Heart Failure Overview and Classification
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Questions and Answers

What symptom is associated with left-sided heart failure?

  • Jugular venous distention
  • Fatigue
  • Lower limb swelling
  • Paroxysmal nocturnal dyspnea (correct)

    • In which NYHA class would a patient experience discomfort during any physical activity?

  • Class IV (correct)
  • Class II
  • Class I
  • Class III

    • What is a characteristic finding in right-sided heart failure?

  • Hepatomegaly (correct)
  • Third heart sound
  • Orthopnea
  • Pulmonary rales

    • Which ACC/AHA stage involves patients with structural heart disease but no symptoms of heart failure?

    <p>Stage B</p> Signup and view all the answers

    What does the NYHA classification rely on for its assessment?

    <p>Symptoms related to activity limitation</p> Signup and view all the answers

    What is a common therapeutic intervention for patients in Stage A of heart failure?

    <p>Lifestyle modification for risk factors</p> Signup and view all the answers

    Which finding on a chest x-ray may indicate heart failure?

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

    What does the presence of jugular venous distention indicate?

    <p>Right-sided heart failure</p> Signup and view all the answers

    What is required for the classification of heart failure with mildly reduced ejection fraction (HFmrEF)?

    <p>Presence of symptoms and/or signs of heart failure</p> Signup and view all the answers

    Which of the following is responsible for over 70% of heart failure cases in the western world?

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

    Which factor is NOT a precipitating factor for decompensated heart failure?

    <p>Bilateral renal failure</p> Signup and view all the answers

    What clinical syndromes are associated with congestive heart failure?

    <p>Dyspnea and peripheral edema</p> Signup and view all the answers

    Which of the following drugs would likely lead to decompensated heart failure?

    <p>Negative inotropic drugs like verapamil</p> Signup and view all the answers

    What is a common clinical manifestation of acute exacerbation of heart failure?

    <p>Worsening dyspnea and fatigue</p> Signup and view all the answers

    Which condition is a potential precipitating factor for heart failure exacerbation?

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

    In classifying causes of heart failure, which of the following categories does NOT belong?

    <p>Inflammatory response</p> Signup and view all the answers

    What is the primary use of brain natriuretic peptide (BNP) in clinical practice?

    <p>To rule out heart failure</p> Signup and view all the answers

    How do ejection fraction (EF) measurements contribute to heart failure management?

    <p>Identify the type of heart failure</p> Signup and view all the answers

    In which scenario would invasive procedures be particularly necessary?

    <p>Patients with respiratory distress and impaired systemic perfusion</p> Signup and view all the answers

    Which of the following is NOT considered an essential drug for patients with HFrEF?

    <p>Oral anticoagulants</p> Signup and view all the answers

    What role does exercise training play in the management of heart failure?

    <p>It improves functional capacity and reduces mortality.</p> Signup and view all the answers

    What is a potential reason for BNP levels to be falsely low in certain patients?

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

    What are the treatment goals in heart failure with reduced ejection fraction (HFrEF)?

    <p>To improve hemodynamics, relieve symptoms, and prolong survival</p> Signup and view all the answers

    Which of the following is a non-pharmacologic treatment for heart failure?

    <p>Reduction of salt/fluid intake</p> Signup and view all the answers

    What compensatory mechanism involves an increase in heart rate during heart failure?

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

    Which classification of heart failure is characterized by a reduced ejection fraction?

    <p>Systolic heart failure (HFrEF)</p> Signup and view all the answers

    Which of the following is a cause of heart failure with reduced ejection fraction (HFrEF)?

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

    What is a potential consequence of the compensatory mechanisms in heart failure?

    <p>Worsening cardiac function</p> Signup and view all the answers

    What is the role of the Renin Angiotensin Aldosterone System (RAAS) in heart failure?

    <p>It causes renal sodium retention.</p> Signup and view all the answers

    Which of the following statements is true about diastolic heart failure (HFpEF)?

    <p>It involves impaired ventricular filling.</p> Signup and view all the answers

    Which of the following best describes the condition of ventricular dilatation in heart failure?

    <p>Reduced contractile strength</p> Signup and view all the answers

    Which of the following is a common precipitating factor for decompensated heart failure?

    <p>Non-compliance with medications</p> Signup and view all the answers

    Study Notes

    Heart Failure (HF)

    • HF arises from the ventricle's inability to efficiently pump blood throughout the body.
    • Compensatory mechanisms maintain cardiac output and arterial blood pressure, but they worsen over time.
    • Compensatory Mechanisms: Cardiac changes (Frank-Starling mechanism, tachycardia, ventricular dilatation) and Neuro-Hormonal changes (Increased sympathetic activity, RAAS activation, increased vasopressin, catecholamines, and natriuretic peptides.

    HF Classification

    • Ejection fraction (EF) is used to determine systolic function of the left ventricle (calculated as the percentage of blood ejected during systole).
    • Normal EF: greater than 50%
    • Systolic HF (HFrEF): Reduced contractility of the myocardium with ventricular dilatation, leading to a decrease in EF (less than 50%).
    • Diastolic HF (HFpEF): Impaired relaxation of the left ventricle, causing reduced filling and EF (can vary in this type).

    Causes of HF

    • Most common cause: Ischemic heart disease (over 70% of cases).
    • Other causes: Hypertensive heart disease, cardiomyopathies, valvular and congenital heart diseases.
    • Categories of causes: Diseased myocardium, abnormal loading (preload or afterload), and arrhythmias.

    Decompensated HF

    • Decompensated HF: worsening of symptoms and clinical findings in preexisting HF.
    • Precipitating factors: nonadherence to medication, acute myocardial ischemia, high blood pressure, arrhythmias, pulmonary embolism, negative inotropic drugs, drugs that increase salt retention, alcohol or drugs, endocrine abnormalities, infections, and additional cardiovascular disorders.

    Symptoms of HF

    • Left-sided HF: Dyspnea, orthopnea, paroxysmal nocturnal dyspnea.
    • Right-sided HF: LL swelling, abdominal discomfort (hepatomegaly, ascites).
    • Low cardiac output: Fatigue, dizziness.

    NYHA Classification

    • Stage I: No limitation of activity.
    • Stage II: Mild limitation of activity, comfortable at rest.
    • Stage III: Marked limitation of activity, comfortable only at rest.
    • Stage IV: Any physical activity causes discomfort, symptoms present at rest.

    Physical Findings in HF

    • Left-sided failure: Pulmonary rales/edema, displaced apical impulse, third heart sound, and gallop rhythm, mitral regurgitation murmur.
    • Right-sided failure: LL edema, ascites, hepatomegaly, jugular venous distention.
    • Low cardiac output: Hypotension, impaired capillary filling.

    ACC/AHA Stages of HF

    • Stage A: High risk of HF but without structural heart disease or symptoms (e.g., hypertension, dyslipidemia, obesity, diabetes).
    • Stage B: Structural heart disease but without HF symptoms or signs (e.g., MI, LVH, LV dysfunction, valvular heart diseases).
    • Stage C: Structural heart disease with prior or current HF symptoms.
    • Stage D: Refractory heart failure.

    Investigations

    • Chest X-ray: Cardiomegaly, vascular redistribution, Kerley B-lines, interstitial edema.
    • ECG: Ventricular hypertrophy, ischemia, arrhythmias
    • BNP and NT-pro BNP: High sensitivity for decompensated HF, low specificity (elevated in many cardiac and non-cardiac conditions).
    • Echocardiogram: Determine EF, classify HF type, identify valvular heart disease.
    • Other Imaging: Rule out ischemia, assess myocardial viability, diagnose specific etiologies.
    • Invasive Procedures: Pulmonary artery catheter for respiratory distress, coronary arteriography for ischemia, endomyocardial biopsy to diagnose specific diagnoses.

    Treatment of HFrEF

    • Goals: Improve hemodynamics, relieve symptoms, prolong survival.
    • Non-pharmacologic treatment: Reduction of salt/fluid intake, HF self-care education, alcohol moderation or cessation, exercise training/cardiac rehabilitation.
    • Pharmacologic treatment:
      • Essential drugs: ACE inhibitors or ARNI, beta-blockers, aldosterone antagonists, hydralazine/nitrates.
      • Other drugs: Digoxin, ivabradine, SGLT2 inhibitors, sodium-glucose co-transporter 2 (SGLT2) inhibitors.

    HFrEF Medication Details

    • ACE inhibitors:
      • Benefits: Reduce afterload, improve symptoms, reduce mortality.
      • Examples: Lisinopril, enalapril.
    • ARNI:
      • Benefits: Similar benefits to ACE inhibitors, but more potent.
      • Example: Sacubitril/valsartan.
    • Beta blockers:
      • Benefits: Reduce heart rate, improve contractility, reduce mortality.
      • Examples: Carvedilol, metoprolol succinate.
    • Aldosterone antagonists:
      • Benefits: Reduce sodium and water retention, improve symptoms, reduce mortality.
      • Examples: Spironolactone, eplerenone.
    • Hydralazine/nitrates:
      • Benefits: Reduce afterload, improve symptoms, reduce mortality (especially for African Americans with HF).
    • Digoxin:
      • Benefits: Improves symptoms, may improve EF, but no mortality benefit.
    • Ivabradine:
      • Benefits: Reduces heart rate, improves symptoms.
    • SGLT2 inhibitors:
      • Benefits: Reduce hospitalizations and CV death (especially for patients with type 2 diabetes).
      • Examples: Empagliflozin, dapagliflozin.

    HFpEF Treatment

    • Treatment focuses on: Modifiable risk factors, symptoms relief, and prevention of complications.
    • Key aspects:
      • Optimize blood pressure control: Target a blood pressure of less than 130/80 mmHg.
      • Control diabetes and dyslipidemia: Manage these conditions to reduce cardiac strain.
      • Encourage physical activity: Promote regular exercise to improve cardiovascular health.
      • Treat atrial fibrillation: Manage AF to reduce risk of stroke and improve heart function.
      • Address sleep apnea: Treat sleep apnea to improve oxygenation and reduce cardiac stress.
      • Manage kidney disease: Control kidney problems to optimize fluid balance and blood pressure.
      • Consider volume management: Manage fluid status using diuretics or other medications.
      • Consider other therapies: May include anticoagulation, antiplatelet medications.

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    Description

    This quiz explores the critical aspects of heart failure (HF), focusing on the mechanisms behind its pathophysiology, classification based on ejection fraction, and the common causes of HF. Test your understanding of the different types of HF and their implications for patient care.

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