HF PRE PATHO

Define HF

syndrome characterized by the hearts inability to pump sufficient blood to meet the bodies metabolic needs

HF is a results of what?

structural impairment of ventricular filling or ejection of blood

The 5-year survival rate is ______% and the 1-year survival rate is _____% if NYHA class IV

50;50

What part of the heart is the most to blame for HF?

left ventricle

There is a 8-16% rise in HF rate for every ____% in A1c

1%

Drug class to use in diabetics with HF

SGLT-2 inhibitors

What drug class should you use for those with CAD and/or LV dysfunction

ACEi

What drug class should you use for those with CAD

BB

What % of cases have a prior HTN diagnosis

75%

HF is characterized by a decrease in _______ due to a decrease in stroke volume

CO

Cardiac output equals

stroke volume multiplied by heart rate

Define stroke volume

volume of blood pumped from the ventricle per beat

How is stroke volume determined?

• preload

• afterload

• contractility

Define pre-load

pressure forcing blood into heart during diastole

Define after load

pressure heart must work against to eject blood during systole

Define contractility

the heart’s ability to pump/contract

A decrease in CO activates what mechanisms?

compensatory

What are the neurohormonal compensatory mechanisms

• Activation of RAAS

• increase in naturetic peptide secretion

• miscellaneous (AVP, endothelin, cytokines)

What are the detrimental neurohormones?

• endothelin

• aldosterone

• angiotensin II

• vasopressin

• NE

What are the beneficial neurohormones?

• ANP

• BNP

• NO

• bradykinin

• prostacyclin

What % ejection fraction is associated with HFrEF?

40% or less

What % ejection fraction is associated with HFpEF?

50% or more

What % ejection fraction is associated with HFmrEF?

41-49%

What % ejection fraction is associated with HFimpEF?

40% or more

HFrEF is referred to as _______ HF and HFpEF is referred to as _______HF

systolic; diastolic

HF with reduced ejection fraction is often associated with what?

previous MI

What is the etiology of HF with preserved EF?

systemic HTN or alone without a component of systolic HF

HFpEF is more common in what patient populations?

elderly

What are the ECG findings with HFrEF?

Reduced LVEF <40%

What are the ECG findings with HFpEF?

Preserved LVEF >40%

Which has a higher mortality rate: HFrEF or HFpEF?

HFrEF

The ACC/AHA stages of HF are class _____ of the NYHA classification

1

What are risks factors in stage B pre-heart failure

• increased natriuretic peptide levels

• persistently elevated cardiac troponin in the absence of competing diagnoses

What are common signs and symptoms of HF (patient perspective)

• dyspnea

• fatigue

• edema

True or false: dyspnea/fatigue and edema may not occur together

true

What are some signs of HF with a physical exam?

• pulmonary crackles

• cool extremities

• tachycardia/pnea

• peripheral edema

• jugular venous distention

• hepatojugular reflux

• cachexia

• mental status changes

What lab tests indicated HF?

• BNP >35

• NT-proBNP >125

• EKG

• SCr

• CBC

• Chest X-ray

• Echo

• hyponatremia

What are some medications that can worsen HFrEF?

• NSAIDS

• TZDs

• DPP4

• Class 1 antiarrhythmics

• Sotalol

• Non-DHP CCb

• anticancer meds

• stimulants

• pregabalin/gabapentin?