279 Heart Failure: Pathophysiology and Diagnosis Flashcards
It is a complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood, which in turn leads to the cardinal clinical symptoms of dyspnea and fatigue, edema and rales
Heart Failure
Etiologies of Heart Failure with Depressed EF (<40%)
Coronary artery disease
Myocardial infarction
Myocardial ischemia
Chronic pressure overload
Hypertension
Obstructive valvular diseasea
Chronic volume overload Regurgitant valvular disease Intracardiac (left-to-right) shunting Extracardiac shunting Chronic lung disease Cor pulmonale Pulmonary vascular disorders
Nonischemic dilated cardiomyopathy
Familial/genetic disorders
Infiltrative disorders
Toxic/drug-induced damage
Metabolic disordera
Viral
Chagas’ Disease
Disorders of rate and rhythm
Chronic bradyarrhythmias
Chronic tachyarrhythmias
Etiologies of Heart Failure with Preserved EF (>40%)-50%
Pathologic hypertrophy
Primary hypertrophic cardiomyopathies
Secondary hypertension
Aging
Restrictive cardiomyopathy Infiltrative disorders (amyloidosis, sarcoidosis) Storage diseases (hemochromatosis)
Fibrosis
Endomyocardial disorders
Etiologies of Heart Failure High Output States
Metabolic Disorders
Thyrotoxicosis
Nutritional disorders (beriberi)
Excessive blood flow requirements
Systemic arteriovenous shunting
Chronic anemia
Myocyte Changes during LV Remodeling
Myocyte loss
Necrosis
Apoptosis
Autophagy
Alterations in extracellular matrix
Matrix degradation
Myocardial fibrosis
Alterations in Myocyte Biology during LV Remodeling
Excitation-contraction coupling
Myosin heavy chain (fetal) gene expression
β-Adrenergic desensitization
Hypertrophy
Myocytolysis
Cytoskeletal proteins
Alterations in LV Chamber Geometry during LV Remodeling
Left ventricular (LV) dilation
Increased LV sphericity
LV wall thinning
Mitral valve incompetence
It refers to the changes in LV mass, volume, and shape and the composition of the heart that occur after cardiac injury and/or abnormal hemodynamic loading conditions
Ventricular Remodeling
Cardinal Symptoms of HF
Fatigue
Shortness of breath
It is defined as dyspnea occurring in the recumbent position, is usually a later manifestation of HF than is exertional dyspnea
Orthopnea
It results from redistribution of fluid from the splanchnic circulation and lower extremities into the central circulation during recumbency, with a resultant increase in pulmonary capillary pressure
Orthopnea
It refers to acute episodes of severe shortness of breath and coughing that generally occur at night and awaken the patient from sleep, usually 1–3 h after the patient retires
PND
Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain.
NYHA Class III
Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.
NYHA Class IV
Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activ- ity does not cause undue fatigue, palpitations, dys- pnea, or anginal pain.
NYHA Class I