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| Heart Failure is a _________clinical syndrome that can result from _________ |
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| Heart Failure is a progressive clinical syndrome that can result from any disorder that impairs the ventricle filling/ejecting blood. |
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| Systolic function in HF patients is usually_____ |
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| Normal, with normal LFEV. Heart failure is thought to be primarily a distolic dysfunction of the heart. |
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| Heart failure affects men more than women until_____ |
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| Systolic dysfunction may also be termed... |
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| Causes of Systolic Dysfunction |
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| CAD (most common); reduced muscle mass (MI), dilated cardiomyopathy; ventricular hypertrophy (pressure overload – systemic or pulmonary hypertension, aortic or pulmonic valve stenosis); volume overload (valvular regurgitation, shunts) |
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| Diastolic dysfunction may also be termed... |
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| Restriction in Ventricular Filling |
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| Causes of diastolic dysfunction |
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| increased ventricular stiffness, ventricular hypertrophy, infiltrative myocardial dz, myocardial ischemia and infarction, mitral or tricuspid valve stenosis, pericardial damage (pericarditis, pericardial tamponade) |
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| Name the compensatory mechanisms of the heart |
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| tachycardia and increased contractility, fluid retention and increase preload, vasoconstriction and increased afterload, ventricular hypertrophy* and remodeling*. |
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| What are two key components of heart failure progression? |
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| ethanol, amphetamines, cocaine methamphetamine |
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| Rosiglitazone, pioglitazone |
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| Steriods, androgens, estrogens |
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No Cure.
Improve patients QOL, relieve or reduce symptoms, slow progressions/hospitalization/risk factors |
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High Risk of developing HF
HTN, CAD, atherosclerosis, DM, obesity, metabolic syndrome |
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Structural Heart Disease but no HF
Previous MI, LVH, systolic dysfunction |
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Structural HD and current/previous HF
LV systolic dysfunction, dyspnea, fatigue, reduced exercise tolerance |
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| Refractory Heart Failure requiring interventions. Discharge implausible without devices or inotropic therapy |
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| [ACC/AHA Staging: Recognizes the evolution and progression and risk factor modification and preventive treatment strategies.] |
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| NYHA functional classification; classify symptomatic HF according to the clinician’s subjective evaluation; does not recognize preventive measure or progression. Pts symptoms can change abruptly] |
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| Cardiac Disease without obvious symptoms |
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| Cardiac Dz with slight limitations. Ordinary activity causes fatigue, dyspnea, angina |
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| Cardiac Disease with marked limitations in physical activity Comfortable at rest |
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Cardiac disease and unable to carry on any physical activity without discomfort
Symptoms present at rest |
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Stop smoking, control risk factors
ACEI or ARB
May add diuretics/ BBlockers |
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| Stage A plus previous MI and asymptomatic LV remodeling |
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Most pt. require 3 meds: diuretic, ACEI, and BBlocker
Sodium Restriction, wt loss, immunizations |
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| Mechanical circulatory support, positive ionotropic therapy , surgery, transplant hospice |
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| Patients not responding to ACEI |
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Use ARBs
Combined use of ACEI/ARBs increases risk of renal dysfunction and hyperkalemia |
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| Aldosterone Antagonist Risk |
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| Increased risk of hyperkalemia |
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| Doesn't improve survival in HF but improves LVEF, QOL |
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| Conditions that exacerbate Digoxin risk |
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| hypokalemia, hypothyroidsim, MI, acidosis Toxicity occurs at 2 ng/ml |
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| diuretics and vasodilators |
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| Hydralazine + Nitrates can be used in patients who |
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Don't tolerate ACEI etc.
African Americans |
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| Drawbacks to hydralazine+ Nitrates |
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Must be dosed 3-4 times a day
2 meds versus 1 creates compliance issues |
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| Conditions requiring Hospitalization |
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Blood pressure very low
Worsening renal failure
systemic edema
pulmonary congestion |
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| Heavy Diuresis, removing fluid at about 500 mL/hour |
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Eliminate exacerbating factors
Optimum volume control
Fluid Status stable
Optimal pharmacotherapy
Follow up 7-10 days after discharge |
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