Gupta-- Heart failure Flashcards
Define heart failure
- failure of heart to pump enough blood to meet body’s needs… clinical syndrome caused by various pathologies
what specific symptoms are seen for HF
- impaired CO
- venous congestion
- fluid retention
what are the 2 big categories of HF
- high demand –> high output but still an inadequate supply
- normal demand but there’s actually a problem with the output, so you have low supply
define cardiac index
CO/surface area
what happens to vessels in high output HF
- decrease in systemic vascular resistance (vasodilation in order to respond to decreased O2 and increased CO2
- need increased SV and HR to increase CO and maintain MAP (still doesn’t work though in those with HF)
Name three main causes of low output HF
- decrased cardiac output
- increased SVR
- Increased HR
2 and 3 is in response to try to increase CO
2 categories of low output HF
give definitional LVEF for each
- diastolic – filling problem EF greater than or equal to 40 percent)
- Systolic – pumping problem (LVEF < 40 percent)
what are the three main causes of diastolic HF? Systolic?
diastolic:
- Older
- female
- HTN
systolic:
1. idiopathic
2. ischemic (MAJORITY)
3. HTN
what is main etiology of myocarditis
viral infection
Name three main categories of systolic heart failure
- right ventricular failure
- left ventricular failure
- biventricular
Give two main problems in right ventricular failure and examples
- volume overload (atrial septal defect, anomalous pulmonary venous return)
- pressure overload (cor pulmonale– chronic; pulmonary embolism – acute)
What are major criteria for CHF
- paroxysmal nocturnal dsypnea
- increased CVP (> 16 cm H20)
- check JVD and hepatojgular reflux - rales
- cardiomegaly on CXR
- acute PE
- weight loss > 4.5 kg after treatment
- S3 gallop
Define cardiomegaly on CXR
- ratio of maximal horizontal cardiac diameter to maximal horizontal thoracic diameter
normal is <0.5
Name minor criteria for CHF
- bilateral lower extremity edema
- nocturnal cough
- hepatomegaly
- tachycardia
- pleural effusion
How do you need to fulfill framingham criteria to diagnose CHF
2 major or 1 major + 2 minor
Physical exam for high output heart failure
- traube’s sign
- quincke’s pulse
- wide pulse pressure
- bounding pulses
- hyperkinetic heart
- warm extremities
clinical appearance of low output heart failure
- coughing
- tiredness/SOB
- plerual effusion
- ascites
- peripheral edema
- pulmonary edema
- because of starling curve, heart can’t even pump well
labs to order to find out etiology of HF
- CMP
- CBC
- urinanalysis
- TSH
- Fasting lipid profile
- anemia studies (B1, folate… beriberi)
- BNP
- troponin
what are some etiologies of HF
- HIV
- hemochromatosis (iron gets in and causes difficulty contracting)
- rheumatologic diseases
- amyloidosis
what is swan ganz catheter and what is it used for?
- pulmonary artery catheter… giving estimate of left atrial pressure, while also testing blood here to see oxygen saturation…
- determine CO
What are TTE’s good for?
- determining ejection fraction (to see if you have high output normal EF or high output reduced EF)
- wall motion
- valvular problem?
- wall thickness
indications of endomyocardial biopsy
- Unexplained new onset of HF associated with ventricular arrythimas and/or heart block
- Failure to respond within 1-2 weeks of treatment
when do you think giant cell myocarditis
how do you treat?
- acute exacerbation of HF with arrythmia
- treat with high doses of steroids
what patient population is especially susceptible to low output HF
- elderly
prognosis of low output heart failure
- 50% of patients dx with CHF will be dead in 5 years
describe progression of heart failure
- series of acute events followed by decreased function.. until they finally lose too much myocardial function
which carries worse prognosis, HFpEF or HFrEF
SAME
