Flashcards in Heart Failure Deck (50)
Impaired contractility that leads to a decreased ejection fraction
Impaired ventricular filling during diastole due to either impaired relaxation or increased stiffness of the ventricle or both
"High Output" HF
Increase in CO is needed for the requirements of peripheral tissues for oxygen
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"
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"
Increased intensity of pulmonic component of second heart sound indicates......
Heard over left upper sternal border
NYHA Class I
Symptoms only occur with vigorous activity (like playing a sport)
NYHA Class II
Symptoms with prolonged or moderate exertion (like climbing stairs)
Slight limitations of activities
NYHA Class III
Symptoms occur with usual activities of daily living (Walking across a room)
NYHA Class IV
Symptoms occur at rest
ACC/AHA HF Stage A
Risk factors present for HF, but have no structural heart disease or symptoms
ACC/AHA HF Stage B
Structural heart disease without HF
ACC/AHA HF Stage C
Structural heart disease with HF symptoms (prior or current)
ACC/AHA HF Stage D
Refractory HF requiring specialized interventions
Signs and symptoms of left-sided HF
Paroxysmal Nocturnal Dyspnea
S3 and S4 sounds present
Signs and symptoms of Right-sided HF
"Backed up veins" Symptoms
Peripheral pitting edema
Tests to order for new patient with CHF
CXR (pulmonary edema, cardiomegaly, r/o COPD)
Cardiac Enzymes (r/o MI)
Echocardiography (estimate EF, r/o pericardial effusion)
Paroxysmal nocturnal dyspnea
Awakening after 1-2 hours of sleep due to SOB
Nocturnal cough is worse in what position?
Recumbent (same pathophysiology as orthopnea)
From where and why is brain natriuretic protein (BNP) released?
Released from ventricles in response to ventricular volume expansion and pressure overload
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
Though not used to diagnose CHF, why can BNP be useful?
Can help differentiate between dyspnea caused by CHF and COPD
What NT-proBNP value virtually excludes diagnosis of CHF?
Compare potency of diuretics used in CHF patients
Loop diuretics (furosemide) most potent
Thiazide diuretics (hycrochlorothiazide) modestly potent
What CHF stages is spironolactone effective in?
Advanced stages Classes III and IV
What is an alternative to spironolactone and when would it be used?
Eplerenone can be used if spironolactone causes gynecomastia
Contraindication of spironolactone
Standard treatment of CHF includes
All patients with systolic dysfunction even if asymptomatic should be on....