Hemodynamics
Mr. Garcia has moved here on the Frank Starling curve, increasing preload, but no longer increasing stroke volume.
What is the flat portion or plateau of the Frank-Starling curve
This type of heart failure is defined by reduced ejection fraction.
What is systolic heart failure?
Which side of the heart is responsible for Mr. Garcia’s leg swelling and liver congestion?
What is the right side?
This type of test can help rule out a heart attack as the cause of heart failure symptoms.
What is troponin?
This medication slows the heart rate and reduces strain on the heart.
What is a beta-blocker?
Despite high LVEDV, Mr. Garcia’s stroke volume remains low. What hemodynamic parameter we calculated best explains his symptoms?
What is decreased cardiac index?
This is the condition in which poor heart function leads to worsening renal function.
What is cardiorenal syndrome?
Mr. Garcia says he sleeps sitting up due to trouble breathing. What is this symptom called?
What is orthopnea?
A CXR will commonly display these symptoms in left sided-heart failure
These medications degrade bradykinin and can cause angioedema, and cough
What are ACE inhibitors?
This symptom appears as preload increases but output plateaus.
What is dyspnea?
What structural myocardial adaptation occurs in chronic volume overload, such as in dilated cardiomyopathy?
What is eccentric hypertrophy (sarcomeres added in series)?
Results from low albumin, contributing to worsening edema
What is reduced oncotic pressure?
This is a measure of the heart's efficiency, specifically the volume of blood pumped out per minute, adjusted for an individual's body surface area
This diuretic has mortality and symptom benefits, but requires close renal and potassium monitoring
What is Spironolactone?
In terms of the Frank-Starling curve, what does a leftward shift represent clinically when using diuretics?
What is decreased preload?
How does low cardiac output paradoxically lead to sodium and water retention?
What is activation of RAAS and SNS stimulation?
What does the S3 sound represent in the context of Mr. Garcia?
What is rapid ventricular filling into a dilated, non-compliant left ventricle?
This is calculated using the Mosteller formula ( √((height (cm) x weight (kg)) / 3600) )
What is body surface area?
This is the main parameter considered for the NYHA classification
What are limitations of physical activity?
What physiologic mechanism causes pulmonary edema once the LVEDP surpasses oncotic pressure?
What is fluid transudation into alveoli due to increased hydrostatic capillary pressure?
Which two competing effects of RAAS worsen HF while trying to preserve perfusion?
What are vasoconstriction (↑ afterload) and aldosterone-mediated volume overload (↑ preload)?
What simple daily action can help Mr. Garcia notice early signs of worsening heart failure at home?
What is daily weight monitoring?
These echocardiogram findings indicate DCM
What is bi-ventricular dilation, thin walls, reduced EF?
This is why we decided to use an ARNI (Angiotensin Receptor–Neprilysin Inhibitor) instead of the less expensive ACE inhibitors
What is reduced cardiovascular mortality, reduced heart failure hospitalization, and dual action of the medication?