Heart Failure Flashcards
Classification of heart failure?
- Functional
NYHA - Stuctural
WHO/AHA
Causes of heart failure?
- Cardiomyopathy
- Hypertensive heart diseases
- Valvular heart disease
- Rheumatic heart disease
- Severe arrhythmias
- Congenital heart disease
- Ischemic heart diseases
What is heart failure?
a clinical syndrome where structural or functional abnormalities of the heart makes the heart unable to pump adequate amount of blood required by the metabolizing tissue of the body or can do so with elevated ventricular filling pressure.
What are the stages of heart failure?
Stage A - at risk
Stage B - pre-HF
Stage C - HF
Stage D - advanced HF
Describe stage A of HF?
patients risk for HF but without current or prior symptoms and signs of HF and without structural cardiac changes or elevated biomarkers of heart disease
Describe stage B of HF?
patients without current or prior symptoms or signs of HF with evidence of one of the following:
1. structural heart disease
2. abnormal cardiac function
3. elevated natriuretic peptide or cardiac troponin levels
Describe stage C of HF?
patients with current or prior symptoms and/or signs of HF causes by structural and/or functional cardiac abnormality
Describe stage D of HF?
severe symptoms and/or signs of HF at rest, recurrent hospitalizations
Classification of HF by ejection fracture?
- HF with reduced EF
- LVEF < 40% - HF with mildly reduced EF
- LVEF < 41-49% - HF with preserved EF
- HF with LVEF > 50% - HF with improved EF
- HF with a baseline LVEF of <40%
New York Heart Association functional Classification?
Class I - IV
NYHA class I?
- no limitation of physical activity
- ordinary physical activity does not cause HF symptoms
NYHA class II?
- slight limitation of physical activity
- comfortable at rest
ordinary physical activity results in HF symptoms
NYHA class III?
- marked limitation of physical activity
- comfortable at rest
- less than ordinary physical activity results in HF symptoms
NYHA class IV?
- HF symptoms at rest
- any physical activity causes HF symptoms
What are the forms of heart failure?
- Systolic failure/diastolic failure
- Forward failure/backward failure
- High output failure/low output failure
- Acute failure/chronic failure
- Right-sided failure/left-sided failure
Systolic failure and forward failure?
Inability of the ventricle to contract normally and expel sufficient amount of blood
Causes of systolic/forward failure?
- Ischaemic heart disease
- Myocardial infarction
- cardiomyopathy.
Clinical features of left ventricular systolic failure?
- Inadequate COP resulting in weakness
- fatigue
- exercise in tolerance and other symptoms of hypoperfusion
Diastolic and backward failure?
The ventricle is unable to relax and/or fill normally and adequately
- increase resistance to ventricular filling
Causes of diastolic/backward failure?
- Constrictive pericarditis
- Restrictive cardiomyopathy
- Hypertrophic cardiomyopathy
- Cardiac tamponade.
Clinical features of diastolic/backward failure?
- Left ventricular diastolic failure
− Orthopnea
− PND - Right ventricular diastolic failure
− Increase jugular venous pressure
− Pedal edema
− Congestive hepatomegaly
High output heart failure?
the heart pumps a greater amount than usual but is still not enough to meet the demands of the bodys organs
Causes of high output failure?
- Hyperthyroidism
- Arteriovenous fistula
- Anemia
- Pregnancy
- Beriberi
- thiamine (B1) deficiency - Paget’s disease
NB: Arteriovenous O2 concentration difference will be below normal (35–50 mL/L)
High output failure vs activity?
Cardiac output may not recede below the lower limit in normal condition but it will be below the lower limit during exercise
Low output failure?
heart failure characterized by reduced cardiac output
Causes of low output failure?
- Ischemic heart disease,
- Dilated cardiomyopathy
- hypertension
- VSD
Low output failure vs activity?
Normal COP → 2.5–3.5 L/min/m2
1. At rest—Within normal limit
2. At exercise—Fail to increase adequately
Chronic heart failure?
gradual fall in cardiac output
Causes of chronic heart failure?
- Dilated cardiomyopathy.
- Multivalvular heart disease that affects slowly due to salt, H2 O retention.
Clinical features of CHF?
Arterial pressure well-maintained with accumulation of water in extravascular space leading to edema
Acute heart failure?
Sudden fall in cardiac output.
Clinical features of AHF?
Sudden fall in systolic blood pressure and sudden decrease in COP lead to systemic hypotension without pedal edema.
Causes of AHF?
- Sudden development of large MI.
- Rupture of chordae tendineae.
- Accelerated hypertension (acute left heart failure)
- Massive pulmonary embolism (acute right heart failure)
What are precipitants of heart failure?
Means heart failure which was previously stable not has a sudden worsening or decompasation
Describe precipitants of heart failure?
FAILURE
1. Failure to take medication(non adherence)
2. Arrhythmia/anemia
3. Infection/infarction
4. Lifestyle changes
5. Upregulators(pregnancy or thyrotoxicosis)
6. Rheumatic heart disease/renal disease
7. Embolism
Causes of RHF?
- Cor pulmonale
- Congenital valvular pulmonary stenosis
- Pulmonary hypertension, secondary to pulmonary emboli
Clinical features of RHF?
- Edema
- elevated venous pressure
- Hepatomegaly or ascites
Causes of LHF?
- MI
- cardiomyopathy
- hypertension
- Aortic stenosis
Clinical features of LHF?
- Dyspnea
- Orthopnea
- Pinkish frothy sputum
- Cyanosis
- Basal rales due to pulmonary congestion
- S3 gallop
Causes of right heart failure secondary to left heart failure?
- Mitral stenosis with pulmonary hypertension.
- Salt-water retention.
- Muscle bundle composing both the ventricles are continuous.
- Both ventricles share a common wall.
- Biochemical changes that occur in left heart failure involve and impair the function of right ventricle and cause right heart failure
Symptoms of heart failure?
- dyspnea
- orthopnea
- paroxysmal nocturnal dyspnea
- Cheyne-Strokes respiration
- fatigue and weakness
- abdominal symptoms
- cerebral symptoms
Dyspnea?
- Severity of dyspnea correlates with the functional NYHA classification.
- It is due to interstitial pulmonary edema which causes activation of receptor in the lung
- result in rapid shallow breathing,
- increase fatigue of respiratory muscle due to imbalance of O2 demand and supply to respiratory muscle.
Orthopnea?
Dyspnea in recumbent position.
- It is a late manifestation of HF than exertional dyspnea due to redistribution of fluid from leg and abdomen to thorax
- causing increase in pulmonary capillary pressure combined with elevation of diaphragm.
Paroxysmal nocturnal dyspnea?
- Severe shortness of breath and cough that generally occurs at night during sleep although when metabolic demand is minimum
Causes of paraxosmal nocturnal dyspnea?
- Depression of respiratory center during sleep.
- Due to reduced pulmonary compliance from interstitial pulmonary edema.
- Due to redistribution of blood from leg and abdomen to cardiopulmonary circuit in recumbent posture.
Cheyne strokes respiration?
- Decreased sensitivity of respiratory center to PaCO2
- Increased circulation time from lungs to brain in atherosclerotic and hypertensive patient.
Fatigue and weakness?
due to low cardiac output
Abdominal symptoms?
- Due to congested liver and portal hypertension
- Anorexia
- Nausea
- Abdominal pain and fullness.
Cerebral symptoms?
- Confusion
- Difficulty in concentration and impairment of memory, headache, insomnia and anxiety
General signs of HF?
- hypotension
- edema
- cyanosis
- sinus tachycardia
- pulsus alternans
- pulsus pervus
- extremity may be cold, pale and diaphoretic
- jaundice
- cardiac cachexia
How HF causes hypotension?
Acute heart failure results in systolic hypotension (reflecting reduced stroke volume).
- But DBP will rise due to peripheral vasoconstriction.
Type of edema in HF?
- Pitting bipedal edema—due to increased venous pressure.
- Presacral/genital edema seen in bedridden patient.
