heart failure Flashcards
heart failure definition
EF definition
insufficient oxygen supply to body tissues (inability to pump enough blood to meet the demand of the body)
EF: percentage of blood pumped by the heart per beat (N= 60-80%)
pathophysiology of HF with reduced ejection fraction? with etiology examples?
reduced contractility -> systolic dysfunction -> reduced left ventricular ejection fraction -> decreased CO
causes: loss of myocytes (MI, CAD, dilated cardiomyopathy)
arrythmias/valvular heart disease
pathophysiology of HF with normal EF?
decreased ventricular compliance -> diastolic ventricular dysfunction -> reduced ventricular filling but increased diastolic pressure (stiff not relaxing to be filled with blood) -> decreased CO
causes: restrictive cardiomyopathy (amyloidosis and fibrosis after surgery/radiation)
ventricular stiffness from long standing ventricle hypertrophy
consequences of decompensated HF?
forward failure: poor organ perfusion -> hypotension, renal dysfunction
backward failure:
left ventricle -> backup of blood into the lung capillaries -> capillary hydrostatic P becomes higher than oncotic -> blood leaks into alveoli PULMONARY EDEMA
right ventricle -> systemic venous congestion -> PERIPHERAL EDEMA -> congestion of internal organs (nutmeg liver: liver with ischemia)
high adrenergic activity: high heart rate
activation of RAAS
clinical features of left and right sided HF?
generally: nocturia, tachycardia, S3S4 gallop, pulsus alternans
left sided: SOB progressive (on exertion, orthopnea, PND), bilateral basilar rales
explanation: supine position reabsorbs peripheral edema and worsens pulmonary edema
right sided: peripheral pitting edema, distended jugular veins prominent with hepatojugular reflux, hepatic congestion (jaundice, abdomen pain from liver capsule distention)
investigations?
transthoracic echocardiogram: shows EF, valvular disease, ventricle hypertrophy, cardiomyopathy, and for tx follow up
ECG: arrythmia, MI, LVH
xray: pulmonary edema, cardiomegaly, kerly lines
blood tests: renal and liver profile, CBC for anemia, BNP (high in HF)
Pharmacotherapy?
improve survival:
1. ACEI or angiotensin receptor blockers
given to ALL PATIENTS
2. B blockers once patient is stable on ACEI
antiarrythmic, decrease HR
3. mineralocorticoid antagonist (spironolactone)
given for advanced stages
SE: hyperkalemia and gynecomastia
improve symptoms:
diuretics (loop diuretics like furosemide)
device therapy:
implantable cardioverter-defibrillator reduces sudden death from VT/VF
