3.7 Clinical Aspects of Heart Failure

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3.7 Clinical Aspects of Heart Failure
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2014-01-24 13:15:19
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  1. What is Congestive Heart Failure?
    • Failure of the heart as a pump
    • Mostly left but can be right
  2. What are some symptoms associated with Heart Failure?
    • Onset may be rapid or slow
    • Commonly presents with:
    • Fatigue (effort intolerance)
    • Shortness of Breath (inclusive of orthopnea, PND)
    • If left-sided: Pulmonary Edema, Wheezing, cough
  3. Describe left-sided Heart Failure?
    Heart can't pump blood out effectively
  4. What are symptoms of left sided heart failure?
    • Dyspnea
    • Tachypnea
    • Crackles in lungs
    • Dry, hacking cough
    • Paroxysmal Nocturnal Dyspnea
    • (Pulmonary System - Think Lungs!)
  5. What is right sided heart failure?
    Can't pump out venous blood returned by the veins
  6. What are some symptoms of Right sided heart failure?
    • Dependent edema
    • Jugular venous distension
    • Abdominal distention
    • Hepatomegaly
    • Splenomegaly
    • Anorexia/ Nausea
    • Weight gain
    • Nocturnal diuresis
    • (Systemic Circulation)
  7. What are some possible underlying causes of right sided heart failure?
    • Left Sided Heart Failure
    • Pulmonary HTN
  8. What are the similarity and differences of right and left sided heart failure?
    • Right sided heart failure - can't pump out venous blood returned to it by the veins
    • Left sided heart failure - can't maintain an adequate circulation of blood in the bodily tissues
  9. What is the difference between systolic and diastolic dysfunction?
    • Systolic dysfunction - heart's inability to contract
    • Diastolic dysfunction - heart's inability to relax (ejection fraction can look normal; must see h and p)
  10. What is Class I of NYHA Classification?
    • Mild
    • No limitation of physical activity
    • Can do ordinary things that result in fatigue, SOB, irregular heart beats
  11. What is Class III of NYHA Classification?
    • Moderate
    • Marked limitation of physical activity
    • Less than ordinary activity causes fatigue, rapid/ irregular heartbeat, SOB
  12. What is Class II of NYHA Classification?
    • Mild
    • Slight limitation of physical activity
    • Ordinary physical activity results in fatigue, rapid/ irregular heartbeat, SOB
  13. What is Class IV of NYHA Classification?
    • Severe
    • Unable to carry out any physical activity w/o discomfort
    • Symptoms of fatigue, rapid/ irregular heart beat (palpitation) or SOB (dyspnea) are present at rest
    • If any physical activity is undertaken, discomfort increases
  14. Factors associated with a worse NYHA classification
    • Recent hospitalization
    • Elevated BUN
    • Systolic BP <100 mmHg or pulse >100
    • Ventricular dysrhythmias
    • Anemia
    • Hyponatremia
    • Cachexia
    • DM, COPD, Cirrhosis
  15. Whats a good exam to measure ejection fraction?
    • Echocardiography - common method
    • Cardiac catheterization 
    • MRI of heart
    • MUGA (multiple gated acquisition) - nuclear scan
    • CT of heart
  16. What are the classes for NYHA Classification?
    Class I - Class IV
  17. What is NYHA functional classification system for heart failure?
    • Qualitative measurement of HF
    • Quantitative measurement done indirectly by measuring cardiac Ejection Fraction
    • Assesses the severity of functional limitations and correlates fairly well with prognosis
  18. What will we hear when the pt has fluid built up in the lungs?
    Rales, crackles, fluid up
  19. What will patients experience when there is fluid built up in the lungs?
    • Dysnea
    • Shortness of Breath
    • Orthopnea - SOB when lying down
  20. What happens physically when there is less blood going out?
    • Cyanosis
    • Kidneys - retention of electrolytes (Na)
    • Vasoconstriction to peripheries
    • Muscle fatigue
    • ↓ Absorption
    • Constipation
    • Anorexia
  21. How will a person feel when there is less blood going out?
    • Tired
    • Fatigue
    • Malaise
  22. What are possible underlying causes of Left sided heart failure?
    • HTN (Chronic)
    • MI
    • Myocarditis
    • Toxins (Chemo, ETOH)
    • Diabetes (microvascular diseases)
    • Coronary Artery Disease (CAD)
    • Cardiomyopathy
    • Endocarditis
    • Valvular Heart Disease
    • Congenital Heart Disease
  23. What could cause right ventricular systolic dysfunction?
    • Usually: Consequence of left ventricular dysfunction
    • Sometimes: Right ventricular infarct
    • Pulmonary HTN
    • Severe tricuspid regurgitation
  24. What are signs of left sided heart failure?
    • Fluid congests the lungs due to diminished CO
    • May see cyanosis, cachexia (wasting), renal hypoperfusion
  25. What are signs of right sided heart failure?
    • Fluid congests the SVC and IVC
    • May see jugular venous distention, peripheral edema, hepatosplenomegaly, ascites
    • Cyanosis may be present
  26. What are some lab tests to order for CHF?
    • BNP
    • CBC
    • CMP (Comprehensive Metabolic Panel)
    • TSH/ T3/ T4
  27. What are some things to rule out when thinking CHF?
    • Anemia
    • Renal Failure
    • Thyroid Disease
  28. Right sided heart failure might present w/ ____ edema, jugular venous ______, nocturnal _____
    • Dependent edema
    • Jugular venous distension
    • Nocturnal diuresis
  29. Left sided heart failure might present w/ nothing more than _____, complaints of __pnea, ____pnea, ___ cough
    • Fatigue
    • Dyspnea
    • Tachypnea
    • Dry cough

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