Heart Failure Review Flashcards

Comprehensive vocabulary flashcards covering the definition, pathophysiology, etiology, clinical features, classifications, investigations, and management of Heart Failure based on the provided lecture transcript.

Heart Failure

A complex clinical syndrome of cardiac pump dysfunction resulting from structural or functional impairment of ventricular filling or ejection of blood.

Frank-Starling relationship

The principle stating that in a normal heart, increasing preload results in greater contractility; however, a failing heart produces relatively less contractility on exertion.

Natriuretic Peptides (BNP and NT-proBNP)

Peptides released from the ventricle in response to volume expansion and pressure overload that counteract RAAS and SNS activation, causing vasodilation and decreased sodium and water retention.

HFrEF (Heart Failure with reduced Ejection Fraction)

Also known as systolic dysfunction, it is characterized by impaired contractility and an ejection fraction of $< 40\%$. Most commonly caused by ischemic heart disease or recent MI.

HFpEF (Heart Failure with preserved Ejection Fraction)

Also known as diastolic dysfunction, it is characterized by impaired ventricular filling with an ejection fraction of $> 50\%$. HTN is the most common cause.

High-output heart failure

Heart failure occurring in conditions like severe anemia, AV fistulas, pregnancy, and thiamine deficiency.

$S_3$ (Ventricular gallop)

A sound caused by rapid filling into a dilated compliant left ventricular chamber; heard best at the apex with the bell, occurring after $S_2$. It is normal in children, athletes, and pregnancy.

$S_4$ gallop

A sound caused by forceful atrial contraction against a noncompliant stiff ventricle; heard at the left sternal border before $S_1$. It is always pathological and absent in A-fib.

Orthopnea

Difficulty breathing in the recumbent position that is relieved by using pillows.

Paroxysmal nocturnal dyspnea (PND)

Awakening after $1$ to $2$ hours of sleep due to acute shortness of breath.

Cardiac asthma

A condition that mimics bronchial asthma, presenting with shortness of breath, wheezing, and coughing due to heart failure.

Congestive heart failure mortality rate

The overall $5$-year mortality for all patients with CHF is approximately $50\%$, with sudden death from ventricular arrhythmias being the most common cause of death.

NYHA Class 3

A classification indicating marked limitation of ordinary physical activity, though the patient remains comfortable at rest.

B-type natriuretic peptide (BNP) diagnostic threshold

Levels $> 100\,\text{pg/mL}$ correlate strongly with decompensated CHF.

NT-proBNP exclusion threshold

A level of $< 300$ virtually excludes the diagnosis of CHF.

Echocardiography

The initial imaging test of choice used to assess size and function of ventricles, detect valvular diseases, and estimate EF.

ARNI (Sacubitril/Valsartan) initiation rule

Stop ACEIs $36$ hours before starting an ARNI to avoid an elevated risk of angioedema.

Digoxin Toxicity

Symptoms include GI (nausea, vomiting, anorexia), cardiac (ectopy, AV block), and CNS (visual disturbances, confusion). Risks include hypokalemia and renal failure.

Implantable cardioverter defibrillators (ICD) logic

Lowers mortality by preventing sudden cardiac death; indicated for nonischemic DCM or ischemic heart disease at least $40$ days post-MI with LVEF $\le 35\%0$ and NYHA class II-III.

Cardiac resynchronization therapy (CRT) indication

Indications similar to ICD but specifically used for patients with a prolonged QRS complex $> 130\,\text{ms}$.

Ventricular Assist Device (VAD) maintenance

Requires lifelong anticoagulation with heparin or warfarin without exceptions.

Cardiac cirrhosis

A complication of right-sided heart failure characterized by 'nutmeg liver'.

Cardiorenal syndrome Type 1

Acute cardiorenal syndrome where acute heart failure leads to acute kidney injury (AKI).

Flash pulmonary edema

The rapid accumulation of fluid in the lungs, typically presenting in emergent heart failure scenarios.

ADHF Management priority

IV diuretics (for fluid overload) are considered the most important intervention; Beta blockers are contraindicated in the acute phase.