Exam 2 - Heart Failure Flashcards
what is the MC cause of HF?
coronary artery disease
what is the MC mechanism of HF?
heart injury from something leads to progressive weakening
what is systolic heart failure?
the heart doesn’t contract as well
what is diastolic HF?
the ventricles can’t relax as well
can systolic HF and diastolic HF occur together?
yes and often do
what is the difference between acute and chronic HF?
acute is like a large MI, with sudden symptoms like pulm edema and hypotension
chronic is slow onset of symptoms like peripheral edema and fatigue
what is the MC common cause of RHF?
what are other causes?
MC = left-sided heart failure
other: COPD/pulm HTN
what are the MC causes of L sided HF?
CAD and HTN
what else can cause left-sided heart failure?
post MI
L sided valvular disease
to name some
what is backward failure?
ventricles don’t empty correctly and pressure builds up behind ventricles
what is forward failure?
poor CO leads to decreased renal perfusion, decreased activation of RAA axis, and Na/H20 retention
One of the mechanisms of HF is redistribution of CO. what does this mean?
you have low CO, so your body increases blood flow to vital organs, and decreases blood flow to skin and muscle.
When your body redistributes CO, what system does that activate?
sympathetic/adrenergic system
Why is it bad that your sympathetic/adrenergic system is activated in HF?
it tries to maintain your BP by increasing cardiac afterload
this makes your weak heart weaker
what hormones does you sympathetic system secrete?
epi/NE
What does a longterm increase of epi/NE do to your heart?
remodeling
muscle thins, stretches, and dilates
Another mechanism of HF is water and Na retention. what “axis” guides this process?
renin-angiotensin-aldosterone axis
What triggers the RAA axis to begin?
your kidneys sense that they have decreased perfusion/BP
what happens once your kidneys sense decreased perfusion/BP?
kidneys release renin
what does renin do?
converts the enzyme angiotensinogen to angiotenin I
What then happens to angiotensin I?
the enzyme ACE converts angiotensin I into angiotensin II
What does angiotenin II do? (2 things)
- vasoconstricts (increases resistance/BP)
- stimulates release of aldosterone from adrenal glands
what does aldosterone do?
increases the reabsoption of Na and H20 into the body
what do long-term high levels of aldosterone do to the heart?
remodeling
what is class 1 HF?
no limitations
no symptoms
what is class 2 HF?
can do ADLs
get symptoms on exertion
What is class 3 HF?
increasing limitations with physical activity
doing ADLs cause symptoms
What is class 4 HF?
getting symptoms at rest or with minimal activity
What are the 3 symptoms of HF that are associated with breathing?
dyspnea (on exertion, then with rest)
orthopnea
paroxysmal nocturnal dyspnea
what patho causes dyspnea?
increased venous pressure
what patho causes orthopnea?
redistribution of excess fluid to the lungs while supine
What is another sx caused by Na and water retention?
unexplained weight gain
what patho causes these symptoms: fatigue, weakness, abdominal discomfort?
decreased CO to muscles, GI system
Why would a person also get cerebral symptoms with HF (like memory loss)?
decreased perfusion to the brain
There are legit so many things for PE so i’m just going to touch on a few.
What will you hear when listening to the lungs?
inspiratory crackles
starting at bases and moving upward
what will you hear when listening to the heart?
S3 gallop
what does an S3 gallop sound like?
after S2 (during diastole), a low-pitched thud
what causes an S3 gallop?
as blood hits the stiff wall, it rapidly decelerates
this hitting and deceleration makes a “thud” sound.
On PE you see a + hepatojugular reflux. what is this?
you push on the liver, and see the jugular vein pop out because of all the fluid
overall physically, what will this person look like?
cachexic
What 2 signs on CXR are somewhat unique to HF?
increased upper lung markings
Kerley B lines
What is the best diagnostic test for HF?
echo/doppler
On ECG, what is it super important that you assess?
ejection fraction
what does ECG look like for systolic and diastolic failure?
systolic: low EF, thin ventricle walls, dilated LV
diastolic: high EF, thick ventricle walls, small LV
You could also get a BNP level. What’s the deal with that?
it’s released by the ventricles when the heart is acutely stressed
How about treatment?
in the next deck :))))))
