Heart Failure (intro) Flashcards by Hannah McMahon

What is heart failure?

Progressive disease where the heart cannot pump efficient amount of blood for the body

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Is there a cure for heart failure?

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What is important to think about when talking about heart failure?

The flow of deoxygenated vs. oxygenated blood flow

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List 11 risk factors for heart failure:

HTN
obesity
pre-diabetes
diabetes
cardiac disease (esp. MI)
familial / genetic cardiomyopathies
cardiotoxicity r/t cancer
substance abuse
autoimmune disease
iron overload
inflammatory disorders (covid)

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There is a greater incidence of heart failure in what race/ ethnic group?

African americans & hispanics

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What is the biggest etiology of heart failure?

Chronic hypertension

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Etiologies of heart failure:

Ischemic heart disease

R/t ischemic insults to myocardium, weakens the strength of ventricular contraction

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COPD is the leading cause of ____ ____ failure

Right ventricular failure

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COPD can cause RV changes and HF called ___ _____

cor pulmonale

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COPD can cause development of what and explain how?

Pulmonary HTN → due to constriction of arterial vessels & increased workload & exhaustion of RV

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Cardiomyopathies can be _____ or _____

restrictive or hypertrophic

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Does HF lead to an increase or decrease in cardiac output?

decrease → decreases ability of the heart to get oxygenated blood where it needs to go

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List 3 underlying problems in HF

muscle damage
↑ in workload to maintain an efficient output
structural abnormality

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Underlying problems in HF:

Muscle damage

Atherosclerosis (hypertrophy) or cardiomyopathy

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Underlying problems in HF:

↑ in workload to maintain an efficient output is seen in pts with:

HTN; alcoholism; MI; A-fib; or valvular disease

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Underlying problems in HF:

Structural abnormality

Congenital cardiac defects

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Left sided HF occurs when…

LV is unable to pump re-oxygenated blood from the lungs to the heart’s LA

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Which sided heart failure is more common?

Left sided

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In left sided HF the ventricles are too ____

stiff (not contracting properly)

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Left sided HF can lead to what 2 things?

Decreased cardiac output
pulmonary congestion

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Left sided HF is a common cause of _____

right sided heart failure

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What are the 2 types of left sided HF?

systolic HF
Diastolic HF

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Systolic HF (left sided)

LV cannot contract forcefully enough to keep blood circulating normally throughout the body

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Which left sided HF is not able to maintain adequate cardiac output?

Systolic HF

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Diastolic HF (left sided)

LV has grown stiff or thick & is unable to fill the heart properly, which reduces the amount of blood pumped out to the body

Which type of left sided HF is the remodeling of the LV?

Diastolic HF → unable to relax to allow the blood to get in

Diastolic HF: A decrease in the amount of blood getting into the heart leads to ____

A decrease in the amount of blood able to get out of the heart

Systolic HF deals with ____ of the heart

Contraction of the heart

Systolic HF (left-sided) has an EF of ____

< 40% (low)

List 9 symptoms of systolic HF (left sided)

1. Tiredness/ fatigue 2. ↓ urine production 3. ↑ HR; may be irregular 4. ↑ BP 5. enlarged heart 6. pulmonary congestion (SOB) 7. Coughing 8. Weight gain 9. ↓ blood flow to extremities

Symptoms of Systolic HF (left sided) Tiredness/ fatigue

Lack of O2

Symptoms of Systolic HF (left sided) ↓ urine production

B/c fluid is backing up not being filtered by the kidneys

Symptoms of Systolic HF (left sided) ↑ HR; may be irregular

b/c the heart is trying to do its job

Symptoms of Systolic HF (left sided) What time of day is coughing often worse?

Often worse at night; when lying flat

Symptoms of Systolic HF (left sided) Why does pulmonary congestion occur?

Fluid or blood coming from the lungs CANNOT go anywhere → leads to build up in the lungs (↓ gas exchange)

Diastolic HF deals with ventricles being too ____ to properly ___ the heart

too stiff to properly fill the heart

What does the EF look like in diastolic HF

> 50% (normal)

What does diastolic HF often result from?

Hypertension

What type of left sided HF does not have any medications available to fix it?

Diastolic HF

List 10 Sx associated with left sided HF as a whole:

1. Paroxysmal nocturnal dyspnea 2. elevated pulmonary capillary wedge pressure 3. pulmonary congestion 4. restlessness 5. confusion 6. orthopnea 7. tachycardia 8. exertional dyspnea 9. fatigue 10. cyanosis

What secondary Sx are associated with pulmonary congestion in left sided HF? **Hint: 5**

1. cough 2. crackles 3. wheezes 4. blood-tinged sputum (frothy) 5. tachypnea

Why do we see blood tinged sputum or secretions in left sided HF?

The blood is trying to find any means to get to where it needs to be; way of getting rid of excess in the lungs

What is normal EF range?

55-70%

Explain normal role of diastole & systole

Diastole (filling) → ventricles fill normally with blood Systole (pumping) → ventricles pump out ~ 60% of the blood

Explain what happens in the heart when there is systolic dysfunction

1. The enlarged ventricles fill with blood 2. the ventricles pump out < 40-50% of the blood

Is Systolic dysfunction stiffening of ventricles or hypertrophy?

Hypertrophied → more blood coming in but EF is low meaning less blood is leaving → causing traffic jam leading to the lungs

Explain what happens in the heart when there is diastolic dysfunction

1. stiff ventricles fill with less blood than normal 2. ventricles pump out ~ 60% of blood, but amount may be lower than normal

Is diastolic dysfunction hypertrophy or stiffening of the ventricles?

Stiffening of ventricles → less blood coming into heart; meaning less will exit

List the vicious cycle of LV failure:

LVF → ↓ renal perfusion → renin production stimulated → persistent cycling of RAAS → further deterioration of heart function

Is right sided HF more or less common than left sided?

Less common

What happens in right sided HF?

Deoxygenated blood coming from the body, but right side of heart NOT pumping as well as it should → leads to "back-up" of blood in body

List 10 symptoms of right sided HF:

1. Weakness/ fatigue 2. Leg/ feet edema (dependent) 3. vein distention → JVD 4. Weight gain 5. Increased urination 6. Hepatomegaly / splenomegaly 7. Increased abdominal girth (ascites) 8. Increased peripheral venous pressure 9. anorexia & complaints of GI distress 10. secondary to chronic pulmonary problems

What is ascites?

Fluid distention in abdomen; very hard (looks pregnant) → can be seen in cancer patients

Right sided HF has less ____ and more ____

Less O2; More CO2 → can still have some impaired gas exchange

What organ gets less blood in right sided HF?

Kidneys

Why can hepatomegaly (enlarged liver) be seen in Right sided HF?

Portal vein is very close → so we see congestion here

What type of patients is right sided HF seen in?

COPD/ smokers

When we talk about right sided HF we should think _____ _____

peripheral swelling

Activation of the SNS causes what 7 things:

1. ↑ HR & contractility tachycardia 2. vasoconstriction 3. activates the renin-angiotensin system (RAS) 4. direct cardiotoxicity 5. ↑ myocardial O2 demand 6. ↑ wall stress 7. ↓ preload/ ↑ afterload

About 50% of patients with HF have ____ or more comorbidities

three or more

What are the 4 goals of Tx for HF?

1. address effects of HF on ABCs 2. Tx of the existing Sx of the crisis situation 3. Prevention of further or expanding complications 4. Tx of the underlying cause

Classification of HF: New onset/ De Novo HF:

1. Newly diagnosed HF 2. No previous Hx of HF

Classification of HF: Resolution of Sx:

**Resolution of S/S of HF** 1. stage C w/ previous Sx of HF w/ persistent LV dysfunction 2. HF in remission w/ resolution of previous structural &/or functional heart disease

Classification of HF: Persistent HF

Persistent HF with ongoing S/S &/or limited functional capacity

The worse the stage of HF gets the higher chance of ____ or ____

Morbidity or mortality