Heart Failure Flashcards
(52 cards)
Systolic Heart Failure heart shape
Big, globular, larger volume
Diastolic HF heart shape
Normal shape, thicker, has problems with eccentric relaxation
High-Output cardiac failure pathophysiology
Peripheral vascular resistance is detected as being lower so the body holds onto more salt
Low-output cardiac failure pathophys
Body reads low cardiac output
Drivers of these changes
Maintaining MAP for brain and kidneys
Cornerstone of therapy
Volume control
Can HF get better?
Yes, you can take them out of HF.
New York Heart Association Class
Know this for presentations.
Class I: normal exercise tolerance
Class II: symptoms with ordinary exertion
Class III: symptoms with only mild exertion
Class IV: symptom at rest
EF and disease class relationship
There is no association
ACC/AHA 2001 Guideline for Stages
Stage A: High risk (no HF): HTN, CAD, DM, FH of CM
Stage B: Asymptomatic HF: Previous MI, LV systolic dysfunction (no symptoms), asymptomatic valvular disease
Stage C: Symptomatic: Known heart disease, SOB and fatigue, reduced exercise tolerance
Stage D: Refractory end-stage HF: Can’t improve symptoms or can’t sustain improvements
Systolic/Diastolic dysfunction and Staging
Both forms of dysfunction follow the same Stages.
Do Stages change?
No, once you are Stage C you will always be stage C or worse. The Classes can change, the stages can’t.
Number 1 goal for management
Stabilizing patient (symptom relief), then stabilize the disease
What causes dyspnea
Elevated LV end diastolic pressure / PCW pressure
What causes exercise intolerance
Inability to increase cardiac output
What happens to SVR during exercise
It goes down as muscles fill with blood
Fatigue cause
Decreased CO
What causes edma
Increased venous pressure/sodium retention
Neurohormonal activation
Sympathetics and Renin-Angiotensin System
Causes of decompensation
Infection: 1 degree C increase causes 10-15% increase of O2 consumption
Infarction/Ischemia
Indiscretion: too much salt
Iatrogenesis: NSAIDs effect on kidneys can cause decompensation. CCBs are bad for systolic dysfunction.
Narrow pulse pressure means
Means diminished stroke volume. Systolic is lower and diastolic is higher because of increased End diastolic volume)
Most reliable sign of volume overload
JVD
Right sided HF signs
Elevated JVP, edema, ascites/pulsatile liver, tachy, hypotension with severe disease (low preload)
Left sided HF signs
Dyspnea, orthopnea, Paroxsymal nocturnal dyspnea, rales, presence of S3, tachy, narrow pulse pressure, hypotension
