CHF (EXAM 4) Flashcards
CHF is the most common __________ diagnosis in the U.S. in those > 65
- inpatient
What are the important epidemiology factors for CHF?
- very common!
- incidence increases with age (75% of cases are in those > 65)
- M > F
- 25% higher incidence in African American patients
- some forms of cardiomyopathy are genetic
Who is the most at risk for developing CHF?
Those with:
- Coronary heart disease
- Smokers
- HTN
- Obesity (huge risk factor!)
- Diabetes
- Valvular heart disease
Heart function and cardiac output depend on these 4 thing:
- contractility of myocardium
- preload of the ventricle
- afterload applied to ventricles
- heart rate
(issues with any of these 4 factors can result in CHF)
What is this the definition of?
- the pressure in the ventricle at the end of diastole
PRELOAD
AFTERLOAD: They systemic ________ ________ (pressure) that the heart works ______ to pump blood (pressure in the ventricle wall during ejection)
- vascular resistance
- against
Describe the Frank-Starling Law
- Stroke Volume (SV) of the heart increases in response to increase in the volume of blood filling the heart (end diastolic volume)
aka - increase in the volume of blood going into the ventricle during diastole = more stretch of ventricle = increased force of contraction and quantity of blood pumped during systole
What is the #1 and #2 most common causes of CHF in the U.S?
1 –> MI
#2 --> Untreated/inadequately treated HTN
- remember: HTN increases the LV afterload -->
longterm this can result in LV hypertrophy
What type of dysfunction is this describing?
- ventricular filling is abnormal
- mycocardial relaxation is impaired or chamber is noncompliant (stiff)
DIASTOLIC DYSFUNCTION
- Slowed, delayed, and incomplete myocardial relaxation
- Increased dependence on LV filling from atrial contraction
- Increased passive stiffness and decreased distensibility of the LV
- Shift of filling from early to late diastole
- stiffness comes from excess hypertrophy/compositional changes of myocardium
_________ dysfunction - is an abnormality of diastolic relaxation, filling, or distensibility of the LV, regardless of symptoms of EF
Diastolic
HFpEF is? Describe it
Heart Failure Preserved Ejection Fraction
- clinical signs and symptoms of heart failure, LV diastolic dysfunction, and a normal LVEF
What is generally considered a normal EF%?
> 50% (varies slightly by clinic)
_________ is the most common mechanism of SYSTOLIC DYSFUNCTION
Ischemia
Another important mechanism:
- decreased LV ejection fraction (EF) < 40-50%
Other causes:
- idiopathic dilated cardiomyopathy
- inflammation (ex: myocarditis)
- infiltration (ex: amyloidosis)
- toxin-induced cardiomyopathies (ex: cocaine, ethanol)
- valvular heart disease
Adaptations to heart failure Part I:
- if SV is ________ by high afterload or ________ contractility, pressure and EDV ________.
- if SV is DECREASED by high afterload or DECREASED contractility, pressure and EDV INCREASE.
- leads to dilated ventricles if chronic
Adaptations to heart failure Part II:
Reduced CO causes:
- ________ sympathetic activity leads to: ________ myocardial contractility, ________ HR, and __________ venous tone.
- _________ of renal blood flow and GFR.
- INCREASED sympathetic activity leads to: INCREASED myocardial contractility, INCREASED HR, and INCREASED venous tone.
- leads to ventricular modeling and progressive
ventricular dysfunction - REDUCTION of renal blood flow and GFR.
- leads to RAAS system activation
Which side of heart failure is this?
- Impairment in adequate circulation of blood into systemic circulation –> blood backs-up into the pulmonary vasculature causing pulmonary edema and dyspnea
LEFT
(Left sided = think Lungs!)
- may hear crackles
- can be systolic or diastolic
And what about this side for heart failure?
- Unable to adequately pump venous blood into the pulmonary circulation –> fluid backs up into the body leading to peripheral edema, increased JVP, and ascites
RIGHT
**often caused by left heart failure
What body system is very connected to the heart other than pulmonary?
RENAL!
Cardio______ Syndrome
- CardioRENAL Syndrome
- acute or chronic dysfunction of the heart or kidneys can induce acute or chronic dysfunction in the other organ system
**Remember - heart, lungs, and kidneys are all very connected!
What can trigger decompensated HF?
Hint: think about blood volume, issues with rhythm, blood flow, etc
- uncontrolled HTN
- Increased salt & water intake (or noncompliance with
diuretics) - tachyarrhythmias (esp. new onset afib)
- ischemia
- worsening renal failure
- anemia
- chronic lung disease
- infection
What is the prominent symptom of LEFT sided heart failure?
Name 3 other symptoms along with the above.
- DYSPNEA
(Progression: DOE –> orthopnea, PND –> dyspnea at rest) - chronic non-productive cough
- fatigue
- exercise intolerance
________ retention is the prominent symptom of RIGHT sided heart failure.
- FLUID retention
How many classes of heart failure does the NYHA classify? Describe them! (I know I am annoyed by this one too!)
*Paulson said to know these well!
- FOUR
I –> No limitation of physical activity. Asymptomatic.
II –> Slight limitation of physical activity. Comfortable at
rest. Ordinary physical activity results in fatigue,
palpitation, dyspnea, or angina.
III –> Marked limitation of physical activity. Comfortable
at rest. Less than ordinary activity leads to fatigue,
palpitations, dyspnea, or angina.
IV –> Unable to cary out ANY physical activity without
discomfort. Symptoms of heart failure at rest. If any
physical activity is undertaken, discomfort worsens.
PE:
What might you see on a patient’s vital signs when they present with CHF?
- Tachycardia
- Hypotension OR Hypertension
- Hypoxia
