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27 Cards in this Set
- Front
- Back
as L vent ejection fraction decreases...
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mortality increases!!!
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Heart failure
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-an inability of the heat to effectively supply an output of bloof to meet the bodies demands of metabolism and or be able to only at elevated pressures or volumes
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ejection fraction
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percentage of blood ejected during each beat. This is determined by SV/LVEDP. Normal >50%, Mild 40-50%, Moderate 30-40%, Severe <30%.
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preload
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-Equals left ventricular filling. Which is equivalent to Left Ventricular End Diastolic Pressure (LVEDP).
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afterload
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Equals the resistance to left ventricular emptying or the force which the heart has to pump against.
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Causes of CHF
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1. Coronary heart dz: 60-75% of cases
2. Toxic substances to myocardium: cocaine, adruamycin and ETOH 3. Inflammatory: myocarditis/endocarditis/pericarditis 4. Cardiomyopathy 5. Increase prsssure: HTN/aortic stenosis 6. increase volume: mitral and aortic regur 7. Endocrine: DM/ thyroid dz 8. pulmonary 9. infiltrative: sarcoidosis, amyloidosis and hemochromatosis 10. brady or tachycardia |
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causes conti
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11. Congenital: left ot right shunts
12 metabolic: anemia, thiamine deficiency 13. pregnancy: peripartum, hugh risk amoung pre/eclampsia 14. iatrogenic: vol overload/transfusion |
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Left sided heart failure
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-Classified as systolic, diastolic or as a combination of both
-will prevent blood from leaving the pulmonary system -this leads to third spacing of fluid in the pulmonary system |
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diastolic heart failure
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-About 30% of left heart failure. The left ventricle is unable to relax or stretch. This causes an increased LVEDP despite a normal or reduced LVEDV.
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systolic heart failure
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1. depressed stroke vol despite an inc in LVEDP or LVEDV
2. Starlings law failed 3. classic dilated and stretched heart |
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right sided heart failure - causes
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-primarily left sided heart failure.
Cor pulmonale, pulmonic valve dz -right sided hearted failure will cause third spacing of fluid in the abdominal cavity and peripheral tissues -abdominal symptoms |
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Presenting symptoms (left sided)
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1. dyspnea
2. orthopnea 3. paroxysmal noctural dyspnea 4. exercise intolerance 5. fatigue 6. edema 7. cough (pink frothy sputum) 8. sleep disorders 9. CNS disorder 10. cachexia 11. increase abdominal girth (ascites) 12. vague abdominal complaints |
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presenting signs
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1. rales
2. JVD 3. hypoxia 4. tachycardia 5. dysrhythmias (afib) 6. pericardial effusion 7. pleural effusion 8. displaced PMI 9. cyanosis 10. S3/S4 (gallops), S3 is the most accurate predictive sign of CHF 11. leg edema |
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presenting signs cont
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12. liver tenderness/enlargement
13. heart murmur 14. cephalization 15. kerley's B-lines 16. bat wing |
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Lab tests
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1. CBC
2. chemistries 3. lipids 4. blood sugar 5. cardiac enzymes 6. LFTs 7. serum ferritin 8. thyroid function |
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imaging
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1. BNP
2. ECG 3. CXR 4. Echocardiography 5. endomyocardial biopsy |
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stages in the evolution of heart failure
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A: HF risk factors, no heart dz, no sx
B: heart dz, no sx--> asymptomatic LV dysfunction C: prior or current HF sx D: refractory HF sx |
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stages- clinical characteristics
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A: HTN, DM, hyperchol., Fh
B: heart dz C: dyspnea, fatigue, reduced exercise tolerance D: marked sx at rest despite max. therapy |
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Beta blockers
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-used in all stable pts with HF
-counteracts sympathetic pathway -decreases neurohormonal activation/remodeling of heart structure -antiarrythmic -avoid in COPD/bradyarrhythmias -carvedilol, bisprolol, metoprolol, succinate |
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ACE inhibitors
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-initiate in all pts with sx of HF and reduced LVEF
-decreases neurohormonal activation -some pts intolerant due to bradykinin elevation/cough/angioedema -monitor renal function/potassium levels |
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ARB's
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-may use in pts who are ACEI intolerant
-monitor renal function/K levels -may be used in conjunction with ACEI in some pts |
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diuretics
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-should be used in HF pts with fluid retention
-should be used in conjunction with salt and water mgmt/restriction -monitor renal function and electrolytes -spironolactome may be added for moderate to severe pts with close observation |
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hydralazine/nitrates
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-These may be used in conjunction with each other for African Americans already on optimal medical management or for patients intolerant to ACEI/ARB/Diuretics due to renal dysfunction or other side effects
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internal cardiac defibrillator
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-May be used for patients for Primary prevention of SCD in patients with EF<36% and moderate symptoms with life expectancy >1year
-Secondary prevention of SCD in patients with reduced EF and hemodynamically destabilizing ventricular arrythmia -No benefit within 40 days of MI |
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cardiac resynchronization therapy
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-May be used in patients with EF<36%, QRS duration >0.12 with atrial fibrillation on optimal medical therapy or moderate to severe patients in sinus rhythm on optimal medical therapy
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drugs to avoid
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-antiarrythmic agents, except amiodarone
-CCBs: inc mortality -NSAIDs: cause Na retention |
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heart transplant indications
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-refractory cardiogenic shock
-documente dependence on IV inotropic support to maintain adequate organ perfusion -peak VO2 < 10 ml/kg/min -severe sx of ischemia not amenable to revascularization -recurrent symptomatic ventricular arrhythmias refractory to all therapeutic modalities -C/I: age, severe comorbidity |