Heart Failure Flashcards
What is heart failure?
Abnormal heart function:
any cardiac structural or functional disorder leading to inadequate cardiac output &/or elevated ventricular filling pressures
impairs the ability of the ventricle to fill (diastolic) with or eject (systolic) blood
Sx of Heart Failure
Complex clinical syndrome with signs and symptoms of:
reduced cardiac output, and/or
unable to meet metabolic demands of the body
–> only able to maintain cardiac output with abnormally high cardiac pressures (more harm than good over time)
Pulmonary (cough) or systemic congestion (edema) at rest or with stress
Heart Failure prognosis
HF prognosis is worse that many cancers
What is a predictor of mortality for HF?
The number of HF hospitalizations is a strong predictor of mortality
Changed primary endpoint –> Change to hospitalizations as hospitalization carries a lot of weight
Describe HF Timeline
A progressive condition:
increasing frequency of acute events with disease progression leads to high rates of hospitalization and increased risk of mortality
with each acute event, myocardial injury may contribute to progressive LV dysfunction
Pathophys of HF
Cardiac output is ↓ in heart failure
HR is controlled by the autonomic nervous system
SV is the volume of blood ejected per heartbeat, which is dependent on preload, afterload, and contractility
myocardial injury –> compensatory responses in an attempt to maintain cardiac output
intended to be short-term to maintain BP & renal perfusion, but with the persistent decline in cardiac output in HF, results in long-term activation of the compensatory mechanisms
HF symptoms (e.g. shortness of breath, fatigue, edema)
What is CO?
Cardiac output (CO) = heart rate (HR) x stroke volume (SV)
What is preload?
Stretching of muscle fibers in the ventricle
What is contractility?
More blood in ventricle, greate rthe contractility to push the blood out
What is afterload?
Pressure the blood has to pump against in aorta to get the blood out
What is stroke volume?
the volume of blood ejected per heartbeat
dependent on preload, afterload, and contractility
What is the frank-starling law?
ability of the heart to alter the force of contraction based on changes in preload
↑ ventricle volume ↑ contractility ↑ stroke volume
the more the heart fills, the stronger the force of contraction
if the heart is over stretched, it loses its ability to return force
Variation of frank starling law
normal: more filling, greater force
mild – moderate LV dysfunction: more filling, no more force
severe LV dysfunction: more filling, less force
What is the neurohormal modeL?
Activation of neurohormones:
Pharmacotherapy targeting neurohormones can slow progression, and reduce the risk of morbidity & mortality in HF-rEF
What are the compensatory repsonses and the beneficial and detrimental effects?
What is the universal definition of heart failure?
BNP levels in Heart Failure
HOW DOES ENTRESTO WORK?
Neprilysin –> ENTRESTO –> inhibits
