CHF ppt- Pales Flashcards
syndrome vs disease
Syndrome is a constellation of signs and symptoms occurring together and characterizing a particular abnormality or condition
The same syndrome may occur with different diseases, which may have distinctly different etiologies and pathogenesis
CHF defn
Clinical Syndrome in which an abnormality of cardiac structure or function is responsible for the inability of the heart to eject or fill with blood at a rate sufficient to meet the demands of the metabolizing tissues.
Pump failure
Systolic components of heart function/ dysfunction
Myocardial function
How strong the muscle is
Preload (EDV)
The more heart fibers are stretched the more difficult it is for them to contract increasing work/pressures and causing hypertrophy (Starling law)
After-load
Resistance against heart contraction/ejection of blood
Heart rate
Too slow—decreases cardiac output ( CO = SV x HR)
Too fast — not enough time to fill ( CO = SV x HR)
diastolic components of heart function/ dysfunction
Impaired relaxation –functional problem
Ischemia
Impaired compliance (“stiff” ventricle) –anatomical problem related to interstitial fibrosis
Hypertrophy
Hypertension
High output failure
Normal heart function with
increased metabolic demand
Increased peripheral blood flow from decreased PVR
systolic vs diastolic heart failure
Systolic Heart failure results from inadequate cardiac output (C.O.)/Ejection Fracture (E.F.)
C.O. = S.V. x H.R.
S.V. = E.D.V. – E.S.V.
E.F. = S.V./E.D.V.
Diastolic Heart Failure results from inability of the ventricles to relax and fill normally with blood during diastole.
Forward vs. Backward Heart Failure
Relates to clinical manifestations of the heart failure as a result of pump failure
Forward failure is decrease in perfusion of the organs/tissues down-stream from the heart
Backward failure is “backing up” of the blood into the organs upstream, increasing hydrostatic pressure, which leads to congestion/edema
Left-sided Heart Failure
Left Ventricle primarily affected.
Caused by conditions primarily affecting left ventricle - CAD/MI - Aortic/Mitral valves problems HTN - Cardiomyopathies
Forward failure symptoms are primarily in systemic circulation (downstream)
Backward failure symptoms/congestion in the lungs (upstream)
Right-sided heart failure
Right ventricle primarily affected. Caused by conditions primarily affecting right ventricle - Pulmonary diseases/cor pulmonale - Tricuspid/pulmonary valves - Pulmonary Hypertension - Pulmonary emboli
Backward failure symptoms/congestion in the systemic venous circulation (upstream)
Biventricular Failure
End result of left and right failure
Acute heart faillure
due to a sudden and severe event - Massive MI - Chorda tendinae rupture - Large PE Predominantly forward failure Flash Pulmonary Edema
chronic heart failure
Progresses slowly
Has exacerbation
Predominantly backward failure
Heart Failure vs. Cardiomyopathy
Heart failure is a syndrome
Cardiomyopathy is a large group of heterogeneous disorders of myocardial function in the absence of abnormal loading conditions such as with hypertension, CAD or valvular disease.
Left Heart Failure.CAD/MI
Due to death or functional ischemic dysfunction of myocardial tissue due to complete or partial blockage of coronary arteries
Degree of dysfunction depends on the percent of myocardium affected
Ischemic cardiomyopathy (Old term, still widely used)
Infectious Myocarditis
One of the main causes of dilated cardiomyopathy and left heart systolic failure in young patients.
Multiple etiological agents
- Viral
- Bacterial
- Fungal
- Helminthic
Febrile illness or URI frequently precedes cardiac symptoms by few weeks
Symptoms can present acutely (fulminant) or gradually
Non-infective Myocarditis
Toxic Myocarditis
- Chemotherapy
- Doxorubicin (Adriamycin)
- Heavy metals (copper, iron, lead)
- Lithium
- Malaria drugs
- Radiation causing inflammation and fibrosis
Autoimmune/ CTD associated Myocarditis
- Giant Cell Myocarditis
- PM/DM
- SLE/RA
Cocaine and myocardium
May cause vasospasm leading to MI
May cause arrhythmia
May cause drug-induced myocarditis/cardiomyopathy due to released catecholamines
Alcoholic Cardiomyopathy
From prolonged chronic alcohol use (at least 10 years of chronic exposure)
Due to direct toxic effect of alcohol on myocardium
Different from beriberi disease, although thiamine deficiency is frequent in alcoholics
Peripartum Cardiomyopathy
Between last month of pregnancy and first 5 months after delivery
Likely due to immune-mediated process
No preexisting cardiac disease
More than ½ of patients improve within 6 months
Takotsubo Cardiomyopathy
A.K.A. Stress cardiomyopathy
A.K.A. Apical Ballooning Syndrome
A.K.A. Broken Heart Syndrome
stress- neurogenic –> myocardial stunning, heart failure, angina, coronary spasm, arrhythmias, stress cardiomyopathy
80% are women
Triggered by an acute medical illness or by intense emotional or physical stress
Postulated mechanisms include
- catecholamine excess
- coronary artery spasm
- microvascular dysfunction
- OR dynamic mid-cavity or left ventricular outflow tract obstruction which may contribute to apical balooning.
Symptoms are similar to an acute MI
- CP, SOB, Syncope,
Hypertrophic CardiomyopathyGenetic (HOCM)
Group of disorders
Myocardial hypertrophy unrelated to any pressure or volume overload
Due to different genes mutations
Myosin heavy chains
Proteins regulating Calcium handling
Most are autosomal dominant
Inter-ventricular septum often disproportionally involved
Sub-aortic stenosis is often present
May cause diastolic or systolic dysfunction
