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Flashcards in 11 18 2014 Heart Failure Deck (15)
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500,000 new cases a year Prevalence = 5 million # of heart failure is increasing due to aging population AND interventions that prolong life after serious and damaging cardiac insults. Age 65 or older


what are the 3 determinants of stroke volume?

preload Afterload Myocardial contractility


Risk factors for Heart Failure?


Atherosclerotic heart disease ( CAD #1 for systolic heart failure)



Metabolic syndrome

Cardiotoxins (alcohol/ medication/chemotherapy)

Family hisotry of cardiomyopathy



Stages of Heart failure?


Stage A

High risk factors with no symptoms of heart failure

Stage B

Structural heart damage/disease, no symptoms

Stage C

Structural disease, previous or current symptoms

Stage D

Refractory symptoms requring special interventions


Functional stages of heart failure?

Class I:   no functional impairment

Class II: dyspnea at moderate exertion

Class III:  Dyspnea at minimal-- mild exertion  

- can't go up stairs or can't roll garbage can to corner

Class IV:  Dyspnea at rest ( rare)


Natural history of heart failure?



Ejection fraction formula?

  = SV/ EDV


systolic heart failure

Systolic heart failure is the inability of the heart to pump out enough blood to meet demand. Decrease in CO.

- decrease of ESPVR slope in Pressure-volume loop -- systolic emptying ceases at a higher than normal end-systolic volume.

- Damage to myoctyes -- fibrosis = dysfunction

= decrease in stroke volume. 


* heart failure with decreased EF


Diastolic heart Failure

Diastolic heart failure is the inability of the ventricle to hold a lot of blood -- aka not compliant enough to get the blood the body needs. Decrease in C)

* Heart failure with preservation of EF (ejection fraction)


Isolated right heart failure causes?

- (less common)

- diseases of the lung parenchyma or pulmonary vasculature



Compensatory mechanisms for heart failure?  


1. Frank-Starling mechanism

-increase stretching of myocytes (due to incomplete emptying of chamber)

- induce greater stroek volume on subsequent contractions

- had a limit


2. Neruohormonal alterations

- Adrenergic nervous system-- baroreceptor reflex


- ADH produciton and release from posterior pituitary

* increase systemic vascular resistance

3. development of ventricular hypertrophy and remodeling


Symptoms of left sided heart failure:

-Dyspnea (most prominent feature)

- Orthopnea

-Paroxysmal nocturnal dyspnea: severe breathlessness that awakens the patient from 2 to 3 hrs after retiring to bed

-nocturnal cough

- Fatiue  (exercise intolerance)


Physical findings of someone with left sided heart failure

- Diaphoresis (sweating)

- Tachycardia, tachypnea (hyperventilation)  

(due to decrease fluid loss and decrease perfusion of kidneys)

- Pulmonary rales

- Loud P2

- S3 gallop ( in systolic heart failure)

- S4 gallop (diastolic heart failure)

- Mitral Regurgitation ( LV dilation)


Symptoms of right heart failure

- peripheral edema

- right upper quadrant discomfort ( due to hepatic enlargement)


Physical findings of right sided heart failure

- Jugular Venous Distention

- Hepatomegaly

- Peripheral Edema

- tricuspid regurgitation (due to RVH)