Heart Failure Flashcards
Heart failure is what?
Stops circulating blood throughout the body
( Insufficient blood supply/oxygen to tissues & organs )
So when your heart isn’t pumping enough oxygen or blood to tissues and organs what happened to our cardiac output?
Decreases
With a decrease cardiac output it leads to what? (4)
Explain them each
Decreased tissue perfusion
- so when your kidneys aren’t perfused, they will activate RAAS
Fluid volume imbalance
- which then causes this retention of fluid/sodium
- increase in blood pressure
Activity intolerance
- edema & gas exchange
Impaired gas exchange
- blood backing up into the lung
What are the function of cardiac output ( 5 )
Pre load
After load
Contractility
Heart rate
Any process that affects Cardic output can cause heart failure
What does preload mean for cardiac output?
Amount of volume of blood that sits in the left ventricle ready to be pumped out
( Amount of blood your left ventricle can hold )
What does afterload mean for cardiac ouput? (2)
The force the heart is pumping against
( aortic seteosis & hypertension )
The heart has to pump harder when the after load is more? True or false?
And why?
True
In order to get blood out of left ventricle
What does contractility mean in cardiac output ?
The ability of the muscle fibers in the heart to contract
What does heart rate mean for cardiac output?
How fast the heart beats per minute
Any change in any of these 5 functions of Cardiac output will cause what?
Heart failure
To measure the severity of heart failure we look at what?
Ejection fraction
What is ejection fraction mean?
It’s the division of amount of blood pumped out of the left ventricle
———————-
By the amount of blood that was in the left ventricle
What is the normal ejection fraction percentage?
55-65%
What does 55-65% mean or indicate for us when we use ejection fraction to measure the severity of a heart failure?
55-65% of blood being pumped of the left ventricle during each heart beat
What are some risk factors of heart failure? (4) big mains !
Hypertension !!
( modifiable risk )
Heart attack !!
Coronary artery disease
High Cholesterol
What are some co morbidities that contribute to development of heart failure risk factors? (5)
Comorbidities being like what other dieases & factors
Diabetes ( high Blood sugar )
Metabolic syndrome ( impaired glucose metabolism )
- these two effect the elasticity of blood vessels cause of the high sugar
Advanced age ( decrease elasticity )
Tobacco use
Vascular disease
Etiology of heart failure ?
Anything that effects cardiac output
What’s the primary cause of heart failure?
Heart attack
Conditions that directly damage the heart
What’s the precipitating cause of heart failure?
( what does precipitation mean too )
Hypertension
Conditions that increase workload of the heart
How does heart attack work or cause heart failure?
Area of/ part of the heart wall that is dead
Big piece of scar tissue on the heart
Which impacts how the heart beats
That dead piece doesnt move like the rest of the heart
Which causes more strain to pump or doesn’t give enough oxygen and blood in the body
The bigger the area of the heart attack/multiple impacts the heart availability to contract effectively
How does hypertension effect heart failure? (4)
High blood pressure
End up left ventricular hypertrophy
Which causes decrease cardiac output
Not enough space of left ventricle
How can we classify heart failure?
Left sided vs right sided
What’s the most common form of heart failure?
Left sided
Right sided is a consequence of left sided heart failure? True or false?
True
Left sided heart failure happens when? (2)
Can’t empty enough blood ( systole )
Or can’t fill it up during (diastole)
Systolic reduced ejection fraction is ?
Problems with left ventricle contraction or empty
Diastolic preserved ejection fraction is ?
Problem with filling up the left ventricle
So overall left sided heart failure results from what?
Left ventricular dysfunction
( either can’t empty out enough blood or be able to fill up with blood )
What happens when we have left ventricular dysfunction, where does the blood go into? (2)
Think of the blood flow
Backs up into left atrium & pulmonary veins
So when it blood backs up into left atrium and pulmonary veins what happens to our bodies?
3 steps
Increase pulmonary pressure
Causing fluid leakage
Pulmonary congestion & edema
If we were to assess a patient with left side heart failure what would we see?
What would we hear? And why?
Pulmonary congestion
Pulmonary edema
Hearing crackles
Due to the fluid in the lungs ( all the blood backing up )
How would we treat the crackles in the lungs of a patient with left sided heart failure? Example?
Loop Diuretics
Floresimine
With a patient with crackles why can’t we use albuterol?
Because the obstruction sound we are hearing aren’t from airway obstruction but instead the build up of fluid from the backing of blood into the lungs which causes the crackles
What are some symptoms of left sided heart failure? (4)
Paroxysmal nocturnal dyspnea !!
Pink sputum !
Elevated pulmonary capillary wedge pressure
Cough
Crackles!!
Wheezes
Blood tinged sputum
Tachypnea
Restleness
Confusion
Orthopnea!!
Tachycardia
Exertional dyspnea
Fatigue
Cyanosis
Pathophysiology of systolic heart failure
What is it?
The inability to pump blood forward out of the left ventricle
What is systolic heart failure caused by? (4)
Impaired contractile function
Increased afterload
( pressure the heart has to pump against to get blood out )
Cardiomyopathy
Mechanical abnormalities
What’s the ejection fraction of systolic heart failure?
10%
Pathophysiology diastolic heart failure
What is it?
And results in decrease what ?2)
Impaired ability of the ventricles to relax and fill during diastole
Results in decrease stroke volume & cardiac output
Diastolic heart failure has normal ejection fraction? True or false?
True
What happens when we have diastolic heart failure?
What type of problem will it cause in our ventricle, and from conditions can cause that (4)
Left ventricular hypertrophy !!
From hypertension, mi, valve disease or cardiomyopathy
Pathophysiology
Mixed heart failure?
What is it?
Both systolic & diastolic failure
Does mixed heart failure have poor ejection fraction? And what is it?
Yes
Less than 35%
With mixed heart failure we can see what?
High pulmonary pressure
Biventricular failure means what?
Both poor filling and emptying capacity of left ventricle
What is right sided heart failure?
Right ventricular dysfunction
When the right ventricular doesn’t work for right sided heart failure where does the blood back up into (2)?
Think of the blood flow
Right atrium & venous circulation
So when the blood backs up into the right atrium and venous circulation what do we end up with ? (4) explain each one
Think of the symptoms on the patients
Jugular venous distention
- seeing when patient lying down 45 degree
Vascular congestion of GI tract
Hepatomegaly, splenomegaly
- enlarged liver & spleen’s
Peripheral edema
What are some symptoms of right sided heart failure? (6)
Fatigue
Peripheral venous pressure
Ascites !!
( fluid accumulation in abdomen )
Enlarged liver & spleen !!
COPD
Distended jugular veins!!
Anorexia !!
Weight gain ( retaining fluid ) !!
Dependent edema ( feet & ankle sweeping )!!
What is biventricular failure?
Both left & right ventricular dsyfunction
So when we have biventricular failure what happens ? (3)
Fluid builds up
Venous engorgement
Decreased function to vital organs
When you have heart failure there are some things your body does to compensate
So how does RAAS do this for us?
( just to know, this isn’t effective for us, just happens to us )
(5)
- Cardiac output decreases renal perfusion
- Decreased perfused Kidneys will release renin
- Renin causing angiotension to be converted into angiotension 2 causing vasoconstriction
- Peripheral vasoconstriction increase BP
- Aldosterone is released causes sodium & water retention
Our kidneys don’t know that blood pressure isn’t the problem but will try to get blood pressure up for the sake of it
Compensatory mechanisms
Sympathetic nervous system
How does this work?
(3)
- Baroreceptors sense low arterial pressure
( body assumes that is from low blood pressure ) - It’ll release catecholamines
- Which stimulates b adregenic receptors that increase heart rate and ventricular contractility ( force heart contracts )
Compensatory mechanism
Dilation of left ventricular
How does this work? (2)
Think of the law!!
And leads to what?
We’ll have the frank starling law
- increased preload causes a more forceful ventricular contraction
( increase fluid in the left ventricular you’ll have more force of ventricular contraction )
But this will lead to left ventricular hypertrophy
Compensatory mechanisms
Hypertrophy
How does this work? (2)
Increase muscle mass/ heart wall thickens
Overtime decrease CO & needs more oxygen to work better, Dysrthymia risk
Compensatory mechanism
Remodeling
How does this work? (4)
What is going to be continuous?? Think of how the ventricular change in remodeling
Continuous activation of neuro homronal responses ( RAAS & SNS )
Hypertrophy of ventricular myocytes
Ventricles larger but less effecting pumping
Can cause left threatening dysthymia and suddenly Cardiac dearth
Things that are beneficial counter regulatory mechanisms are what?
Natriuretic peptides
What are the 2 natriuretic peptides that are release?
Atrial natriuretic peptide (ANP)
Brain ( b-type ) natriuretic peptide (BNP)
When are natriuretic peptides released ? (2)
In response to increased blood volume & ventricular wall stretching
Natriuretic peptides causes what and counteracts what?
Causes vasodilation and lowers BP
Counter acts effects of sns & raas
( lower heart rate & decrease BP )
Natriuretic peptides improve what? (2)
Think about the physical aspect
And what is it helping with
GFR ( better working kidney )
excretion of water & sodium
We will do a test to measure BNP, and if you have high BNP what does that mean?
You have more fluid retention & increase severity of heart failure
Counter regulatory mechanism in heart failure
Nitric oxide & prostaglandin
How does it work? (2)
Released from what & response to?
Causes & results in & decrease ?
Released from vascular endothelium in response to compensatory mechanism
Causes relaxation of arterial smooth muscle & resulting in vasodilation and decreased afterload ( heart doesn’t work that hard )
