Heart Failure Flashcards
top 4 causes of heart failure
- ischemic heart disease
- rheumatic valvular disease
- hypertension
- COPD
cardiac output =
heart rate x stroke volume
heart rate influenced by
Sympathetic and parasympathetic
stroke volume influenced by
preload
afterload
contractility
normal adult cardiac output is ____
4.0-8.0 L/min
In Heart Failure you have _____ preload
increased
Frank Starling law
stretch of the myocardial fibers –> contractility
RAAS in HF
stimulation of the RAAS in HF
___ (hormone) is stimulated in HF
vasopressin
which nerves system is activated in HF
SNS
what increase in HF and acts as antagonist to angiotensin and adolsterone
natriuretic pepetides
___ is used for diagnosis of HF
BNP
classification of HTN
primary
secondary
drug induced
examples of drugs causing HTN
NSAIDs
Prednisone, Hydrocortisone
OCP
Pseudoephedrine, Methylphenidate
Tegretol
Lithium
SNRIs (Venlafaxine)
Herbals: Ginseng, natural licorice
Substance Misuse: ETOH, Cocaine
HTN is caused by increase in ___ and ____
cardiac output and peripheral resistance
a goal in treating HTN is
prevent Target Organ Damage
cardiovascular disease
cerebrovascular disease
renal disease
peripheral arterial disease
hypertensive retinopathy
causes of A fib
Genetics, Advancing age
Structural heart disease: CAD/ACS, HF, Valvular disease,
Congenital heart disease
HTN
Obesity, OSA
Increased ETOH use
Thyroid dysfunction
A fib is ___
irregular and tachy
classification of A fib
paroxysmal A fib (> 30 sec, < 7 days)
persistent A fib (> 7 days, < 1 year)
long standing persistent A fib (> 1 year(
permanent A fib
pathophysiology of A Fib
Underlying cardiac disease creates a vulnerable atria
(HF, dilated left atrium, ↑ left atrial pressure)
Alters substrate or tissue of atria
In the LA, ectopic foci around ostia of pulmonary vein and SVC
Pulmonary veins have unique electrical characteristics (pacemaker cells)
A triggering event initiates AF in this ectopic foci
Abnormal handling of calcium – Ca2+ leaks from sarcoplasmic reticulum & activates a current; spontaneous depolarization of myocyte
Inflammatory signaling in the atria (i.e. cytokines IL-6, TNF-⍺) may also contribute to process of initiating and perpetuating AF
There is reentrant activity in the atria - electrical signal travels in a loop (circular), repeatedly exciting the atrial tissue causing an irregular heartbeat
Fibrosis and hypertrophy can initiate and maintain reentry impulses
AF alters cardiac hemodynamics:
Uncoordinated contraction with ventricles, loss of atrial kick, decreased ventricular filling
Decreased CO and SV
Turbulent blood flow within atria - increased risk of thrombus formation
pediatric congenital heart disease: left-to-right shunting
Blood shunts from high pressure oxygenation left side, to low pressure deoxygenated right side
Results in increased pulmonary blood flow
atrial septic defect (ASD)
Hole in the interatrial septum resulting in left to right shunting
Volume overload of the RA and RV, RV enlargement
ventricular septal defect (VSD)
Defect in the interventricular septum, left to right shunt
LV volume overload – signs/symptoms of HF
In a fetus, ______ resistance > _____ resistance; at birth when lungs expand there is a significant decrease in ______, which reaches a normal balance by age ______
In a fetus, pulmonary resistance > systemic resistance; at birth when lungs expand there is a significant decrease in pulmonary resistance, which reaches a normal balance by age 2-8 weeks
patent ductus arteriosus (PDA)
PDA is a normal fetal artery connecting aorta and PA; in a fetus blood does not need to circulate to lungs for oxygenation
PDA usually closes in term infants 12-72 hours after birth
coarctation of the aorta (CoA)
Narrowing of a segment of the aortic lumen at site of ductus arteriosus
HFrEF: Heart Failure with a reduced ejection fraction
Patients with a LVEF ≦ 40%
HFmEF: Heart Failure with a mid-range ejection fraction
Patients with a LVEF 41-49%
HFpEF: Heart Failure with preserved ejection fraction
Patients with a LVEF ≧ 50%
Left-sided Heart Failure
If the heart is unable to pump appropriately there is an increase in pressure in the pulmonary vasculature (leading to pulmonary congestion) and poor systemic perfusion
Most common cause of chronic HF
Right-sided Heart Failure
Right sided heart failure is the inability of the right ventricle to perfuse the pulmonary circulation
Systemic venous circulation pressures increase
Recovered ejection fraction
Patients who previously had HFrEF but now have a LVEF > 40%
clinical manifestations of HF
Tachycardia (HR > 100 bpm)
Hypotension
Decreased oxygen saturation
Weight gain
Increased JVP, positive HJR
Pulmonary rales
Displaced LV apex
Extra heart sounds (S3, S4), murmurs
Ascites, Hepatomegaly
Peripheral edema
Cool extremities
____ sided failure can ________ pressures and lead to _____ sided failure.
Left sided failure can increase pulmonary pressures and lead to right sided failure.
NYHA (New York Heart Association) Functional Class
NYHA I: Asymptomatic with no limitation in physical activity
NYHA II: Mild symptoms and slight limitation with ordinary activity (dyspnea)
NYHA III: Marked limitation in activity due to symptoms (walking a short distance of 20-100 m); comfortable only at rest
NYHA IV: Severe limitation. Symptomatic even while at rest and patient may be bedbound.
AHA Stages of Heart Failure
Stage A
At risk for HF but do not yet have structural heart disease; Asymptomatic
Stage B
Structural heart disease but asymptomatic
History of myocardial infarction, decreased LVEF or LV hypertrophy, asymptomatic vascular disease
Stage C
Structural heart disease and symptomatic
Structural heart disease, symptoms of dyspnea and exercise intolerance
Stage D
Patients with end-stage HF
Symptomatic at rest despite maximal medical therapy; recurrent hospitalizations
Assessment, Work-up for Heart Failure
1. Comprehensive Health History, Assessment of RF’s, Physical Exam
Diagnostics for Heart Failure
ECG
CXR
Kerley B Lines
fine horizontal opacified lines (~ 2cm); Represent fluid in the interstitial space
_____ Gold standard biomarker in HF
Brain Natriuretic Peptide (BNP)
2 types of tests with different reference ranges: BNP and NT-proBNP
BNP ranges
In acute setting:
if BNP is < 100 pg/mL then HF is unlikely (NT-proBNP < 300 pg/mL)
if BNP > 400 pg/mL then HF is very likely
Obese patients have _____ BNP levels
Obese patients have lower BNP levels
BNP is a hormone secreted by _____ ; Stored in ______
BNP is a hormone secreted by cardiomyoctes; Stored in ventricles
