Heart Failure Flashcards
What are the seven most common etiologies of heart failure?
CAD HT Primary cardiomyopathy Valvular disease Toxins Inflammatory - post partum, viral myocarditis Pericardial disease
What is the definition of heart failure?
Characterized by specific signs and symptoms that result from structural or functional cardiac disorder which impairs ability of heart to fill with or eject sufficient amount of blood or to do so only with elevated filling pressures
What is the pathophysiology of heart failure?
Injury or stress to myocytes –>
Changes in ventricle (remodeling) –>
Increased preload and afterload (increased hemodynamic load), activation of symp nervous system and RAAS –>
Vasoconstriction, volume overload, and stimulation of myocardial growth –>
Increased oxygen demand causing ischemia and impairment of contractility
How can one distinguish between diastolic and systolic heart failure?
Use the LVEF = (LV end diastolic volume - LV end systolic volume) / LV end diastolic volume
Systolic dysfunction LVEF 40%
Heart size enlarged in systolic, normal in diastolic
Common etiology of systolic is CAD, diastolic is HT
What are the different stages of heart failure?
Stage a - high risk for HF but without structural heart disease or symptoms
Stage b - structural heart disease but without symptoms
Stage c - structural heart disease with prior or current symptoms
Stage d - refractory HF, requiring specialized interventions
What are the typical systems associated with decreased CO?
Fatigue Weakness Shortness of breath Tachycardia Low blood and pulse pressure Cool extremities
What is the NYHA classification for heart failure symptom classes and what is their expected mortality?
Class I - adequate functioning, symptoms only with extensive effort - 5-10%
Class II - comfortable at rest, symptoms with ordinary exertion - 10-15%
Class III - symptoms with less than ordinary exertion - 15-20%
Class IV - symptoms at rest - >50%
What are the recommended tests used for the evaluation of heart failure?
Routine blood work - CBC, electrolyte panel, serum creatinine, liver and thyroid function tests, measurement of BNP
BNP - stored in ventricles, release directly proportional to volume and pressure overload of ventricles - above 100
Chest x ray - cardiomegaly, pulm congestion and redistribution
EKG
Echo
Cardiac cath
What is the rationale of using vasodilators in heart failure?
All decrease LVEDP and improve CO by frank starling mechanism
What is the most important medical therapy for patients with heart failure?
Neurohormonal antagonists - improve mortality = ACEIs, ARBs, beta blockers and Aldo antagonists
