Heart Failure Flashcards
What are the 2 main properties of HF?
reduced CO and/or pulmonary or systemic congestion
What is stroke volume?
volume of blood ejected per heartbeat, which is dependent on preload, afterload and contractility
What is Frank-Starling’s law?
ability of the heart to alter the force of contraction based on changes in preload
the more the heart fills, the stronger the force of contraction
if the heart is over stretched, it loses its ability to return force
What is the neurohormonal model of HF?
activation of neurohormones: NE, angiotensin II, aldosterone, vasopressin, proinflammatory cytokines
where pharmacotherapy is targeting
what are the benefits and detriments to increased preload as a compensatory response?
benefit: optimize SV via Frank-Starling mechanism
detriment: pulmonary and systemic congestion
what are the benefits and detriments of vasoconstriction as a compensatory response?
benefits:
- maintain BP during decreased CO
- shunt blood from nonessential organs to brain and heart
detriments:
- increased myocardial oxygen demand
- increased afterload, decreased SV and further activates compensatory responses
what are the benefits and detriments of tachycardia and increased contractility via SNS activation as a compensatory response?
benefit: helps maintain CO
detriments: increased myocardial oxygen demand, shortened diastolic filling time, B1 receptor downregulated, decreased ventricular sensitivity, precipitation of ventricular arrhythmias
what are the benefits and detriments of ventricular hypertrophy and remodeling as a compensatory response?
benefits:
- helps maintain CO
- decreased myocardial wall stress
- decreased myocardial oxygen demand
detriments:
- increased risk of myocardial cell death, myocardial ischemia, arrhythmia and fibrosis
- diastolic and/or systemic dysfunction
what is the universal definition of HF?
structural heart disease with abnormal cardiac function
what are the typical symptoms of HF?
breathlessness
orthopnea
paroxysmal nocturnal dyspnea
decreased exercise tolerance
fatigue, tiredness
ankle swelling
inability to exercise
swelling of parts of the body other than ankles
bendopnea
what are some less typical symptoms of HF?
nocturnal cough
wheezing
bloated feeling
postprandial satiety
loss of appetite
decreased cognitive function, confusion
depression
dizziness, syncope
what are some specific signs of HF?
elevated JVP
third heart sound
summation gallop with third and fourth heart sounds
cardiomegaly, laterally displaced apical impulse
hepatojugular reflux
Cheyne Stokes respiration in advanced HF
