Notes in 06 Heart failiure

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Published	06/26/2023	If Heart failiure is on the left, the back up will be in the {{c1::lung}}If heart failiure is on the right, the back up will be in the {{c1::system}}L…
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Published	06/26/2023	Diagnosis of heart failure: Based upon {{c1::history and physical exam}}- no single diagnostic testsResult of Structural or functional Impai…
Published	06/26/2023	Heart Failiure - Two TypesHigh output hf is associated with:{{c1::Obesity}}{{c1::Hyperthyoidism}}- {{c1::thyrotoxicosis }} leads to increased per…
Published	06/26/2023	{{c1::Ischemic heart disease}} is the number 1 cause of hf.{{c1::HTN}} is close secondViral, systemic illnesses, and alcohol can also lead to hf
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Published	06/26/2023	Classification - Functional: Based on pts sx, they are classified using NYHA fct classification:Class {{c1::I}}- Sx onset with more than {{c1::ordinar…
Published	06/26/2023	ACC/AHA Stages ClassificationStage A- Pts at high risk for hf with {{c1::no sx or structural heart disease}}Stage B- Pts have {{c1::structural heart d…
Published	06/26/2023	Stage A- Reduction of risk fx and aggressive tx of {{c1::comorbidities}}Stage B- Aggressive risk fx reduction and tx with {{c1::ace /arb}} and or {{c1…
Published	06/26/2023	Mortality rarte following hospitalization:{{c1::10}}% by 30 days{{c1::22}}% at a year{{c1::42}}% at 5 yearsThis can increase to greater than 50% with …
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Published	06/26/2023	Sx are related to: Reduced {{c1::cardiac Output}}:FatigueAnorexiaWeakness{{c1::Fluid}} retention:DyspneaOrthopneaParoxysmal nocturnal dyspneaedem…
Published	06/26/2023	Signs of Heart failiure:Neck- Elevated {{c1::jugular venous pressure}} ({{c1::right}} sided)Lungs- crackles {{c1::(left}} sided failure)Heart:Laterall…
Published	06/26/2023	Normal Value of jugular venous pressure:Normal Valve is {{c1::6-8}} cm H20Greater than {{c1::8}} is abnormal
Published	06/26/2023	SV X HF = Cardiac outputEDV - ESV / EDV = {{c1::Ejection fx}}Normal is >/= {{c1::50}}%
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Published	06/26/2023	Workup For Heart failure:EKG- {{c1::Arrhythmias}} can cause or exacerbate HFEvidence of {{c1::ischemia}} or prior {{c1::mi}}Troponin:Evaluate for…
Published	06/26/2023	{{c1::BNP}} or {{c1::NT-proBNP}}:{{c1::Hormone}} generated by cardiomyocytes in the context of numerous triggner, notably myocardial stretchNatriureti…
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Published	06/26/2023	Xray of Classic CHF Findings:{{c1::Cardiomegaly}}{{c1::Pulm congestion}}{{c2::Kerly B}} lines
Published	06/26/2023	Echocardiogram{{c1::Transthoracic}} echo for ventricular{{c1::Trans esophageal}} for valvular functionRegional wall motion abnormalities{{c1::ventricu…
Published	06/26/2023	MUGA Scan:{{c1::Ejection fraction}} is highly accurate{{c1::EF}} is highly reproducible - works well in monitoring {{c2::progression of disease}}Ideal…
Published	06/26/2023	Ischemic evaluation:{{c1::Left heart catheterization}}Non invasive stress test- not reliable in {{c1::females}}
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Published	06/26/2023	{{c1::Right heart Catheterization}}:Routine hemodynamic monitoring not reommendedUseful in pts with {{c1::resp distress}} or clinical evidence of {{c1…
Published	06/26/2023	{{c4::Cor Pulmonale}}:Right sided hf often related to {{c1::pulmonary htn}}- increased {{c1::r side afterload}}Increased Systemic Vascular volume:{{c1…
Published	06/26/2023	Remodeling in {{c1::HFrEF}}:Dilated {{c1::wall thinning}}, heavier spherical
Published	06/26/2023	Reccomendations for HFpEF:{{c1::SGLT2}} (new class of recomendation) 2a{{c1::MRAs}}- (new class of recommendation) 2bARNi- (New class of reccomendatio…
Published	06/26/2023	{{c1::Sodium Glucose Cotransporter}} - 2i for HF:Effective in heart failure with {{c2::ef <40%}} ({{c2::HFrEF}})Left ventricular ef (LVEF) >{{c1…
Published	06/26/2023	{{c1::Aldosterone Receptor Antagonist: Mineralcorticoid receptor antagonist: (MRA)}}Shown to prevent many of the maladaptive effects of {{c1::aldoster…
Published	06/26/2023	Angiotensin Receptor - {{c3::Neprilysin}} Inhibitor{{c1::ARNi}} is currently used for tx of pts with hf with r{{c1::educed ejection fx (HFrEF)}}Drugs …
Published	06/26/2023	HF Tx: Stage ATreating {{c1::htn}} reduces lifetime risk of hf by 50%{{c1::statins}} for pts with {{c1::atherosclerotic disease }} or hdlA1C: &gt…
Published	06/26/2023	HF Tx: Stage B: Stage A reccomendation +...{{c1::Ace inhibitor }} and {{c1::beta blokcer}} should be started to prevent hfCONTRAINDICATION:{{c2::…
Published	06/26/2023	Tx Stage b: Ace inhibitors:Reduce {{c1::mortality}} /{{c1::hospitlaization}}Impeded {{c2::maladaptive LV remodeling}}Prevent sx hf{{c2::Angiotensin re…
Published	06/26/2023	HF stage: {{c1::B- Beta blockers}}:'{{c1::-olols}}' Reduce mortalityImpede {{c1::maladaptive LV remodeling}}Prevent sx hf
Published	06/26/2023	HF Tx stage C:All of stage A and B recommendation apply{{c1::NA}} restriction is reasonalble to prevent fluid retention{{c1::Cardiac rehab}} to improv…
Published	06/26/2023	Tx of class C- Diuretics:{{c1::Furosemide}}- The go 2  diuretic in early disease with normal kidney fxnIncrease urine {{c1::Na Excretion}} a…
Published	06/26/2023	Treatment Stage C of HF: Aldosterone Antagonist:Indicated for NYHA class {{c1::II-IV}} sx with LVEF </= 35%Reduce morbidity, mortality, hospit…
Published	06/26/2023	Tx Stage C- {{c1::Hydralazine}} + {{c1::isosorbid dinitrate}}Reduce morbidity and mortality in {{c1::african americans}} with Class {{c2::III- IV}} sx…
Published	06/26/2023	Treatment Stage C- {{c1::Digoxin}}:O'don hates this one- avoid if possible but sometimes necessaryReduce hospitalizations, improve qol
Published	06/26/2023	Stage C HFpEF:Control {{c1::bp}}{{c1::Diuretics}} can provide sx relief in the setting of volume overload{{c1::Arbs}} might be considered to decrease …
Published	06/26/2023	Device Therapy: Prevents {{c1::sudden cardiac death}}- high mortality with this in cvd in usImplantable cardioverter-defibrillator therapy is eff…
Published	06/26/2023	ICD reccomendation:Reduce mortality in pts >{{c1::40 days post mi}} with LVEF of <{{c1::35%}} and class II or III sx on GDMT who have an expecte…
Published	06/26/2023	Cardiac Resynchonization therapy:Progression of HF can be accompanied by {{c1::prolongation of qrs }}
Published	06/26/2023	Electrical Desynchrony:Mortality increases with {{c1::increasing QRS duration}}Reduces cardiac output Exacerbated functional {{c1::mitral va…
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Published	06/26/2023	Treatment D- Recommendtion:Stage {{c1::A-C recommendations apply}}Consider fluid restriction {{c1::1.5 - 2L per day}}{{c1::Ionotropes}}, mech circulat…
Published	06/26/2023	{{c3::Ionotropic}} Support:{{c1::Dobutamine}}, {{c1::dopamine}} can be used in cardiogenic shock to maintain bp and end-organ perfusionContinuous…
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