Heart failure Flashcards
Cardiomyopathy and causes
- disease of the myocardium
- often idiopathic, can be caused by HTN, ischemia, inherited disease, infx, toxins, myocarditis, auto-immune condition
- leads to HF
***Pump problem
Dilated cardiomyopathy
- ischemic prob, bowel disease, post/peripartum, drugs, infx, genetic
- leads to heart fail with dec EF
- expanded L vent
Hypertrophic cardiomyopathy
- huge left vent muscle; EF dec with time
- r/t HTN
- high risk of arrythmias
Restrictive cardiomyopathy
- least common
- ventricles resistant to filling (hardens), rigid and stiff
- R side heart fail, systemic congestion
- r/t amyloid disease
Heart failure
chronic progressive condition where the heart muscle can’t pump enough blood to meet the body’s needs for blood and oxy
- dec CO, dec myo contractility, inc pre and afterload
preload
amount of fluid vol in the L vent before it squeezes
afterload
pressure the heart has to squeeze against when it contracts (high BP, high afterload)
myocardial contractility
How efficiently the pump works
HF patho
- volume overload from heart not pumping well
- impaired ventricular filling (worse diastole)
- weak ventricular muscle
- dec ventricular contractility function - squeeze not as effective
Causes of HF
- repeated ischemic episodes of unstable angina and MI (papillary muscle rupture)
- chronic HTN, COPD (altered pump pressure alters R vent)
- dysrhythmias that dec CO and perfusion
- valve disease
- PE (RVF)
Risk fx for HF
HTN, DM, MI, Black/AfAm, genetics, 65+, smoking and sedetary, obesity, severe anemia, congenital heart defect, viruses, alc/drug abuse esp cocaine and crack, kidney prob (inc BF, HTN, accum nitrogenous waste)
Left side heart HF
- blood builds up in pulmonary circulation
- pulmonary edema, crackles, wheezes, frothy sputum (bloody too), orthopnea, paroxysmal nocturnal dyspnea (PND), tripod position
- HTN often
R side heart failure
- blood builds up in systemic circ
- often bc severe COPD with cor pulmonale
- congested R chambers and R vent hypertrophy b/c pulmonary HTN from vasoconstriction pushes back against the blodd
- backflow into vena cava dec to lungs
- JVD, dependent edema, wt gain, hepatosplenomegaly
- pulm HTN
Normal EF
55-65%
HFrEF aka systolic HF
- EF under 40%
- impaired contractility, inc afterload, inc cardiomyopathy, mechanical problems
- L vent loses squeezing power (dec SV and CO)
- L vent fail, blood b/u, fluid accum
HFpEF aka diastolic HF
- vents can’t relax and fill with diastole
- HTN main cause (also obese, fem, old at risk)
- L vent still, noncompliant, high filling pressure (dec SV and CO)
- dec CO–fluid congestion
- EF norm or moderate (40-44%)
Chronic HF
- episodes of decomp HF with new or worsening s/s
What occurs with chronic HF?
Ventricular remodeling
Ventricular remodeling
- weak heart muscle secreted angio II, aldosterone, catecholamines, ILGF, growth hor, and TNF-alpha
- provoke genetic change of cells that cause apoptosis, hypertrophy of cardiomyocytes, collagen deposits, and myocardial fibrosis
When is S3 gallop common?
during rapid fill of ventricle in early part of diastole
- inc pressure w/i ventricle
- high ventricle diastolic end vol
- abnormal–HF in ppl over 40
Best tx for HF
dec causes
