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)
Cardiotoxins (alcohol/ medication/chemotherapy)
Family hisotry of cardiomyopathy
Stages of Heart failure?
High risk factors with no symptoms of heart failure
Structural heart damage/disease, no symptoms
Structural disease, previous or current symptoms
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)
-Paroxysmal nocturnal dyspnea: severe breathlessness that awakens the patient from 2 to 3 hrs after retiring to bed
- 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
- Peripheral Edema
- tricuspid regurgitation (due to RVH)