Heart Failure Classification NYHA
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Questions and Answers

What is the criteria for diagnosing a patient with HFrEF?

  • Previous LVEF ≤40% and a follow-up measurement of LVEF >40%
  • LVEF ≥50%
  • LVEF 41%–49%
  • LVEF ≤40% (correct)

    • What is the classification of HF based on LVEF ≥50% and evidence of spontaneous or provokable increased LV filling pressures?

  • HFimpEF
  • HFrEF
  • HFpEF (correct)
  • HFmrEF

    • Why is LVEF considered important in the classification of patients with HF?

  • Due to its correlation with age
  • Due to differing prognosis and response to treatments (correct)
  • Due to its effect on symptoms
  • Due to its impact on diagnosis

    • What type of HF is characterized by LVEF 41%–49% and evidence of spontaneous or provokable increased LV filling pressures?

    <p>HFmrEF</p> Signup and view all the answers

    What is the term for HF that requires specialized interventions?

    <p>Refractory HF</p> Signup and view all the answers

    What type of HF is characterized by previous LVEF ≤40% and a follow-up measurement of LVEF >40%?

    <p>HFimpEF</p> Signup and view all the answers

    What percentage of heart failure cases are caused by ischemic heart disease?

    <p>50-60%</p> Signup and view all the answers

    What is the estimated 5-year mortality rate for patients with heart failure?

    <p>50%</p> Signup and view all the answers

    What is the primary etiology suspected in 30-40% of patients with heart failure?

    <p>Hypertension</p> Signup and view all the answers

    What is a compensatory mechanism to increase stroke volume in heart failure?

    <p>Dilation of the heart</p> Signup and view all the answers

    What percentage of men under age 65 with heart failure will die within 8 years?

    <p>80%</p> Signup and view all the answers

    What is the median survival following onset of heart failure for women?

    <p>3.2 years</p> Signup and view all the answers

    Long-term treatment of hypertension reduces the risk of heart failure by approximately what percentage?

    <p>50%</p> Signup and view all the answers

    What is the etiology of heart failure in 5-10% of patients?

    <p>Idiopathic dilated cardiomyopathy</p> Signup and view all the answers

    What is a common symptom of volume overload and congestion in heart failure?

    <p>Hepatomegally</p> Signup and view all the answers

    What is the role of serum creatinine in heart failure?

    <p>It may be increased due to hypoperfusion</p> Signup and view all the answers

    What is the purpose of an electrocardiogram in heart failure?

    <p>To show numerous abnormalities including acute ST-T wave changes</p> Signup and view all the answers

    What is the significance of BNP > 35 pg/mL in heart failure?

    <p>It indicates ambulatory patients with HF</p> Signup and view all the answers

    What is the role of chest x-ray in heart failure?

    <p>To detect cardiac enlargement, pulmonary edema, and pleural effusions</p> Signup and view all the answers

    What is hyponatremia associated with in heart failure?

    <p>Low serum sodium</p> Signup and view all the answers

    What is the LVEF threshold for patients with HF with reduced ejection fraction (HFrEF)?

    <p>≤40%</p> Signup and view all the answers

    What is the term for patients with HFrEF who improve their LVEF to >40%?

    <p>HFimpEF</p> Signup and view all the answers

    What is a significant reduction in LVEF over time a sign of?

    <p>Poor prognosis</p> Signup and view all the answers

    Which of the following is a common cause of heart failure?

    <p>Hypertensive heart disease</p> Signup and view all the answers

    What is a type of cardiomyopathy?

    <p>All of the above</p> Signup and view all the answers

    What is an example of high output heart failure?

    <p>Severe chronic anemia</p> Signup and view all the answers

    What is a type of restrictive cardiomyopathy?

    <p>Amyloidosis</p> Signup and view all the answers

    What is a cause of heart failure that is not mentioned in the content?

    <p>Pulmonary embolism</p> Signup and view all the answers

    What is the effect of increased sympathetic drive on cardiac output?

    <p>Increased heart rate</p> Signup and view all the answers

    What is the primary function of natriuretic peptides in the body?

    <p>Water and salt homeostasis</p> Signup and view all the answers

    What is the result of activation of the renin-angiotensin system?

    <p>Retention of sodium and water</p> Signup and view all the answers

    What is the effect of myocardial hypertrophy on cardiac performance?

    <p>Initially beneficial, but later detrimental</p> Signup and view all the answers

    What is the source of atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP)?

    <p>Myocytes</p> Signup and view all the answers

    What is the effect of natriuretic peptides on blood pressure?

    <p>Decrease blood pressure</p> Signup and view all the answers

    What is the main component of the diagnostic pathway for patients with suspected heart failure?

    <p>Assessment of BNP or NTproBNP</p> Signup and view all the answers

    What is the effect of natriuretic peptides on the kidneys?

    <p>Increase renal blood flow</p> Signup and view all the answers

    Study Notes

    Heart Failure Classification

    • Heart failure can be classified based on the New York Heart Association (NYHA) functional classification system, which has four classes:

      • Class I: Comfortable at rest, but ordinary physical activity causes symptoms of HF
      • Class II: Slightly limited by symptoms of HF during ordinary activity
      • Class III: Markedly limited by symptoms of HF during less-than-ordinary activity
      • Class IV: Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest

    • Heart failure can also be classified based on left ventricular ejection fraction (LVEF):

      • HFrEF (HF with reduced EF): LVEF ≤40%
      • HFimpEF (HF with improved EF): Previous LVEF ≤40% and a follow-up measurement of LVEF >40%
      • HFmrEF (HF with mildly reduced EF): LVEF 41%–49% and evidence of spontaneous or provokable increased LV filling pressures
      • HFpEF (HF with preserved EF): LVEF ≥50% and evidence of spontaneous or provokable increased LV filling pressures

    Causes of Heart Failure

    • Common causes of heart failure:
      • Coronary artery diseases
      • Hypertensive heart diseases
      • Cardiomyopathy (dilated, hypertrophic, restrictive)
      • Valvular heart diseases
      • Constrictive pericarditis
      • High output heart failure (e.g. chronic anemia, thyrotoxicosis, atrioventricular shunt)
      • Cardiac dysrhythmia and heart block

    Etiologies

    • Heart failure can result from any disorder that affects the ability of the heart to contract (systolic function) and/or relax (diastolic dysfunction):
      • Ischemic heart disease (50-60% of cases)
      • Hypertension (30-40% of patients)
      • Idiopathic dilated cardiomyopathy (5-10% of patients)
      • Other cardiomyopathies (e.g. alcoholic, viral, hypertrophic)
      • Drug-induced

    Prognosis

    • The prognosis of heart failure is poor, with factors affecting prognosis including age, gender, LVEF, renal function, blood pressure, heart failure etiology, and drug or device therapy
    • The 5-year mortality rate is 50%, and the median survival following onset is 1.7 years for men and 3.2 years for women

    Pathophysiological Changes

    • Compensatory mechanisms:
      • Dilation of the heart to increase stroke volume
      • Increased sympathetic drive to increase cardiac output
      • Activation of the renin-angiotensin system, leading to secondary hyperaldosteronism with retention of sodium and water
    • Myocardial hypertrophy: an intrinsic compensatory mechanism to maintain cardiac performance, but can lead to ischemic changes, impairment of diastolic filling, and alteration of ventricular geometry

    Natriuretic Peptides

    • Natriuretic peptides play a significant role in water and salt homeostasis, providing counter-regulatory balance to the neurohumoral pathways
    • The natriuretic peptide system consists of three main peptides: atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), and C-type natriuretic peptide (CNP)
    • Elevated circulating levels of natriuretic peptides are found in patients with chronic heart failure, and assessment of BNP (or its inactive N-terminal fragment, NT-proBNP) is a key component of the diagnostic pathway for patients with suspected heart failure

    Symptoms and Signs

    • Volume overload and congestion: orthopnea, pulmonary crackles, edema, ascites, hepatojugular reflux, hepatomegaly, engorged neck veins, dyspnea, tachypnea, cough
    • Cardiac: enlargement, gallop, tachycardia
    • General: limitation of activity, inability of concentration, nocturia, anorexia, nausea, bloating

    Laboratory Tests

    • BNP > 35 pg/mL for ambulatory patients or > 100 pg/mL for patients hospitalized or with decompensated HF
    • NT-proBNP >125 pg/mL for ambulatory patients or > 300 pg/mL for patients hospitalized or with decompensated HF
    • Electrocardiogram may be normal or show numerous abnormalities
    • Serum creatinine may be increased due to hypoperfusion
    • Complete blood count is useful to determine if HF is due to reduced oxygen-carrying capacity
    • Chest x-ray: useful for detection of cardiac enlargement, pulmonary edema, and pleural effusions
    • Echocardiogram: used to assess LV size, valve function, pericardial effusion, wall motion abnormalities, and ejection fraction

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    Description

    Classify heart failure based on the New York Heart Association (NYHA) functional classification system, which has four classes. This system helps assess the severity of heart failure symptoms during physical activity.

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