1What four factors impacts the amount of blood your heart can pump?
preload
afterload
contractility
HR
2the contractile phase when your heart sends blood out to the body is?
systole
3the phase when your heart refilles blood is?
diastole
4the amount of stretch your heart has at its maximal fullness right before it empties is?
preload
5the pressure your heart has to overcome to eject blood is?
afterload
6your hearts ability to squeez is?
contractility
7What are the factors that can lead to heart failure?
excessive preload or afterload
decreased HR
MI
conduction issues
cardiomyopathy
heart muscle enlargement
8What medications are used to deal with preload problems?
loop diuretics (lasix)
9What is the most common symptom with left sided heart failure?
dyspnea on exertion
10What are some other symptoms associated with left sided heart failure?
orthopnea
paroxysmal nocturnal dyspnea
chronic nonproductive cough
11What are some symptoms associated with right sided heart failure?
peripheral edema
hepatic congestion
JZVD
occasional loss of appetite
12What are some causes of acute exacerbations of chronic HF?
noncompliance with meds
increased salt intake
over exertion
PE
arrythmia
13On PE what might you see/hear?
crackles in the lungs
tachycardia
S3 gallop
hypoxia
diminshed 1st heart sound
14What does parasternal lift or heave indicate?
pulmonary HTN
15What does a lift or heave at the PMI suggest?
left ventricular hypertrophy
16What does JVP estimate?
right atrial pressure
17What is the gold standard for assessing CHF?
echocardiogram
18What might you see on CXR with CHF?
kerley B lines
19What treatments have been shown to improve survival in patients with preserved LVEF?
nothing
20What should be done in patients with preserved LVEF?
manage fluid overload with diuretics
treat comorbities
21What is the mainstay treatment for heart failure with reduced LVEF?
ACEI/ARBs
beta blockers
diuretics
22What drugs worsen HF?
nondihydropyradine CCBs
antiarrhythmic agents
NSAIDs
thiazolidinedoines
23What percentage of LVEF indicates ace inhibitors as first line?
if LVEF is less than 40%
24What is the therapeutic effect of ace inhibitors?
decreases BP and CHF symptoms
25Theraeutic effect of BB?
decreases force of contraction
26In addition to first line therapy what other drugs can be used for CHF?
aldosterone antagonists
nitrates
digoxin
vericiguat
SGLT2 inhibitors
27If a suspected patient has heart failure and hyperkalemia what drug(s) would you avoid?
RAAS meds
28What might you find on chest x ray with congestive heart failure?
pulonary vascular congestion
kerley B lines
cardiomegaly
29In an acute setting what makes HF unlikely?
normal BNP and normal ECG
30What does an echocardiogram differentiate in HF?
without or with preserved LV function
31What does echocardiogram show?
size and function of both ventricles and atria
measures LVEF
detects valvular abnormalities, intracardiac shunts, wall motion abnormalities, pericardial effucions and dilated cardiomyopathy
32What therapies have been shown to improve survival of hear failure with preserved LVEF?
none
33What are you doing with prescription meds when it comes to patients with heart failure with preserved LVEF?
manage fluid overload with diuretics
treat comorbities
34Do ace inhibitors reduce afterload or preload?
afterload
35What is the therapuetic effect of aldosterone antagonists?
increases urine output and decreases workload of the hear
36What do nitrates do?
reduces RV and LV filling pressures
reduces afterload
37What effect does digoxin have?
increases cardiac contractility
38What are some non pharmacological treatmens for HF?
ICD
biventricular pacing
diet and exercise training
LVAD
heart transplant
39What are osme ways to prevent flares?
limit salt intake
space out activities- decreases workload on heart
obtain adequate rest
educate patients on early symptoms to detect flares
obtain flu and pnuemonia vaccines
check bodyweight daily- fluid overload?
40When should you admit to the hospital?
unexplained new or worsened symptoms
postive cardiac biomarkers
hypoxia
gross fluid overload
pulmonary edema