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Therapeutics Kerr
Stable Heart Failure
13
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2nd Grade
08/30/2009

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Cards

Term
Causes of HF: Systolic
Definition
  1. HTN
  2. MI or Ischemia
  3. Drug induced
  4. Volume overload
  5. Pressure overload
  6. Dilated cardiomyopathies
Term
Causes of HF: Diastolic
Definition
  1. HTN
  2. Ventricular hypertrophy (pressure overload)
  3. MI or Ischemia
  4. Valve stenosis
  5. Pericardial disease
Term
Precipitating Factors for Stable HF
Definition
  1. Lack of compliance
  2. Arrhythmias
  3. Pulmonary Infection
  4. MI/CAD/Valvular Disease/Dilated Cardiomyopathy
  5. Uncontrolled HTN
  6. Environmental
  7. Emotional Stress
  8. Thyrotoxicosis
Term
Precipitating Medications for Stable HF
Definition
  1. Androgens, Estrogens, Licorice, NSAIDs, Salicilates, Corticosteroids: increase Na/H2O retention
  2. TCA, Antiarrhythmics, BB: decreased contractility
Term
Symptoms and Signs of Right Sided HF
Definition

Symptoms:

  1. Abdominal pain
  2. Nausea
  3. Constipation
  4. Anorexia
  5. Bloating
  6. Ascites

Signs:

  1. Peripheral edema
  2. Hepatomegaly
  3. Jugular Venous Distention (JVD) or Jugular Venous Pressure (JVP)
  4. Hepatojugular Reflex (HJR)
Term
Symptoms and Signs of Left Sided HF
Definition

Symptoms:

  1. Dyspnea on Exertion
  2. Paroxysmal Nocturnal Dyspnea (PND)
  3. Orthopnea
  4. Tachypnea
  5. Cough
  6. Hemoptysis

Signs:

  1. Bibasilar rales
  2. Pulmonary edema
  3. S3 gallop
  4. Pleural effusion
  5. Cheyne-Stokes Respiration
Term
Nonspecific Symptoms and Signs of HF
Definition

Symptoms:

  1. Exercise intolerance
  2. Fatigue
  3. Weakness
  4. Nocturia
  5. CNS Symptoms

Signs:

  1. Tachycardia
  2. Pallor
  3. Cyanosis of digits
  4. Cardiomegaly
Term
Non-Pharmacological Treatments for HF
Definition
  1. Exercise
  2. Na Restriction
  3. Fluid avoidance
  4. Support groups
  5. Placement of Implantable Cardioverter-Defibrillator (ICD) --> consider this option over antiarrhythmic agents if EF <30% 
  6. Cardiac resynchronization therapy: biventricular pacemaker --> indicated for Class III-IV NYHA receiving optimal therapy
Term
Chronic Systolic HF Pharmacological Therapy
Definition
  1. Diuretics
  2. ACEI or ARBs
  3. Beta Blockers
  4. Digoxin
  5. Spironolactone/Eplerenone
  6. Warfarin/Antiplatelet
Term
Stage A HF
Definition
  • High risk patient that does not yet have HF
  • No identified structural/functional abnormalities
  • No signs/symptoms of HF

 

Examples:

  1. HTN
  2. CAD
  3. DM
  4. cardiotoxic drug therapy
  5. alcohol abuse
  6. h/o rheumatic fever
  7. FHx of cardiomyopathy

Treat current disease states and have them controlled

Term
Stage B HF
Definition

Developed structural heart disease associated with HF, but never had signs or symptoms of HF

 

Examples:

  1. LVH or fibrosis
  2. LV dilation or hypocontractility
  3. Asymptomatic valvular heart disease
  4. Previous MI

 

 

Term
Stage C HF
Definition

Current or prior symptoms of HF and underlying structural heart disease

 

Examples:

  1. Dyspnea or fatigue due to LV systolic dysfunction
  2. Asymptomatic patients who are undergoing treatment for prior symptoms of HF
Term
Stage D HF
Definition

Advanced structural heart disease and marked symptoms of HF at rest despite treatments and require interventions

 

Examples:

  1. Frequently hospitalized for HF; cannot be safely discharged from the hospital
  2. In hospital awaiting heart transplantation
  3. At home receiving IV support for symptomatic relief
  4. Mechanical ventilation
  5. Hospice setting

 

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