Heart Failure Flashcards
what is heart failure
the inability of the heart to pump out enough blood to keep up with the blood demand of the body
Systolic heart failure
- ejection fraction
- patho
- most commonly because of….
Systolic HF: inability of the heart to squeeze the blood out — because of a weakened heart flappy and too compliant
- due to a decrease in contractility or an increase in preload
causes…
- MI: you had an MI and now the heart wall cant contract as well MI is most common reason
- dilated cardiomyopathy: flappy heart cant pump out the blood that well
- mitral or aortic regurgitation: too much preload makes it harder to pump it all out – cells get tired
systolic HF is HF with a REDUCED EJECTION FRACTION HFrEF
Diastolic Heart Failure
- patho
- ejection fraction
- commonly due to what
Diastolic: a STIFF heart, not compliant so it CANT FILL
inability to fill up and increased afterload
- post MI: fiberosis of the heart makes it unable to fill
- restritive cardiomyopathy: heart cant fill up
increased afterload:
- HTN MC CAUSE OF DIASTOLIC: theres so much pressure in teh aorta it takes more to push out– cant do that
- aortic stenosis: increased afterload and needs more force to push blood out – cant do it
- HOCM: hypertrophic obstructive cardiomyopathy
DIASTOLIC HF is HFpEF preserved EF
Left Sided Heart Failure
- #1 reason
- patho
- symptoms
left sided heart failure: the inability of the left heart to pump blood out to circulation
#1 reason is cornary artery disease & ischemia!!!
other reasons…
- arrythmias
- valve disease
- uncontrolled HTN
- dilated cardiomyopathy
Symptoms : think: theres a weak pump, or increased resistance in the vasculature (htn) –> backflow to LUNGS (Left = lungs)
- paroxysml nocturnal dyspnea
- pulmonary congestions (wheeze, crackles, tacypnea)
- confusion (poor perfusion to brain)
- fatigue, cyanosis
- tachycardia
- exertional dyspnea
Right Sided Heart Failure
#1 reason
patho
symptoms
right sided heart failure: right ventricle can push blood to the lungs!!!
right sided = core pulmonale
#1 reasons is left sided heart failure!!!
other reasons…
- lung disease (vasculare of lung already damanged)
- COPD
- cystic fiberosis
- autoimmune disease
Symptoms : blood cant get to lungs – back up to hear – backup to VENOUS system
- fatigue
- increased peripheral venous pressure
- ascites
- edema!!! (LE)
- enlarged spleen and liver
- distended jugular veins
- weight gain
NYHA classifications
Class I - IV meaning
AHA/ACC Stages
A-D
NYHA Classes
you can jump from class to class depending on symptoms
Class I: mild: no limit to activity, no symptoms
Class II: slight limit to activity; comfortable at rest but activiy rbings fatigue, palpataions and dyspnea
Class III: very limited ability to have activity; comfortable at rest
Class IV: inability to carry out activity without extreme discomft; possible symptoms at rest too
AHA Stages A-D you CANNOT go backwards in the stages
A: pt. at high risk for HF, but no structural or functional issue
B: a structural issue is there –> no symptoms
C: symptoms, structural issue but managed with meds
D: advanced disease, hospital management, transplant or palliatve care
Symptoms in general of HF & findings on physical Exam
symptoms
- SOB, dyspnea
- paroxysmal nocturnal dyspnea
- orthopnea
- bloating of abdomen
- swelling LE
- weight gain!!!
- fatigue
Physical Exam
- JVP: see increased pulse pressure when measuring
- Systolic: S3
- Diastolic: S4
- lungs: wheezing, rails, rhonci
- ascites and hepatomegaly
- Edema on LE
- skin color changes (cyanosis if left heart failure)
Diagnostic Studies for Heart Failure
Echo: see pressure changes in LV and RV & estimated EF
EKG: evidence of LVH or RVH
Chest Xray: cardiomegaly
Left or RIght Heart Cath: to get pressures?
Labs
- BMP
- CBC
- LFT
- BNP
- Trops
- Thyroid
- Iron
- Coags
- Nutrition
Treatment for Heart Failure
Primary medications. pt. needs to be on
ARNI, ACE or ARB
PLUS
Beta Blocker (if not currently fluid overloaded)
PLUS
MRA (spirnolactone)
PLUS
SGLT2i
what with the ACE/ARB/ARNI do for heart failure ?
MOA for each
names
these will DECREASE afterload by decreasing systemic vascular resistance essentailly reducing pressure
ACEs
- block AGII formation: decrease pressure and decrease reuptake of salt and water in RAAS
- -pril ; linsinopril, enalipril, captopril
ARBs
- block receptor for AGII: decrease pressure and decrease RAAS system reuptake
- - sartan: losartan, valsartan, candesartan
ARNIs
- “entresto”: valsartan/sacubitril –> inhibits the degrading of ANP and BNP –> BNP normally will stop the RAAS system – entresto stops BNP from being degraded –> thus we are stopping the RAAS system
how do aldosteron antagonists work?
sprinolactone, eplerenone
- normally–> aldosterone increases reabsorbtion of salt and water — but we dont want this (this will increase fluid)
- this is triggered because there is poor perfusion to the kidneys– kidneys think they need more pressure! but they dont
so we block the action of aldosterone
decreases preload for heart failure pts.
how do diuretics work for HF
- work to reduce preload!!!! want less volume in the system
- we choose to use Loops > thiazides
How do SGLT2i work
names
- these work by stoping glucose reabsorbtion into the blood, which also stops sodium reabsorption
- therefore more is excreted, and more water is excreted and drop in volume!!!
names
- flozin : canagliflozin, dapagliflozin, empagliflozin
how do Beta Blockers work for HF
use only if the pt. is not currently fluid overlaoded
- olol’s
work by
- decreases preload and afterload –> slows the HR leading to an increase in time for O2 to get to the tissues & results in BETTER squeezes by the heart
Besides beta blockers – what other inotropes are there that can be used in HF
milrione & dobutamine, digoxin too
- these increase inotrope of the heart –> leading to a stronger squeeze of the heart muscles
Milrinone: vasodilator too (watch with hypotension)
Dobutamine: B1 and B2 affinity (watch with COPD)
**cannot use BB with these since these are postive inotropes and BB are negative*
