Heart failure Flashcards
heart failure definition
Complex clinical syndrome resulting from any structural or functional impairment of ventricular Unable to meet metabolic tissue requirements or cannot fill completely
or ejection of blood
HF w/ reduced EF (HFrEF)
EF ≤ 40%
pumping problem
HF w/ preserved EF (HFpEF)
EF ≥ 50%
Borderline hf
41%-49%
improved hf
> 40%
LV Diastolic Dysfunction
Delayed LV relaxation
Increased myocardial stiffness
Reduction in LV compliance
Restricted LV filling
LA HTN, LA systolic and diastolic dysfunction, pulmonary venous congestion, and exercise intolerance
LV systolic dysfunction
Contractility is reduced
Reduced SV
Increased LV end-systolic volume and end-diastolic volume
Compensatory LV dilation
Increased LV end diastolic pressure
Pulmonary venous congestion.
the hallmark of chronic LV systolic dysfunction
decreased ef < 40%
Class 1 diastolic hf
Class I - abnormal LV relaxation pattern with normal left atrial pressure
Class 2,3,4 diastolic hf
abnormal relaxation and reduced LV compliance resulting in an increase in LVEDP
Acute Decompensated HF
Worsening symptoms of preexisting condition
de novo acute HF
Sudden increase in intracardiac filling pressures and/or acute myocardial dysfunction
Chronic Heart Failure
Present in pts withlong-standingcardiac disease
Accompanied by venous congestion, but BP is maintained
Frank-starling relationship
SV is directly related to LVEDP
Magnitude of the increase in SV produced by changing the tension of ventricularmuscle fibers depends on myocardial contractility
Inotropic state
- myocardial contractility as reflected by the velocity of contraction developed by cardiac muscle
Afterload
- tension the ventricular muscle must develop to open the aortic or pulmonic valve
Systolic HF and low CO causes SV to be …..
SV is fixed
Diastolic HF HR
Tachycardia leads to decreased CO
ANP
ANP stored in atrial muscle and released in increases in Atrial pressures
BNP
BNP secreted by the atrial and ventricular myocardium
ANP and BNP inhibit….
ANP and BNP inhibit cardiac hypertrophy and fibrosis
earliest subjective finding of CHF
dyspnea
concentric hypertrophy
pressure overload = thickened wall
Early Cxray sign of LV fialure
Distention of the pulmonary veins in the upper lobes
Gold standard to Diagnose HF
TEE
dx
synmtoms
pHF > 50%
LVED dysfunction
Kerley lines
A- upper
B = middle
C = = lower lobes
BNP that correlates with HF diagnosis
BNP levels > 500 pg/mL – HF diagnosis (90% positive predictive value)
300 pg/mL - detecting dyspnea of cardiac origin
Labs that represent cardiac inflammatory factors
C-reactive proteins
Growth differentiation factor 15
Class 1 HF
no S/s
Class 2 hf
slight limitations with physical acitivty
Class 3 HF
marked limitation of physical activity
Class 4 HF
pt is unable to perform physical acitvity
Class A HF
no evidence of cv dz
Class B HF
Evidence of minimal structural cv dz
Class C HF
Evidence of moderately severe structural c dz
Class D HF
Objective evidence of severe structural cv dz
Diuretics for HF
Thiazide and Loop
First-line therapy for patients presenting in acute heart failure
Cardiac resynchronization therapyrecommended for….
NYHA class III or IV
LVEF < 35%
QRS duration of 120–150 milliseconds
IABP causes….
Increases aortic diastolic blood pressure and coronary perfusion pressure
Enhances LV ejection
