Flashcards in heart failure Deck (31):
1
Heart failure is the
inability of the heart to pump blood forward at a sufficient rate to meet the metabolic demands of the body (forward failure), or the ability to do so only if the cardiac filling pressures are abnormally high (backward failure)
2
HR is a
syndrome describing a constellation of signs and symptoms caused by many possible abnormalities of heart function
3
Poor FORWARD blood flow is a
1. key requirement of HF
2. LOW FLOW (↓ cardiac output)
4
BACKWARD buildup of pressure
1. is almost always present as well
2. CONGESTION (↑ filling pressures)
3. Typically a response to low flow
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____ determines dysfunction
function
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dysfunction: Displacement pumps
1. Squeeze (contraction)
2. Fill (relaxation)
3. Failure of either systole or
4. diastole causes HF
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dysfunction: 2x pumps
left and right in series
Left, right, or both can fail
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dysfunction: Coordinated by an
1. electrical system
2. Too slow, too fast, asynchronous … all ↓ efficiency
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dysfunction: Directed by
1. 4x valves
2. Regurgitation (backflow) or stenosis (resistance) stress heart
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dysfunction: Supplied by
1. coronaries
2. Regurgitation (backflow) or
3. stenosis (resistance) stress heart
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dysfunction: Encased in
1. pericardium
2. Regurgitation (backflow) or
3. stenosis (resistance) stress heart
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key mediators of blood flow
1. intropy
2. preload
3. afterload
4. stroke volume
5. heart rate
6. cardiac outpuut
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Ventricular output increases in relation to
greater filling
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Inotropy =
contractility
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The more the LV is filled, the more it
will contract
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↑ Preload produces
increased SV (and thus CO) for the same inotropic state
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Same filling (preload) of LV produces a
greater squeeze of contraction
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Determinants of inotropy
1. Catecholaminergic / adrenergic stimulation
2. Calcium
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↑ Inotropy produces increased
SV (and thus CO) for the same level of preload
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↑ Preload cause ___ SV
(↑ SV)
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↑ Inotropy causes ___ SV
(↑ SV)
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↑ Afterload causes ___ SV
(↓ SV)
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Weak / damaged myocardium = ___ failure
systolic
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Systolic dysfunction
1. problem with squeeze
2. ↓contraction / ↓ inotropy
3. ↓ SV
4. lower generated systolic BP
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hallmark of systolic dysfunction is
1. Decreased ejection fraction
2. Ventricular enlargement
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Ventricular enlargement
“dilated cardiomyopathy” = DCM
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Decreased ejection fraction
1. “HF with reduced ejection fraction” = HFrEF
2. “left ventricular systolic dysfunction” = LVSD
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Primary causes of systolic HF
1. Direct destruction of heart muscle cells
Myocardial infarction
Viral myocarditis
Peripartum cardiomyopathy
Ideopathic dilated cardiomyopathy
Alcohol
2. Overstressed heart muscle
3. Volume overloaded heart muscle
29
Overstressed heart muscle
can be cause by
1. Tachycardia-mediated HF
2. Methamphetamine abuse
3. Stress-provoked (tako-tsubo cardiomyopathy)
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Volume overloaded heart muscle can be caused by
1. Mitral regurgitation
2. High cardiac output
3. Shunting of blood
4. Wet beriberi (thiamine B1 deficiency)
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