Heart Failure Flashcards
Cardiomyopathy
definition and causes
disease that affects the myocardium–can lead to HF
idiopathic ischemia HTN inherited disorders infections toxins myocarditis auto-immune condition
What is heart failure?
A chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen.
ie. heart can’t keep up with its workload
Most common cause of hospitalization
Major causes of heart failure
repeated ischemic episodes - ischemic cardiomyopathy
MI with or without papillary muscle rupture
Chronic HTN
COPD (RVF)
Dysrhythmias
Valve disorders; mitral insufficiency, aortic stenosis
Pulmonary Embolus (RVF)
Risk factors for HF
HTN–greatest risk factor; DM can also contribute
Within 6 months of MI
Men and postmenopausal women have same risk
Higher incidence in blacks
Genetics
Major risk factors for HF
Increasing age (>65) Ethnicity (blacks>whites) Family hx and genetics DM Ischemic heart disease Obesity HTN Lifestyle factors--smoking and sedentary
Other risk factors for HF
COPD (esp R sided HF) Severe anemia (↓perfusion) Viruses ETOH/drug abuse Kidney conditions
Left sided HF
HTN most common cause
Congestion in left chambers
LV ↑size
Backflow into pulmonary veins
Congestion in lungs
Findings: Cough, crackles, wheezes Frothy sputum, may be blood tinged Paroxysmal nocturnal dyspea (PND)--wake up smothering Orthopnea--can't breathe lying flat, will tripod Restlessness Exertional dypnea Fatigue Cyanosis
Right sided HF
COPD most common cause
Congestion in right chambers
RV ↑ in size, backs up into RA
Backflow into vena cava, decreased to lungs
Congestion in jugular veins, liver, lower extremities
Findings: JVD Dependent edema Weight gain Hepatoslenomegaly Ascites Fatigue
Heart Failure: Reduced Ejection Fraction (HFrEF)
Systolic HF
Less blood pumped out of ventricle
EF < 40% Impaired contractile function Weakened muscle cannot generate SV Younger age, male CAD, DM, valve disease ↑ Risk assoc. with CKD
Heart Failure: Preserved Ejection Fraction (HFpEF)
Diastolic HF
Less blood fills the ventricle
EF normal or moderately decreased (40-49%)
LV is stiff and noncompliant leading to higher filling pressures
Older age, Female
ETOH use, K+ levels
Afib, lung disease, anemia
Ventricular remodeling in HF
The weakened heart muscle secretes molecular substances and other substances are released, ie. A-II, aldosterone, endothelin, TNF-alpha, catecholamines, which normally would help but in this case they do not. There’s also genetic changes, apoptosis, & hypertrophy of cardiac myocytes
All these substances and actions lead to the enlargement and dilation of the LV, worsening HF.
Beta-blockers (carvedilol) prevent remodeling.
S3 gallop in HF
Low-pitched sound heard after S2
High ventricular EDV
Adults >40 y.o. S3 is abnormal and indicative of HF
Treatment of heart failure
ACEi or ARBs, ARNI Beta blockers Mineralocorticoid Receptor Antagonist (MRAs) SGLT2 inhibitors Diuretics digoxin nitrates
Decrease in mortality with decreased EF
RAAS inhibitors
RAAS inhibitors moa with HF
decreases preload and afterload, suppresses aldosterone, favorably impact cardiac remodeling
