Heart Failure Flashcards
Describe heart failure
Heart failure occurs when CO2 is inadequate to provide the oxygen needed for the body. Therefore, heart loses its ability to pump blood throughout the body.
What are the features of heart failure?
1) Typical Symptoms
2) Typical signs
3) objective evidence of a structural or functional abnormality of the heart at rest.
Describe typical symptoms
breathlessness at rest or on exercise, fatigue, tiredness, ankle swelling
What are the typical signs?
Tachycardia, tachypnea, pulmonary rales, pleural effusion, raised jugular venous pressure, peripheral edema, hepatomegaly
What are the objective evidences of structural or functional abnormality at rest?
Cardiomegaly, third heart sound, cardiac murmurs, abnormality on echocardiogram, raised natriuretic peptide concentration.
Causes of heart failure
….
Graph explaining the pathway of heart failure. describe some key points from there
Describe the pathophysiology of the heart failure
mention hemodynamic alterations
neuro hormonal stimulation
inflammation
what is ejection fraction
amount of blood pumped out of the ventricle (systoles, ventricles contracting)
divided by
total amount of blood in ventricle (diastole, ventricles relaxing)
What is preload and afterload?
preload: is the stretch, it is the olume of blood received by the heart
afterload: Is the pressure or resistance the heart has to overcome to eject blood. Therefore its the squeeze.
Hemodynamics of normal heart at rest and during exercise, tell me about 3 zones
1) low pressure zone
2) transition zone
3) high pressure zone (3-5L/m)
Hemodynamics of normal heart during exercise:
15-20L/min in the high pressure zone
what is the difference between hemodynamics of the heart with moderate heart failure vs healthy heart?
Explain some compensatiton systems
Sympathetic nervous system ( heart rate elevation and vasoconstriction)
Renin- antiotensin system (vasoconstruction, Fluid retention) vasoconstruction causes less o2 going to the tissues
Aldosterone = also causes fluid
Angiotensin causes adrenals to produce aldosterone
Aldosterone causes renal retention of fluid. (Normally under dehydration to maintain cardiac output.)
Why is edema caused in heart failure
Due to renal process, the condition that usually occurs under dehydration is ocuring when cardiac output is insufficient. Therefore the fluid thats unable to circulate causes edema
Solution to compensation mechanism:
We want to remove the excess input fluid by using diurrtics or venous vasodilators or arterial vasodilution (by increasing.cardiac output)
Describe hypovolemia
Hypovolemia occurs when you dont have enough fluid volume circulating in your body
What is cardio renal syndrome. What type of mechanism does it have
What are heart failure symptoms? (Highlight important ones)
Symptoms and signs for congestion for left and right atrium
For Right Atrium:
Neck veins
Pleural effusion
Hepatomegaly
Swollen feet, ankles, legs
For Left Atrium
Shortness of breath durşng exercise
Caugh, orthopnea
Paroxysmal nocturnal dyspnea
Crepirations at auscultation
Symptoms and signs for low cardiac output
Poor exercise tolerance
Fatigue
Orthostatic hypotension
Cold extremities
Anlrexia — cachexia
Concentration problems
What are the types and patterns of heart failure?
Types :
Left sided vs right sided heart failure
Systolic vs diastolic heart failure
Patterns:
Acute—chronic—transient
Describe
Acute
Chronic
Transient
Heart failures
Acute means = new/recent onset. 1st presentation(in left ventricule leads acute dyspnoe = difficulty breathing)
Transient : cardiomyopathy due to
Myocardial infarction with revascularization
Myocarditis
Peripartum
Takotsubo(broken heart syndrome)
Chronic = progressive
Chronic stable vs chronic with exacerbation
Compare right and left sided heart failure and present symptoms
Systolic vs diastolic heart failure
Ef<35/40% in systolic
Ef almost 60% in normal heart
Ef> 40/50% but the amount of ejected blood may be lower than normal
Exarcebation in heart failure (alevlenme)
Intercurrent disease: infection, bleeding
Disease progression: ischemia, infarct, atrial fibrillation…
Diet errors
Poor treatment compliance
NSAID, steroids
Talk about disease pattern graphs and severity of HF.
Explain the Importance of anamnesis in diagnosis
Stage A
Stage B
—class 1
Stage C
—class 2
—class 3
•class3a
•class3b
—class4
Stage D
—class r
Which objective findings are presented in heart failure?
Natriuretic peptides
Echocardiogram
Chest x ray
Cardiac magnetic resonance
Right heart catheterization
Coronary angiogram
Biopsies
