Heart failure Flashcards
another name for heart failure
congestive heart failure
what is heart failure
complex clinical syndrome resulting from structural or functional cardiac disorders
pumping difficulties
systolic heart failure
-depressed EF
difficulty filling
diastolic heart failure
-preserved EF
normal venrticular pumping
SVC/IVC->RA-RV-Pulmonary artery-> lungs-> pulmonary veins-> LA-> LV-> systemic circulation
symptoms of heart failure
- fatigue
- poor stamina
- dyspnea: on exertion
- paroxysmal nocturnal dyspnea: in bed at night
- nocturnal cough (orthopnea)
- abdominal fullness, bloating, nausea
- edema
signs of heart failure
- resting tachycardia
- low systolic BP and narrow pulse pressure
- volume overload
- elevated BP
- hepatojugular reflex: press on abdomen
- pulmonary rales
- S3, S4 or summation gallop
- displaced PMI
- murmurs: mitral or tricuspid regurgitation
- hepatomegaly
why have shortness of breath: left side
difficulty of pumping/filling-> back pressure goes into pulmonary circulation-> liquid seeps into alveoli-> alveolar edema (pulmonary edema)
- high pulmonary venous pressure
- see narrow pulse pressure
why have shortness of breath: what happens on right side
back pressure goes-> pulmonary artery
- high pulmonary artery pressure
- get jugular-venous distention
- can go to liver-> ascites
- edema
what is seen on X-ray
pulmonary infiltrates
-enlarged heart (maybe)
what is heard on auscultation of lungs?
crackles or rales on lung bases
symptoms of right CHF
ankles swelling
weight gain
fatigue
muscle atrophy
heart failure pathophysiology
- decreased CO
- poor circulation to organs
- low circulation to musculoskeletal system
- low circulation to kidneys
low circulation to kidneys results in
increase RAA-> salt and water retention, plasma volume expansion, and increased preload
what happens to heart in CHF: systolic heart failure
in systolic heart failure: heart muscle walls thin, cavity sites get bigger
Etiology of heart falire
coronary artery disease=atherosclerosis hypertension diabetes alcohol valvular heart disease viral familial
what happens to heart in CHF: diastolic heart failure
in diastolic heart failure: heart muscle thickens, and cavity site gets smaller
how to we stage heart failure
- Stage A: at risk of CHF (have diabetes, alcoholics)
- Stage B: asymptomatic structural disease (thinning wall or thickening wall)
- StageC: previous/current symptoms
- Stage D: refractory symptoms
class I classifications
no symptoms and no limitations to ordinary physical activity
class II
mild symptoms to ordinary physical activities
class III
marked symptoms with less than usual activity, comfortable at rest
class IV
severe limitations and symptoms at rest. Bed bound patient
steps in diagnosis of CHF
- clinical exam
- ECG
- chest film
- BNP
- echocardiography
what to look for on CXR
- enlargement of heart base
- congested lungs
big heart is
inefficient heart
BNP
comes from heart
- released from wall tension
- enlarged heart-> if increased pressure or volume overload—-> release BNP
- normal BNP <100
what can you see on echo
chamber sizes presence and severity of LV systolic dysfunction valve lesions regional LV function assessment LV diastolic function Valvular abnormalities Pericardial diseases RV abnormalities
normal EF
55-65%
LV EDV- LV ESV)/ (LV EDV
hyperdynamic circulation
70-90% EF
what happens when someone is diagnosed with CHF
-natural progression
treatment of CHF
- diet: low sodium restriction, 2gm or less
- daily weight: check everyday (morning)
- vaccinations (drugs): influenza and pneumococcus)
- limit how much fluid they drink in a day: 1-1.5 liters
drugs that improve symptoms for CHF
improve symptoms:
diuretics
digoxin: to strengthen heart contractility
most common drugs to treat CHF
diuretics, beta-blockers and ACE inhibitors
Spironolactone
Devices
drugs that improve symptoms/prognosis
improve symptoms and prognosis
- ACE inhibitors/ARB’s
- beta-blockers
- hydralazine/isosorbide
- spironolactone
- devices
cardiac resynchronization
improves LV EF
improves symptoms
Reduces function MR
Indications: EF 120ms
advanced therapies
- chronic inotropic support (first option, if fails, go to 2)
- dobutamine
- milrinone - LV assist devices (LVAD): helps heart to squeeze
- Bridge therapy
- destination therapy - Heart transplantation (last option)
acute decompensated CHF
- don’t follow diet
- drink too much fluid
- get volume overload - don’t take medicine
- progression of disease itself: chronic hypertension
treatment of acute CHF
- Diuretics: reduced volume overload
- Vasodilators: decrease preload and afterload, ACE inhibitors, beta-blockers
- Inotropes: augment contractility (stage D patients)
reasons for acute CHF and treatment
- address precipitating causes
- correct myocardial ischemia
- remove offending medications
- treat arrhythmias
- control elevated BP - Patient education
heart failure with preserved LV EF (diastolic heart failure)
increased LV filling pressure due to abnormalities in LV relaxation and compliance
-elderly, history of HTN, CAD common
treatment heart failure with preserved LV EF
control BP diet drugs maintain sinus rhythm Diuretics Relieve MI
larger heart is
NOT stronger heart
-weak
chest pain is symptoms of
MI or heart attack
first line drugs to improve symptoms in CHF
diuretics
What is seen on Chest radiograph
Cardiomegaly Vascular engorgement Cephalization Kerley B lines Pleural effusion Enlarged main PA
Many may be absent in chronic compensated CHF
