Heart Failure Flashcards
Systolic Dysfunction
- Also called?
- Problem?
- Heart failure with reduced ejection fraction (HFrEF)
- Ventricle can fill but can’t pump
Diastolic Dysfunction
- Also called?
- Problem?
- Heart failure w/ preserved ejection fraction (HFpEF)
- Ventricle can’t fill but can pump
Normal Ejection Fraction
Normal ejection fraction: ~50-70%
Ejection fraction: The % of blood that leaves your left ventricle when it contracts
Heart failure w/ reduced ejection fraction (HFrEF)
-Ejection Fraction?
Ejection Fraction < 40%
Heart failure w/ mildly reduced ejection fraction
-Ejection Fraction?
EF 40-50%
Heart failure w/ preserved ejection fraction
-Ejection fraction?
EF > 50%
-The left ventricle doesn’t fill properly, but does contract, so the same % of blood leaves the ventricle, but from a smaller starting volume
Clinical presentations of decreased cardiac output:
- Hypoperfusion
- Congestion
Hypoperfusion: *The Fuck Callie Can’t Oink”
- Tachychardia
- Fatigue
- Cyanosis
- Cold extremities
- Organ dysfunction (Increased serum creatinine, increased LFTs, confusion/AMS)
Congestion:
- Weight gain
- SOB
- Orthopnea
- Paroxymal nocturnal dyspnea
- Pleural effusion on CXR
- Crackles/ Rales on ausculation
- S3 & S4
- Peripheral edema
- B type natriuretic peptide
- Jugular venous distention
Whitney Sings “One moment in time” . Performance powered Callie, Shirley. Performance baptized Jasmine
ACC Classification of Heart Failure
Class A: At risk for Structural Heart Disease, No symptoms
Class B: Structural Heart Disease present, No symptoms
Class C: Structural Heart Disease present, Symptoms present
Class D: Structural Heart Disease present, Refractory symptoms
NYHA Classification of HF
Class I: No limitation w/ ordinary activity
Class II: Slight symptoms w/ activities of daily living
Class III: Extreme symptoms w/ activities of daily living
Class IV: Symptoms at rest
Most common cause of HF?
Myocardial infarction
Number 1 cause of death in a patient with HF?
Sudden cardiac death from ventricular tachycardia/ fibrillation
-Increase in beta 1 stimulation + ventricular remodeling —> ventricular arrhythmia and sudden death
Gold standard test of HF
Echocardiogram
Decreased cardiac output response:
Catecholamine release
-Short term effect?
-Long term effect?
-Norepinephrine/ epinephrine
-Short term: Stimulate B1-R in the heart –> Increase Cardiac Output
-Long term: Apoptosis/ muscle burn out & ventricular remodeling/ fibrosis
•Desensitize B1 R
• Change in B1 : B2 receptor ratio, normal 80 : 20; HF 60 : 40
• Uncoupling of B1 receptors (myocytes won’t contract)
Decreased cardiac output response:
Juxtaglomerular Apparatus
- Patho?
Increased renin —> Stimulates AGII receptors
AGII Receptors:
• Extremities: vasoconstriction
• Kidneys: Na and H2O retention
• Adrenals: NE and aldosterone release- Aldosterone: more ventricular remodeling and promotes more K and Mg excretion
• Heart: stimulates abnormal growth/collagen deposition = worsens remodeling
• Posterior pituitary: ADH release → holds on to more free water
Decreased cardiac output response:
Sodium & H2O Retention
-Patho?
• Promote K and Mg
excretion
• Hang on to additional fluid → increase in preload
