orthopnea
- dyspnea
- JVD S4- CLASSIC
- tachycardia
- diaphoresis
- HTN
- crackles
- PRESERVED LV FUNCTION
- BILATERAL ATRIAL ENLARGEMENT
- PROMINENT PULMONARY VASCULATURE
- NO LVH
- LBBB |
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Term
| Normal ejection fraction is ___%. Patients with dilated cardiomyopathy have __ ejection fractions, so blood just sitting in heart overflows back to the ___ and ___. Initially these patients have __, but later they get __. |
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Definition
- 55-75%
- reduced
- lungs and tissues
- hypertension
- hypotension |
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Term
| Major risk factors for HF: |
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Definition
- CAD
- Diabetes
- Hypertension
- Valvular Heart Disease
- Alcoholism
- Congenital heart defects
- Previous MI |
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Term
| Additional risk factors for HF: |
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Definition
- obesity
- age
- reduced or failing vital capacity
- smoking
- high or low hematocrit levels |
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Term
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Definition
CAD or history of MI
Hypertension
Diabetes
Obesity
Smoking
Family History
Valvular Heart Disease
Alcoholism
Hyperlipidemia
Cardiotoxic Medications
Congenital heart defects
Other:
Age
Reduced or falling vital capacity
High of low hematocrit level
Illicit Drugs
Virus |
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Term
| Most common cause of restrictive cardiomyopathy: |
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Definition
- amyloid or sarcoid infiltrative diseases> normal tissue gets replaced with fibrotic tissue
- hypertension may also cause this |
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Term
| #1 cause of death with HF: |
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Definition
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Term
| Normally myocardium metabolizes glucose and fatty acids to CO2 and water. When there is a lack of oxygen, glucose gets converted to __ instead which __ the extracellular pH. This leads to decreased stores of high energy phosphates like __ and __ leading to impaired __ __ function. Thus __ leaks out and __ gets taken up by the cells. |
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Definition
- lactate
- decreases
- ATP and CK
- impaired cell membrane function
- potassium leaks
- sodium gets taken up |
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Term
Regional disturbances of ventricular contractility→segmental akinesis, bulging (dyskinesia)→↓↓ pump fxn
Extent of damage depends on severity and duration of mismatch between supply/demand
reversible (0-20 minutes)
permanent (> 20 minutes |
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Definition
Results in Dilated LV—Dilated cardiomyopathy
--Enlargement of one or both ventricles
resulting in systolic and diastolic
contractile dysfunction
Most common cause of dilated CM is
ISCHEMIA!
(most often LV dilation post-MI) |
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Term
| Most common cause of dilated cardiomyopathy? |
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Definition
- ischemia (infarct)
(usually LV dilation post-MI) |
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Term
| Syndromes of Heart Failure: |
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Definition
Left Heart Failure
Right Heart Failure
Systolic vs. Diastolic Heart Failure
Acute Decompensated Heart Failure
Heart Failure with Preserved (normal) LV Function |
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Term
| Is systolic or diastolic heart failure more common? |
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Definition
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Term
| Most common causes of systolic heart failure? |
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Definition
| coronary artery disease following a MI |
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Term
| Diastolic heart failure is usually due to __. |
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Definition
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Term
| Most heart failure is a combo of systolic and diastolic heart failure |
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Definition
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Term
| With systolic heart failure the heart does not __ well. With diastolic heart failure the heart does not __ and __ well. |
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Definition
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Term
| Causes of acute decompensated heart failure: |
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Definition
- heart failure history
- MI
- tachydysrhythmias
- thyrotoxicosis
- fluid overload |
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Term
| If someone under the age of 60 gets atrial fibrillation, check their ___ b/c a fib is the most common heart manifestation of __ disorders. |
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Definition
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Term
| Compensatory Mechanisms of Heart Failure: |
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Definition
- Frank-Starling Law of the Heart
- Myocardial Hypertrophy and Dilation
- Sympathetic Nervous System
- Renin-Angiotensin-Aldosterone System |
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Term
| Explain how the renin-angiotensin-aldosterone system trys to compensate for heart failure: |
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Definition
| heart is not pumping well> kidneys got getting the flow they expect> produce renin> angiotensin I> angiotensin II> potent vasoconstrictor> exacerbation of heart failure |
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Term
| 4 difficulties in obtaining an optimal history from a patient with CHF: |
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Definition
- primary symptoms may not be classic
- symptoms may be minimized and attributed to age
- you may not be able to obtain a history
- symptoms associated with HF may have other causes |
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Term
| FACES a screening tool for heart failure: |
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Definition
- Fatigue?
- altered Activity or exercise pattern?
- Congestion in your chest?
- Edema (swelling)?
- Shortness of breath? |
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Term
| Identifying the patient with heart failure: |
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Definition
Past Medical History
CAD, MI, HTN, Diabetes, Valvular Heart Disease
Symptoms*
Exertional dyspnea or fatigue
Orthopnea, paroxysmal nocturnal dyspnea
Decreased Physical Activity
Physical findings†
Hypertensive, elevated jugular venous pressure, third heart sound, laterally displaced apical impulse, rales, edema, cachexia, cardiomegaly on chest X-ray, LVH or LV strain on EKG
Assess cardiac function
Echocardiography, radionuclide ventriculography (MUGA), or cardiac cath may be used to assess ejection fraction |
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Term
| Diagostic and Therapeutic tests for pts with HF; |
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Definition
Chest Roentgenogram
Electrocardiogram
Echocardiography
MUGA Scan
Blood Chemistry
Complete Blood Count
Urinanalysis
Thyroid Profile
B-Natriuretic Peptide
Cardiac Cath |
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Term
| BNP is released from the __ in response to __ and __. Normal BNP is less than __. __ __ can make it really high> treat their symptoms, don't treat high BNP just symptoms. |
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Definition
- ventricles
- strain and stretch
- 100
- Volume overload |
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Term
| A LVEF of less than __ is indicative of heart failure. With __ heart failure LVEF may be normal. |
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Definition
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Term
| NYHA classifications of heart failure: |
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Definition
- Class I: no limitation on physical activity, ordinary activity does not cause symptoms
- Class II: slight limitation on physical activity, ordinary physical activity results in symptoms
- Class III: marked limitation of physical activity, comfortable at rest, but less than ordinary physical activity results in symptoms
- Class IV: unable to perform any physical activity without symptoms, symptoms present at rest, with any activity symptoms increase |
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Term
| NYHA classifies HF based on the __ __ __ required to elicit symptoms. |
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Definition
- degree of activity/effort
limitation of this method is that there is evidence saying there is little relation b/w cardiac function and symptoms |
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Term
| New approach for classification of heart failure: |
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Definition
- Stage A: High risk for developing heart failure (HTN, CAD, DM, FHx)
- Stage B: Asymptomatic HF: Previous MI, LV systolic dysfunction, asymptomatic valvular disease
- Stage C: Symptomatic HF: known structural heart disease, SOB, fatigue, reduced exercise tolerance
- Stage D: Refractory end stage HF: marked symptoms at rest despite maximal med therapy |
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Term
Stage A doesn’t have remodeling or damage. Ejection fraction is normal, everything squeezes fine. Just high risk that’s it.
Stage B: structural changes but no symptoms, this would correlate to class 1, they can never go back to A
Stage C: structural changes + symptoms
Stage D: end stage, always symptomatic |
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Definition
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Term
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Definition
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Term
| Goal bp for HTN and Diabetes: |
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Definition
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Term
| Goal blood pressure for HTN with renal insufficiency with greater than 1 gram/day of proteinuria: |
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Definition
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Term
| Goal blood pressure for renal insufficiency with less than 1 gram/day proteinuria: |
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Definition
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Term
Obesity: Weight reduction and maintenance to achieve BMI < 30 and waist circumference < 35 inches for men, < 30 women
Dietary Sodium: maximum of 2g/day
Smoking: Cessation and Abstinence |
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Definition
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Term
| Target for treatment of heart failure: |
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Definition
- alleviate congestive symptoms
- improve exercise tolerance
- prevent further deterioration of cardiac function
- prolong life
- treat precipitating/aggravating causes
(Most of these can be treated by inhibiting compensatory mechanisms of the heart) |
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Term
| Pharmacological target for treatment of heart failure: |
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Definition
Afterload Reduction
Reversal of Sympathetic Response
Diuresis
Improving Contractility
Control of Dysrhythmias
Control of Blood Pressure
Anticoagulants/Thrombolytic
Avoidance of NSAIDs
Antioxidants, Magnesium and Potassium Replacement
Treatment of Depression |
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Term
| 3 beta blockers approved for heart failure: |
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Definition
- Bisoprolol
- Metropolol succinate
- Carvedilol |
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Term
| BEFORE STARTING BETA BLOCKERS NEED TO HAVE THEM EUVOLEMIC, GET THE EXTRA VOLUME OFF AND CAN START ACE, ONCE EUVOLEMIC START BETA BLOCKER.Rule of thumb is not to stop beta blocker though when they become symptomatic, just reduce dose. |
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Definition
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Term
| __ and ___ are aldosterone antagonists aka potassium sparing diuretics. These are indicated in class __ and __ heart failure when symptoms are present with minimal activity and/or rest. |
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Definition
- Eplerenone
- Spiranolactone
- III and IV |
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Term
| Drugs that help to reduce afterload in heart failure: |
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Definition
- ACE-I
- ARBs
- Nitrates
- Direct vasodilators (Hydralazine) |
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Term
ACE Inhibitors
Still considered the first line agent
Dose to highest dose tolerated |
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Definition
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Term
| Nitrates include __ __ or ___. Adverse effects include __, __, __, and __ __. |
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Definition
- Isosorbide mononitrate or dinitrate
- headache, flushing, dizziness, and postural hypotension |
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Term
| Hydralazine advrse effects: |
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Definition
- headache
- palpitations
- postural hypotension
- nausea
- vomiting
- increased heart rate
- myocardial ischemia
- fluid retention |
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Term
| Thiazide and Loop Diuretics adverse effects: |
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Definition
- hypokalemia
- hyponatremia
- hypomagnesia
- azotemia
- metabolic acidosis
- dehydration
- hyperlipoproteinemia
- hyperglycemia
(loop diuretics also cause hypocalcemia and deafness) |
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Term
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Definition
- hyperkalemia
- azotemia
- gynecomastia |
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Term
| Drugs to increase contractility: |
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Definition
- Digoxin
- Dobutamine (IV only) |
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Term
| Immunizations pt with HF should get: |
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Definition
- Pneumococcal
- Influenza |
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Term
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Definition
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Term
| MCC of death in heart failure: |
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Definition
| - Ventricular tachycardia or Ventricular fibrillation resulting in sudden cardiac death |
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Term
| In order to qualify to get a device for heart failure and Medicare to pay for it have to be expected to live longer than 1 year. |
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Definition
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Term
| Reasons for hospitalization with HF: |
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Definition
Failure of outpatient management
Clinical or ECG evidence of myocardial ischemia or myocardial infarction
Brady- or tachydysrhythmias
Oxygen saturation below 90%
Hypotension
Pulmonary Edema
Inadequate social support for safe and effective outpatient management |
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