B4.028 Heart Failure: Clinical Manifestations and Treatment Flashcards
why is the HF population growing?
improved management of chronic cardiac disease
MI/HF/arrhythmia management
what is the definition of heart failure?
structural or functional cardiac abnormality
inability to adequately supple blood to metabolizing body tissues (inability to meet the body’s metabolic needs)
systolic cardiac dysfunction
impaired ability (usually LV) to eject blood
diastolic cardiac dysfunction
impaired ability of the LV to fill with blood
why is the diagnosis of HFpEF challenging?
largely a diagnosis of exclusion of other potential noncardiac causes of symptoms suggestive of HF
what are the 3 classes of causes of heart failure?
underlying causes (diseases) fundamental causes (pathophysiologic mechanisms) precipitating causes (stimuli for deterioration)
HF underlying causes (diseases)
CAD hypertension myocardial disease valvular disease pericardial disease
examples of myocardial disease that can cause HF
dilated infiltrative inflammatory hypertrophic stress cardiomyopathy (Takotsubo)
examples of valvular diseases that can cause HF
usually left sides aortic stenosis aortic regurg mitral stenosis mitral regurg
examples of pericardial disease that can cause HF
tamponade
constrictive pericarditis
what are the fundamental causes of HF?
increased hemodynamic burden or impaired myocardial O2 delivery triggers mechanisms that
- impact contractility (inotropic state)
- may promote increased TPR (increased afterload)
- promote sodium and fluid retention (increased preload)
which systems are activated in HF
renin-angiotensin
SYM nervous system
remodeling-structural myocardial changes
precipitating causes of HF
inappropriate reduction of therapy arrhythmias MI infection PE unrelated illness drug side effects (NSAIDs) cardiac toxins severe stress
what factors need to be addressed to treat HF?
underlying etiologies
precipitating causes
deleterious reflex responses
what is LV dysfunction?
a pathophysiologic condition that can lead to the clinical syndrome of HF (5x more likely)
early recognition and treatment can limit progression
how do HF patients present?
decreased exercise tolerance
fluid retention
discomfort at rest (SOB, orthopnea)
increased TPR/ peripheral vasoconstriction
HF risk factors
hypertension CAD older age diabetes obesity smoking valvular heart disease
diastolic dysfunction risk factors
older age
female gender
hypertension
what % of people have systolic vs diastolic HF
2/3 systolic
1/2 diastolic
what is a physical exam finding of peripheral vasoconstriction?
cool skin
cyanosis