Chronic Heart Failure Flashcards
What is the number one reason people are hospitalized each year?
Heart Failure
What are some major contraindications for Transplant?
- Malignancy
- Money
- Mental Status
- Age (over 65 or 70 usually no go)
- Drug Addicts
- Non-compliance
What are 3 neurohumoral responses to heart failure?
- Increased RAAS (decreased renal perfusion 2° to low CO)
- Increased NE release (b/c of hypoxia)
- Increased ANP (atrial neurogenic peptide)
How do we determine if someone has heart failure?
• how do we determine severity?
Heart Failure is Defined by Ejection Fraction
• Classifications are used to determine the severity of the disease by looking how HF impacts daily life of the patient
What defines Classes 1-4 of heart failure?
Class I:
• Patient Live a normal Life, no symptoms of HF
Class II:
• Patients may have to stop or slow down during physical activity
Class III:
• Short of breath even getting up and going to the bathroom
Class IV:
• Can hardly breathe, bedridden
When do we most commonly see ECCENTRIC hypertrophy in the heart?
• Most common in: Myocardial Infarction (weakened tissue) and Infection
When do we most commonly see CONCENTRIC hypertrophy?
• Hypertension and some Valvular Diseases
How do you calculate Ejection Fraction?
• what value do we typically want to see?
SV/EDV = EF
• Typically want to see EF of 50% or more
What important aspects of Heart Failure Cannot be predicted by Ejection Fraction?
- Cardiac Output
- Renal Blood Flow
- RAAS activation
- Salt and Water Retention
***EF is a good starting point for Dx but doesn’t tell us much about how the patients condition is affecting their life
What systems are most affected by the massive neurohumoral response to MI?
- Brain
- Kidney
- GI tract
- Skeletal Muscle
What are some GI side effects seen in severe Heart Failure?
• Nausea, Vomiting, Abdominal Pain
Why does renin get released?
• Poor Renal Perfusion - the kidney thinks you’re bleeding to death
What symptoms of heart failure are directly linked to the effects of renin?
- Difficulty Breathing
- Pitting Edema
- Ascites
***all these are effects of water retention
What effects does aldosterone have on the body?
- Increased Na+ reabsorption and K+ excretion
- Vasocontriction
***Both of these increase fluid volume leading to increases in afterload
Why would you want someone whose heart is failing in bed as much as possible?
• When patients are upright there renin levels are increased, however when they lie down they go DOWN
T or F: like renin aldosterone also is decreased in patients who are supine
True, this is likely due to less renin since angiontensin II elicits production of ALDOSTERONE
How much of the Heart’s output is required to maintain GFR?
20%
T or F: its believed that Angiotensin is directly toxic to the heart
True
Why do you want to keep your heart failure patients out of the heat?
• Vasodilates Skin leading to decreased renal perfusion
What is Spirolactone?
• Aldosterone Receptor Antagonist
What are some of the measurable effects to keeping patients bedridden who have CHF?
- INCREASED responsiveness to Medical Management
- Cardiomegaly on CXR was reduce
- Symptoms of overall CHF were reduced
What causes cardiomegaly in heart disease?
• INCREASED AFTERLOAD
T or F: like angiotensin, aldosterone is direct toxin to the heart.
True, BOTH angiotensin and aldosterone are direct toxins to the heart
What is the main compensating mechanism in compensated heart failure?
• what causes patients to move from compensated HF to decompensated HF?
ANP typically balances out RAAS in compensated heart failure
• People move to decompensated heart failure because they are non-compliant with therapy or GO OUT IN THE HEAT
Is INTRAvascular or EXTRAvascular water retention responsible for Jugular Venous Distention?
• what level of fluid retention causes JVD?
INTRAvascular Volume increase is responsible
• JVD caused by 3L of retention
What is the problem with the body’s compensatory mechanisms for congestive heart failure?
• It can never compensate because there is so much extracellular fluid that increased Cardiac Output just leads to more fluid getting pushed into the periphery
What level of extracellular volume causes Ansacara?
30L of extracellular fluid
What are the 4 signs and symptoms to look for in Congestive Heart Failure (CHF)?
- Low Cardiac Output
- Abnormal Retention of Sodium and Water by RAAS
3/4. Signs and symptoms of pulmonary and systemic congestion
What measurable effects do ace inhibitors have on treatment of CHF?
- Reduced Mortality
* Decreased End Diastolic Volume
Why do we want to see reduced end diastolic volumes in CHF pts?
• Because it means they’ll likely have decreased afterload because less blood is getting pumped into the system
*Remember increased blood in the system isn’t good in pts. with CHF because it just gets pushed into lungs and the periphery
What happens to ACE expression in infarcted hearts?
• It gets increased drastically
***Remember ACE is typically only found in the lungs
In someone with ansacara what is the target for amount of fluid to lose everyday?
- what should you monitor?
- why?
- 1000mL is the target fluid loss and NO MORE
- Monintor Serum Creatinine because RENAL PERFUSION is decreased due to rapid loss in blood volume and the kidney may start to shut down
T or F: lying supine helps to decrease the daily sodium balance and make diuretics even more effective.
True, this is because lying down helps to decrease RAAS activation which causes sodium retention via Angiotensin II and Aldosterone, this a multiplicative effect on Increased Sodium loss (this is a good thing)
What is Spironolactone?
• why is it only prescribed to patients who are very symptomatic?
- Aldosterone Antagonist
- Only prescribed to patients who are very symptomatic because you RETAIN a lot of POTASSIUM with this drug
- Diuretics also make you retain Potassium (since Spironolactone is often added to a diuretic you can get really large increases in potassium)
What causes Cachexia associated with heart failure?
- TNF-alpha and IL-6
* RAAS activation also increases nitro-/oxidative stress in: Heart, Skeletal Muscle, Skin, Plasma
Can we treat cachexia associated with HF?
NO, ACE and Aldosterone inhibitors will do nothing
