Basics of Heart Failure and Pericardial Disease Flashcards Preview

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Flashcards in Basics of Heart Failure and Pericardial Disease Deck (12):
1

Pulm edema due to heart failure

Heart fsilure - inadequste cardiac output for tissue needs

Results in compensatory changes that increase BV (retain Na and Cl) presented to pump by the venous system (cardiac preload)

Increased BV raises pulm capically pressure leading ot increased fluid filtration into lung interstitium

If pronounced, this leads to cardiogeinic edema

2

Preload vs. afterload

Preload - on the vein side

Afterload - on the aortic side

3

Cardiogenic edema patho

LV not as good...increased preload because more coming in and less going out...R-L heart connection will swell up and get bigger...hydrostatic pressure increases and cardiogenic edema increases

4

Lung-heart interactions

heart can imapir heart performance via pulmonary edema (and pleural effusion formation)

Lungs can imapir heart performance via increased pulmonary vascular resistance

Also some CV changes with mech ventilation

5

Clinical HF

Poor activity tolerance

Orthopnea and paroxysmal nocturanl dyspnea

Dependent leg edema and JVP (increased central venous blood volume and pressure)

Fine insp crackles more at lung bases (increase lung water leads to alveolar closing and opening during resp cycle)

Heart specific findings - enlarged and dsipalced PMI and S3/S4

6

Pulmonary wedge pressure

Left ventricular filling prssure

Pulm artery catheterization allows measurement of left ventricular filling pressure

7

Chest XR correlation to pulm wedge pressure

INcreased vascular predicle width - increased sys BV

Cardiomegaly

Flow cephalization due to increaseed pulmonary blood volume (vessel recruitment and distension)

The wedge pressure increase relates to this

8

As wedge pressure gets really bad Chest XR

Get interstitial cardiogenic edema

Kerley B lines - look like stacked quarters

heart borders are not sharp anymore

Alveolar cardiogenic edmea - central predominant fluffy opacities

9

Pericarditis
Pericardial effusion
Constrictive pericarditis

Typical chest pain with/without evident effusion

may progress to tamponade

Chronic condition that entraps heart due to thickened adherent pericardium

10

Pericaridal effusion

Fluid in pericardial space enlarges cardiac silhoutte by imaging

Sx depends on both pressure and presence of inflammation (inflammation cuases the pain)

High pressure reduces blood inflow into the heart (preload), reduces output and leads to shokc...this is tamponade

If there is NO tamponade, then no real blood flow complications

11

Effusion - exam and imaging

Heart sounds dimimshed

Pericardial rub ay be present

Lungs clear

Tamponade - increased JVP, hypotension, weak pulse, paradoxial pulse

IMaging - increased cardiac silhouette (water bottle), clear lungs (no edema), may have pleural effison depending on etiology

12

How to differentiate chest XR in heart failure and pericardial effusion

Toracic lung volume (pedicle width)

Vascular marking

Presence of edema