Heart failure Flashcards
Left versus Right HF
- defn
- causes
Left HF - can’t pump blood into systemic
- caused by cancer, CAD, cardiomyopathy, valve disease
- more common
Right HF - can’t pump blood into lungs
- caused by left heart failure (or lung disease)
Forward versus Backwards HF
Forward - sys dysf (low EF)
= HFrEF
r is reduced
Backward - diastolic dysf (poor ventricular filling)
= HFpEF
p is preserved
*usually refers to L side, can be both sides
How is HF diagnosed
clinically - echo and patient symptoms (like tamponade)
CHF
Congestive Heart Failure
- any type of HF (sys or diastolic)
Acute Heart Failure
happens suddenly
also get acute pulm edema (trouble breathing)
uncommon, usually get HF bc years of untreated heart disease
receptors… what do they sense?
proprioceptors
baroreceptors
chemoreceptors
limbic system
proprioceptors - movement
baroreceptors - pressure**
chemoreceptors - waste
limbic system - stress
How does the heart increase CO if exercising or in fight or flight?
press drops = baroreceptors send signal to cardiovascular center in brain = incr sympathetic NS =
-incr contractility and HR
- venous constriction (promotes flow to heart - incr preload)
- arterial constriction (better press so better flow through body but incr afterload)
= incr CO
The pathways that incr CO are good short term (fight or flight, exercise) but bad long term (HF)… Why are they bad for HF?
aterial constriction - heart can’t handle incr afterload, so LVH and further decr CO
renin angiotensin - heart can’t handle incr blood vol (preload), so get pulm congestion, peripheral edema, and decr CO (sarcomeres overstretched)
therefore, worsening HF
How does the renin system incr CO?
incr renin anigiotensin sys and
incr ADH (stops peeing)
= incr blood vol and incr preload
= incr CO
causes of Left HFrEF?
conditions that affect contractility:
- untreated valve disease
- CAD
- DCM
- Chemo
conditions that affect afterload:
- severe AS
- HT
causes of Left HFpEF?
- HT - LVH
- RCM / HCM
= diastolic dysf
Symptoms of left sided HF:
dyspnea
dulled mental state
impaired urine production in day
nocturia
orthopnea
paroxysmal nocturnal dyspnea
nocturnal cough
*fluid goes from feet to body/lungs when you lay down
symptoms of right sided HF:
(without L side)
Abd pain
Anorexia
nausea
*fluid pooling in stomach
peripheral edema
weigh gain
*fluid pooling in body
nocturia
increased urine production at night
orthopnea
difficulty breathing while laying down
paroxysmal nocturnal dyspnea
PND
- severe breathlessness 2-3 hrs after bedtime
HF:
NYHA functional classification
*New York Health Association
Class
I. no limitation of physical activity
II. ok at rest, slight limitation of PA
III. ok at rest, marked limitation of PA
IV. discomfort at rest, worse with PA
Diuretics
make you pee
decreases edema
venous vasodilators
make blood pool in legs instead of in lungs
ACE inhibitors
stop renin angiotensin response so decr preload
ARBs
Angiotensin II receptor blockers
block angiotensin response so decr preload (pee more)
Inotropic drugs
increase contractility
might help if acute HF
Beta blockers
slow HR so more time in diastole and more filling
doesn’t help if have dilated LV
Aldosterone antagonist therapy
blocks renin angiotensin system so decr preload
If heart failure, are there any changes to echo?
No, assess systolic and diastolic function!
