Heart Failure Flashcards
HF:
accompanied by (2), what of heart disease, worldwide criteria (3)
etiology - mechanisms (2), ventricular (4), myocardial disease secondary (8), others (3)
- accompanied by: effort intolerance, fluid retention
- terminal stage of heart disease
- pulmonary & systemic congestion, elevated natriuretic peptide
ETIOLOGY
- mechanisms: pressure & volume overload
- restricted ventricular filling: MS, constrictive pericarditis, LVH, endomyocardial fibrosis
- myocardial disease is either primary or secondary: metabolic, metal, drugs, CT disease, neuro, ARF, CAD
- others: AMI, toxin (alcohol), infection
HF:
pathology - can’t what, dysfunction of (2), hemo
hemodynamic - inc (5.2)
- can’t provide metabolic needs of peripheral organs
- dysfunction of ventricles & neurohormonal
- overcompensatory hemodynamic
HEMODYNAMIC
- inc capillary venous atrial vol & pressure
- inc ventricular end-diastolic vol & pressure
- inc ventricular & atrial contractility (sterling’s law)
- inc lymphatic flow from interstitial spaces
- inc secondary fluid transudation
HF:
myocardial dysfunction (9G)
myocardial insult
myocardial dysfunction
altered load & perfusion
activate RAA & ANS
altered gene
growth & remodeling = apoptosis
ischemia = necrosis
cell death
HF: Types
acute HF - etiology + speed, 1=1=1 –> 1=1=1
chronic - etiology, what happens, factors (5)
factor: fluid overload & systemic
ACUTE HEART FAILURE
- underlying condition develop rapidly
- congestive venous drain into ventricle = rapid decompensation
- block SNS
- dec CO = dec HR = dec BP
CHRONIC HEART FAILURE
- d/t hypertrophy
- acute decompensation but can compensate eventually
- factors: fluid overload, blood loss, stress, systemic infection, pulmonary infection, endocrine
HF: Types
R&L - trend (1=1), pathology (1=1=1)
R&L heart failure
- usually one side more limit if rapid onset
- one ventricle enlarge = compress other = ventricular interdependence
- other ventricle eventually fails too
HF: Types
low output HF - vasowhat = sx (6)
high output - value, associated with what + (5), vasowhat = sx (4)
which most common
associated: AATPP
LOW OUTPUT HF
- most common
peripheral vasoconstriction
- cold clammy pale
- oliguria
- low pulse pressure, widened atrial-venous O difference
HIGH OUTPUT HF
- high CO/cardiac index (>4L/min)
- associated with hyperkinetic circulatory state: anemia, AV fistula, thyrotoxicosis, pregnancy, paget’s bone disease
vasodilation
- pale, flushing
- bounding pulse, N or narrowed atrial-venous O difference
HF: Types
backward HF - pathology (3=1=1 –> 2 –> 1)
forward HF - sx (3) + (2=1=1)
patho: inc pressure in 3 places
BACKWARD HF
- inc pressure in LV LA PV = pressure backward to PA = pulmonary Htn –> dec CO & forward HF –> develop (R) failure too
FORWARD HF
- accounts for HF sx: mental confusion, weakness, fatigue
- Na & water retention = augments ECF = congestive sx
HF: Types
systolic HF - d/t what which is what (2 d/t 2)
diastolic HF - d/t (3), sx (1=2)
SYSTOLIC HF
chronic contractile dysfunction
- myocardial necrosis d/t previous infarct
- depression of inotropy (makes heart pump) d/t ischemia
DIASTOLIC HF
- d/t dec ventricular compliance, fibrosis (stiff), dec relaxation during ischemia
- sx: high pressure = pulmonary & systemic congestion
HF:
clinical types - preserved vs. dec ejection fraction
stages (4)
NYHA (4) - limit, when sx
clinical types
- HF with preserved ejection fraction: EF >50%
- HF with reduced: EF <40%
stages of heart failure
- stage A: high risk
- stage B: structural disease
- stage C: sx
- stage D: refractory HF
NYHA
- class I: no limit
- class II: slight limit; ordinary activity can cause
- class III: marked limit; less than ordinary
- class IV: can’t carry out; even rest
HF:
abdominal manifestations (7)
Mx - Na restriction, exercise frequency for mod vs. vigrous vs. HF + heart reserve %
abdominal manifestation
- easy satiety, bloating, constipation, upper abdominal discomfort
- anorexia
- ascites, hepatic congestion
Mx
- Na restriction: <2gday
Exercise
- 5x/wk for mod
- 3x/wk for vigorous & HF pts (60-70% heart reserve)
HF: Cardiomyopathy
d/t (2)
d/t myocyte injury, infiltration of tissues
HF: Cardiomyopathy
dilated - trend, etiology, pathology/sx (3)
- most common
- etiology: mostly idiopathic
pathology
- enlarged one or two ventricles
- precedes CHF
- systolic dysfunction
HF: Cardiomyopathy - DCM
takotsubo - other name, trigger, when, epidemiology (age sex), pathology, tx
peripartrum - when, where, etiology (1.1), prognosis (survival + recur)
TAKOTSUBO (STRESS-INDUCED CM)
- broken heart
- trigger: emotional
- epi: middle aged, F
- patho: inc catecholamine
- tx: completely reversible with supportive care
PERIPARTUM CM
- last month til 1st 6m post-partum
- epi: Africa, developed
- eti: unclear, lymphocytic inflam
- prog: if survive initial then good long term, inc risk in next pregnancies
HF: Cardiomyopathy - DCM
tachycardia - associated (3), prognosis (recovery)
alcoholic - trend, resembles, alcohol effect (5)
TACHYCARDIA-INDUCED CM
- atrial fibrillation, supraventricular tachycardia, CHF
- prog: full recovery if control arrythmia
ALCOHOLIC CM
- most common secondary CM
- resemble idiopathic DCM
- alcohol = stroke, Htn, arrythmia, CAD, SCD
HF: Cardiomyopathy - DCM
ischemia - what that’s not explained by (2)
valvular - (2) = what
hypertensive - d/t (2), sx (2)
inflammatory - what
ISCHEMIA CM
- depressed vent function
- not unexplained by obstructed coronary artery or ischemia
VALVULAR CM
- valvular stenosis or regurgitation = abnormal loading
HYPERTENSIVE CM
- eti: LVH, heart failure
- sx: systolic or diastolic dysfunction
INFLAMMATORY CM
- myocarditis
