Flashcards in Heart Failure Deck (18)
Describe the 2 types of Heart Failure discussed in Pellico.
1) Systolic Heart Failure - Characterized by a weak heart muscle.
2) Diastolic Heart Failure - Characterized by a stiff non-compliant heart muscle, making it difficult for the ventricle to fill.
(T/F) LVH may displace the apical pulse left and downward while Right-sided heart failure may present with an elevation in jugular venous pressure greater than 4cm above the eternal angle.
What is the significance of an S3 heart sound?
An S3 heart sound is a sign that the heart is beginning to fail and that increased blood volume fills the ventricles with each beat causing oscillation back and forth between the ventricular walls.
That is why it is heard right after S2 or diastole, because it is the sound of extra filling.
What is the significance of an S4 heart sound?
S4 is caused by the atria forcefully contracting in an effort to overcome an abnormally stiff of hypertrophic ventricle. This causes abnormal turbulence in the flow of blood that can be detected as an extra heart sound right before S1 or lub (sound of the AV valves closing).
What is a normal range for CVP? What is the significance of an ⬆ CVP?
1) Normal CVP = 2 to 8 mmHg
2) ⬆ CVP ( > 8mmHg) indicates fluid volume overload or right sided heart failure.
What is the significance of the following X-ray findings in a patient with Heart Failure:
2) Normal Heart Size
1) Cardiomegaly - Systolic heart failure
2) Normal Heart Size - Diastolic heart failure
What is the significance of the following Echocardiogram findings in a patient with Heart Failure:
1) EF of less than 40%
2) EF of greater than 40% with SxS of HF
1) EF of less than 40% - Systolic heart failure
2) EF of greater than 40% with SxS of HF - Diastolic heart failure
Which pharmacological treatments are used for systolic heart failure?
1) ACE I
What are the 4 most common side effects of ACEIs (-prils)?
1) Dry cough
2) Potassium retention (Hyperkalemia)
3) ⬇ Renal fxn
Explain the MOA of the drug Nesiritide and how it can be used in patients with heart failure?
Nesiritide (Natrecor) is a preparation of human BNP that mimics the action of endogenous BNP by causing diuresis and vasodilation, which ⬇ BP and improves CO (given via the IV route only).
How can Vasodilators help patients with HF? Which particular population are they especially useful in treating?
1) Vasodilators are arterial and venous smooth muscle relaxers that ⬇ preload and afterload.
2) Especially effective in treating African Americans with HF
What are the main SxS of Cardiac Tamponade?
1) Pulsus Paradoxus - SBP that is markedly lower during inhalation.
2) ⬇ SBP and resulting narrowing BP
3) ⬆ Venous pressure (seen as JVD)
4) Distant or muffled heart sounds
Which type of diuretic is the 1st line treatment for those diagnosed with HF?
Loop Diuretics i.e., Furosemide because if their efficacy in patients without renal impairment
(T/F) Diuretics should never be used alone to treat HF because they do not prevent further myocardial damage.
True - Instead, ACEIs and BBs can be used to correct remodeling.
What are the 7 causes of PEA, according to Pellico?
5) Massive PE
7) Med overdose (i.e., BBs, and CCBs)
What is the normal range for BNP?
Less than 100 pg/mL is normal.
100 pg/mL and more is indicative of HF
What are the 7 mentioned causes of increased BNP?
1) HF and LV hypertrophy
2) Old age
3) Cardiac inflammation
4) Kawasaki's disease
5) Renal failure
7) Endocrine Disease (i.e., hyperaldosteronism and Cushing's)