Heart Failure Flashcards
Cardiomyopathy: Definition
disease that affect the myocardium
LEADS TO HEART FAILURE
Cardiomyopathy: Causes (8)
usually idiopathic
ischemia
HTN
inherited disorders
infections
toxins
myocarditis
auto-immune condition
Cardiomyopathy: Types (3)
- dilated cardiomyopathy
- hypertrophic cardiomyopathy
- restrictive cardiomyopathy (amyloid)
Heart Failure (HF): Definition
A chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen
–> basically, the heart can’t keep up with its workload
HF: Some Patho
myocardium is weakened—> pump is insufficient to pump blood forward and can’t meet the body’s demands
*MOST common cause oof hospitalization
Cardiac Output is?
decreased with HF
Factors determining Cardiac Output (2)
heart rate
stroke volume
*Cardiac Output= stroke volume x heart rate
Factors that Affect Stroke Volume (3)
- preload (amount of volume in left ventricle before it squeezes)
- afterload (the pressure the heart has to squeeze against when it contracts)
- myocardial contractility (pump muscle)
HF results in? (4)
- decreased cardiac output
- decreased myocardial contractility
- increased preload
- increased afterload
HF: Development (Patho Changes)
volume OVERLOAD–> IMPAIRED ventricular filling–> WEAKENED ventricular muscle–> DECREASED ventricular contractile function
When does the heart fill?
diastole
When does the heart contract?
systole
HF: Etiology: MAJOR Causes (7)
-REPEATED ISCHEMIC EPISODES- ischemic cardiomyopathy
-myocardial infarction– papillary muscle rupture
-chronic HTN
-COPD (RVF)
-Dysrhythmias
-Valve disorders; mitral insufficiency, aortic stenosis
-pulmonary embolus (RVF)
HF: MAJOR Risk Factors (9)
-age (increases with age, most common reason for hospitalization in ages >65)
-ethnicity (Black/African Americans are at a higher risk than Caucasians)
-family history and genetics
-diabetes
-ischemic heart disease
-obesity
-HTN
-smoking
-sedentary lifestyle
HF: Other Risk Factors (8)
-within 6 months of MI
-22% men
-46% women
-men and postmenopausal women have same risk
-COPD
-severe anemia
-congenital heart defects
-viruses (certain viral infections can cause myocarditis)
-alcohol abuse/drug abuse
-kidney conditions
-excess blood volume,
edema, and
accumulation of
nitrogenous waste
(weakens the heart)
Which is considered the GREATEST risk factor for HF?
HTN
Diabetes can also contribute
What hormone is cardioprotective?
estrogen
believed to be why men are typically more common for HF in younger ages until women are post-menopause
HF: Classifications (2)
left sided vs. right sided
Left sided HF: Characteristics (4)
-congestion in LEFT chambers
-LV increases in size (LVH)
-backflow into PULMONARY VEINS
-congestion in LUNGS
*LEFT=LUNGS
Left sided HF: Symptoms (10)
cough
crackles
wheezes
frothy sputum (may be blood tinged)
paroxysmal nocturnal dyspnea (PND)
orthopnea
restlessness
confusion
tachycardia
fatigue
Right sided HF: Characteristics (5)
-congestion in RIGHT chambers
-RV increases in size (RVH)
-backflow into VENA CAVA, decreased to the lungs
-congestion in JUGULAR VEINS, LIVER, LOWER extremities
*RIGHT=BODY
Right sided HF: Symptoms (9)
jugular vein distention (JVD)
dependent edema
weight gain
hepatosplenomegaly
fatigue
ascites
anorexia
GI distress
increased peripheral venous pressure
What is the MOST common cause of LEFT sided HF?
poorly controlled HTN
What is the MOST common cause of RIGHT sided HF?
COPD
HF: Reduced Ejection Fraction (HFrEF) (Systolic HF): Definition
Determined by patient’s EF: EF < 40%
HF: Reduced Ejection Fraction (HFrEF) (Systolic HF): Caused by (4)
IMPAIRED contractile function
increased afterload
cardiomyopathy
mechanical problems
HF: Reduced Ejection Fraction (HFrEF) (Systolic HF): Patho
left ventricle loses ability to generate pressure to eject blood–> weakened muscle cannot generate stroke volume and then lowers CO–> LV fails, blood backs up, and causes fluid backup and accumulation
HF: Preserved Ejection Fraction (HFpEF) (Diastolic HF): Definition
inability of the ventricles to relax and fill during diastole
EF is normal or only moderately decreased (40-49%)
HF: Preserved Ejection Fraction (HFpEF) (Diastolic HF): Cause/Risk Factors (4)
HTN is the primary cause
female
older age
diabetes
obesity
HF: Preserved Ejection Fraction (HFpEF) (Diastolic HF): Patho
LV is stiff and noncompliant leading to high filling pressures–> leads to decreased stroke volume and decreased cardiac output–> reduced CO leads to fluid congestion
Chronic vs. Acute HF
progressive
chronic
+ episodes of “decompensated” HF
-new or worsening s/s
-frequent visits to the ER
-hospitalization
-less common- new
onset HF (20%)
Ventricular Remodeling in HF
a weakened heart muscle
-secretion of molecular
substances
-angiotensin II,
aldosterone, endothelin,
TNF-alpha,
catecholamines, insulin-
like growth factor, and
growth hormone
-provoke genetic
changes, apoptosis, and
hypertrophy of cardiac
myocytes, as well as
collagen deposits and
myocardial fibrosis
these molecules cause changes lead to ENLARGEMENT AND DILATION OF THE LEFT VENTRICLE
-WORSENS HF
What murmur is common in HF?
S3 Gallop
S3 Gallop
-low-pitched sound heard after S2
-during rapid filling of ventricle in the early part of diastole
-high ventricular end-diastolic volume
-increased pressure w/in ventricles
S3 is abnormal and indicative of HF in adults of what age?
older than 40
