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Flashcards in Heart Failure Deck (50)
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1

systolic dysfunction

Impaired contractility that leads to a decreased ejection fraction

2

Diastolic dysfunction

Impaired ventricular filling during diastole due to either impaired relaxation or increased stiffness of the ventricle or both

3

"High Output" HF

Increase in CO is needed for the requirements of peripheral tissues for oxygen

4

Pathologic S3 (ventricular gallop)

Sound of Rapid filling phase into a non-compliant LV

*among most specific signs of CHF

Heard best at apex with bell
S3 follows S2 "Ken-tuck-Y"

5

S4 Gallop

Sound of atrial systole as blood ejected into a non-compliant or stiff LV

Heard best a left sternal border
s4 precedes s1 "TEN-nes-see"

6

Increased intensity of pulmonic component of second heart sound indicates......

Pulmonary Hypertension

Heard over left upper sternal border

7

NYHA Class I

Symptoms only occur with vigorous activity (like playing a sport)

8

NYHA Class II

Symptoms with prolonged or moderate exertion (like climbing stairs)
Slight limitations of activities

9

NYHA Class III

Symptoms occur with usual activities of daily living (Walking across a room)
Markedly limiting

10

NYHA Class IV

Symptoms occur at rest
Incapacitating

11

ACC/AHA HF Stage A

Risk factors present for HF, but have no structural heart disease or symptoms

12

ACC/AHA HF Stage B

Structural heart disease without HF

13

ACC/AHA HF Stage C

Structural heart disease with HF symptoms (prior or current)

14

ACC/AHA HF Stage D

Refractory HF requiring specialized interventions

15

Signs and symptoms of left-sided HF

"Lung Symptoms"

Dyspnea
Orthopnea
Paroxysmal Nocturnal Dyspnea
Nocturnal Cough
Pulmonary Hpertension
S3 and S4 sounds present
Crackles/rales

16

Signs and symptoms of Right-sided HF

"Backed up veins" Symptoms

Peripheral pitting edema
Nocturia
JVD
Hepatomegaly
Hepatojugular Reflex
Ascites
RV Heave

17

Tests to order for new patient with CHF

CXR (pulmonary edema, cardiomegaly, r/o COPD)
ECG
Cardiac Enzymes (r/o MI)
Echocardiography (estimate EF, r/o pericardial effusion)

18

Paroxysmal nocturnal dyspnea

Awakening after 1-2 hours of sleep due to SOB

19

Nocturnal cough is worse in what position?

Recumbent (same pathophysiology as orthopnea)

20

From where and why is brain natriuretic protein (BNP) released?

Released from ventricles in response to ventricular volume expansion and pressure overload

21

What BNP levels correlate strongly with presence of decompensated CHF?

levels >150 pg/mL, but remember you must compare this to the patient's baseline or usual BNP levels, because they may be consistently elevated in CHF

22

Though not used to diagnose CHF, why can BNP be useful?

Can help differentiate between dyspnea caused by CHF and COPD

23

What NT-proBNP value virtually excludes diagnosis of CHF?

24

Compare potency of diuretics used in CHF patients

Loop diuretics (furosemide) most potent

Thiazide diuretics (hycrochlorothiazide) modestly potent

25

What CHF stages is spironolactone effective in?

Advanced stages Classes III and IV

26

What is an alternative to spironolactone and when would it be used?

Eplerenone can be used if spironolactone causes gynecomastia

27

Contraindication of spironolactone

Renal Failure

28

Standard treatment of CHF includes

Loop diuretic
ACE inhibitor
Beta Blocker

29

All patients with systolic dysfunction even if asymptomatic should be on....

ACE Inhibitor

30

If ACE inhibitor can not be tolerated what are some alternatives?

Angiotensin II Receptor Blockers (ARBs)

Hydralazine and Isosorbide dinitrates