Heart Failure Flashcards
left heart failure: signs and Sx
signs: bibasilar pulmonary crackles, tachycardia (due to SNS and Epi/NE from adrenal), S3, pedal, ankle or leg edema
Sx: dyspnea on exertion progressing to dyspnea at rest, orthopnea, PND (paroxysmal nocturnal dyspnea), fatigue
right heart failure: signs and Sx
signs: pedal, ankle or leg edema (buildup of venous back pressure), jugular venous distension, hepatomegaly, ascites
Sx: edema of feet, then ankles, then legs, abdominal distention
normal LVEDP/LVEDV/SV/EF/LVESV
10/150/100/67/50
failing heart
LVEDP/LVEDV/SV/EF/LVESV
40/300/50/17/250
At what % reduction of FSV do patients begin to have symptoms?
25%
How do left HF patients develop edema?
ventricular dilation and myocardial hypertrophy -> decreased CO -> decreased renal perfusion -> increased Na retention -> increased osmotic pressure -> increased ADH -> increased water reabsorption -> edema
Differentiate among pulmonary edema due to Left HF, septic shock, and hemorrhagic shock
pulmonary capillary pressure
left HF: high
septic shock: normal
hemorragic shock: low
systolic HF
elderly
HF with dyspnea, orthopnea, PND, bibasilar pulmonary crackles
NORMAL EF
normal HF
long standing HTN, obese, concentric left ventricular hypertrophy
diastolic HF
noncompliant left ventricle with impaired diastolic function and filling
preserved EF
B-type natriuretic peptide
elevated in HF
function: counter-regulatory; vasodilation and increased sodium excretion
causes of right heart failure
most common: left heart failure cor pulmonale (most are compensated so don't have RHF)
syndrome of inappropriate antidiuretic hormone (SIADH)
25% of acute heart failure
retain lots of water: systolic left HF
peripartum cardiomyopathy (PPCM)
heart failure in previously healthy woman
HF proinflammatory cytokines
TNF, IL-1, IL-6
hemodynamic classifications of HF
- warm and dry (goal)
- cold and dry (inadequate perfusion; need vasodilator)
- warm and wet (congestion; need diuretics)
- cold and wet (congestion and inadequate perfusion; need vasodilators and diuretics)
distributive shock
diffuse vasodilation warm and dry decrease: preload and after load (primary) increase: CO sepsis, anaphylaxis, TSS
obstructive shock
obstruction cold and clammy increase: preload and after load decrease: CO (primary) cardiac tamponade and pulmonary embolism
cardiogenic shock
ventricular failure cold and clammy increase: preload and after load decrease: CO (primary) acute MI, HF, valvular dysfunction, arrhythmia
hypovolemic shock
loss of blood cold and clammy decrease: preload (primary) and CO increase: after load hemorrhage, dehydration, burns
signs of shock
elevated serum lactate
hypotension (remember to adjust for people with HTN)
behavior: disorientation, confusion, obtundation
skin: mottled, cold, clammy, pale or cyanotic
urine: decreased output
compensated aortic regurgitation LVEDP/LVEDV/SV/EF/LVESV
12/250/200/80/50
decompensated aortic regurgitation (HF): LVEDP/LVEDV/SV/EF/LVESV
40/300/150/50/150
How should you treat a patient with severe acute uncompensated aortic regurgitation?
SURGICAL EMERGENCY
