Basics of Heart Failure and Pericardial Disease Flashcards
Pulm edema due to heart failure
Heart fsilure - inadequste cardiac output for tissue needs
Results in compensatory changes that increase BV (retain Na and Cl) presented to pump by the venous system (cardiac preload)
Increased BV raises pulm capically pressure leading ot increased fluid filtration into lung interstitium
If pronounced, this leads to cardiogeinic edema
Preload vs. afterload
Preload - on the vein side
Afterload - on the aortic side
Cardiogenic edema patho
LV not as good…increased preload because more coming in and less going out…R-L heart connection will swell up and get bigger…hydrostatic pressure increases and cardiogenic edema increases
Lung-heart interactions
heart can imapir heart performance via pulmonary edema (and pleural effusion formation)
Lungs can imapir heart performance via increased pulmonary vascular resistance
Also some CV changes with mech ventilation
Clinical HF
Poor activity tolerance
Orthopnea and paroxysmal nocturanl dyspnea
Dependent leg edema and JVP (increased central venous blood volume and pressure)
Fine insp crackles more at lung bases (increase lung water leads to alveolar closing and opening during resp cycle)
Heart specific findings - enlarged and dsipalced PMI and S3/S4
Pulmonary wedge pressure
Left ventricular filling prssure
Pulm artery catheterization allows measurement of left ventricular filling pressure
Chest XR correlation to pulm wedge pressure
INcreased vascular predicle width - increased sys BV
Cardiomegaly
Flow cephalization due to increaseed pulmonary blood volume (vessel recruitment and distension)
The wedge pressure increase relates to this
As wedge pressure gets really bad Chest XR
Get interstitial cardiogenic edema
Kerley B lines - look like stacked quarters
heart borders are not sharp anymore
Alveolar cardiogenic edmea - central predominant fluffy opacities
Pericarditis
Pericardial effusion
Constrictive pericarditis
Typical chest pain with/without evident effusion
may progress to tamponade
Chronic condition that entraps heart due to thickened adherent pericardium
Pericaridal effusion
Fluid in pericardial space enlarges cardiac silhoutte by imaging
Sx depends on both pressure and presence of inflammation (inflammation cuases the pain)
High pressure reduces blood inflow into the heart (preload), reduces output and leads to shokc…this is tamponade
If there is NO tamponade, then no real blood flow complications
Effusion - exam and imaging
Heart sounds dimimshed
Pericardial rub ay be present
Lungs clear
Tamponade - increased JVP, hypotension, weak pulse, paradoxial pulse
IMaging - increased cardiac silhouette (water bottle), clear lungs (no edema), may have pleural effison depending on etiology
How to differentiate chest XR in heart failure and pericardial effusion
Toracic lung volume (pedicle width)
Vascular marking
Presence of edema
