Heart Failure Flashcards
preload
volume entering ventricles
afterload
resistance left ventricle must overcome to circulate blood
signs and symptoms of heart failure
- exertional dyspnea/exercise intolerance
- fatigue, weakness/tiring easily
- orthopnea: SOB in supine
- paroxysmal nocturnal dyspnea: SOB at night
common clinical signs of heart failure
- fluid retention
- ascites
- jugular venous distension
- hepatomegaly
- pitting edema
- tachycardia
classification of heart failure
- right vs left sided heart failure
- congestive heart failure
- HFpEF vs HFrEF
- functional classification (NYHA)
left sided heart failure
- reduced contractility
- decreased LV stroke volume & LV ejection fraction
impact of left sided failure
- reduced stroke volume, EF and cardiac output
- blood flow to the body is reduced –> decreased O2 delivery
- fatigue
- exercise intolerance
- SOB
causes of left sided failure
- uncontrolled HTN
- CAD
- arrhythmias
- history of MIs
- diabetes
- congenital heart disease
- cardiac valve disease
results of left sided heart failure
- vascular congestion
- pulmonary congestion
- pulmonary edema
- hemoptysis
what does reduced contractility lead to
increased LV EDV and increased LV EDP
is blood movement decreased or increased from the left atrium into the left ventricle during ventricular diastole, and why?
- decreased
- due to an increased left ventricle end diastolic volume
due to the decreased blood movement from the left atrium into the left ventricle, what happens
blood accumulates in left atrium causing an increase in left atrium diastolic pressure
signs and symptoms of left sided heart failure
- SOB
- dyspnea
- orthopnea
- fatigue
- exertional dyspnea
- waking up feeling like you are suffocating
- cough
- mitral valve develops regurgitation
- decreased urine production
- restlessness, confusion
- cyanosis
what does DO CHAP stand for
- for left sided heart failure
- Dyspnea
- Orthopnea
- Cough
- Hemoptysis
- Adventitious breath sounds
- Pulmonary Congestion
right sided failure
- contractility of right ventricle is reduced
- doesn’t pump efficiently
impact of right sided heart failure
accumulation (congestion) of blood in right ventricle and atrium and in the systemic circulation, resulting in systemic S&S
signs and symptoms of right sided failure
- congestion in the systemic circulation
- abdominal blotting/swelling/ascites
- kidney failure
- JVD
- weight gain
- dependent edema
- increased fq of DVT and PE’s
congestive heart failure
- heart is unable to pump enough blood to meet metabolic needs
- causes pathological change in the myocardium
- most common
when do symptoms arise in CHF
not until decompensated CHF and exercise capacity declines
class 1 heart failure
- cardiac disease
- no limitation of PA
- no symptoms
class 2 heart failure
- mild symptoms
- slight limitation of PA
- comfortable at rest
- ordinary activity may cause symptoms to flare
class 3 heart failure
- marked limitation of PA
- comfort at rest
- less than ordinary activity
class 4 heart failure
- severe limitation
- symptoms even at rest
stage A HF
people at high risk for developing HF in the future but no functional or structural heart disorder, pre-heart failure
stage B HF
structural heart disorder but no symptoms at any stage
stage C HF
previous or current symptoms of HF in the context of an underlying structural heart problem, managed with medical treatment
stage D HF
advanced disease requiring hospital-based support, heart transplant or palliative care
acute HF
- symptoms appear suddenly or a rapid worsening of existing symptoms of HF occurs
- exacerbation
what is the 5lb rule
- a 5 lb increase in body weight in 24 hrs
- this increases risk for exacerbation
systolic HF
- heart failure with reduced ejection fraction, HRrEF
- left ventricular contractility is reduced in turn reducing EF and O2 delivery
what is the net effect of systolic HF
reduced delivery of blood into systemic circulation and subsequent O2 delivery
diastolic HF
- heart failure preserved ejection fraction, HFpEF
- ventricles are limited in filling, become stiffer and less compliant
- reduced stroke volume
systolic HF or HFrEF is preceded by:
- chronic comorbidities
- more men than women
- frequent hospitalization
diastolic HF or HFpEF is preceded by:
- chronic comorbidities
- more women than men
cardiac remodeling
- negative, heart failure
- ventricular dilation
- thinning of ventricular walls
what are the subcellular changes in cardiac remodeling?
- reduced mitochondrial density
- diruption of myofibrils
- disruption of normal anatomy of the sarcomeres
- disruption of sarcolemma
- fibrosis
what do the subcellular changes in cardiac remodeling result in?
- cardiac dysfunction of HF
- marks the transition from cardiac hypertrophy (compensated) to heart failure (decompensated)
what is HF a response of
- long term hyperautonomic and/or chronic hyperinflammatory state
what are other things that HF can cause damage to?
- endothelial dysfunction
- skeletal muscle damage
- decreased systemic blood flow & increased total peripheral resistance
- kidney dysfunction
- cachexia
what is a key intervention for people with HF
exercise training
