Heart Failure Flashcards
What is Heart Failure?
Inability of the heart to pump sufficient blood to meet the metabolic needs of the body
What is Myocardial Failure?
Defective Myocardial Contraction
What is Circulatory Failure
Abnormality of some circulatory component is responsible for inadequate cardiac output.
What are the Compensatory adaptations to preserve cardiac output?
Adrenergic Adaptation- Inc NE Renin-Angiotensin-Aldosterone system activation later -Peripheral arterial constriction -Na water retention -inf mediators and cardiac remodeling
What are the effects of the Adrenergic Activation in Heart Failure?
Increased vascular tone Decreased circulating NE Decreased Myocrdial NE B-1 Stim= inc HR and Cont a-1 Stim mild inc. inotropism, periph vasoconstriction
What are the effects of the Renin-Angiotensin system Activation in Heart Failure?
Decreased renal perfusion
dec. Na in distal renal tubule
increased Adr stim => Inc. Renin
Sustained High Ang II causes
- organ fibrosis
- enhanced norepi release
What is the procedure of LV remodeling?
Pressure overload = paralell/ concentric Hypertrophy
Volume overload= series or eccentric hypertrophy
Act Pot prolongs in advanced HF and can lead to contractile dys.
Inc wall tension
MV regurgitation
What is Backward Heart failure?
Failure of the LV leads to pulmonary HTN and eventually RV failure
What is Forward Hear Failure?
Heart isn’t getting blood to the tissue in the systemic circulation
What is Righ vs Left Heart failure
Right = Cor pulmonale(as a result of pulmonary HTN
Left = True CONGESTIVE HF
RV failure results in SYSTEMIC congestion
What are the Causes of Heart Failue in order from most to least common?
Ischemia/Infarction Hypertension Arrhythmias(atrial fib) Infectious/Inflammatory Pulmonary Embolus Physical, emotional, envt stress Cardiac Toxins(Chemo, alcohol) High Output States Reduction of Therapy
What are the symptoms of Heart Failure?
SOB- Progressive -exertional -Paroxysmal nocturnal dyspnia -orthopnea -resting dyspnea Diminished exercise capacity Fatigue/weakness Nocturia CNS impairment(memory, insomnia) Symptoms of RV failure
What are the Functional Classifications of Heart Failure?
Class 1- No limitation
Class 2- Slight limitation of Activity- ordinary activity causes symptoms
+Dyspnea, fatigue, palpitations or angina
Class 3- Marked limitation
-less than normal activity precipitates symptoms
-Conversational Dyspnia
Class 4- Symptoms at rest
(Prognosis gets worse as class increases)
What are PE findings in Heart Failure?
Pallor, cool extremities -symp tone causes cutaneous vasocons. Anx, Dyspnea at rest Pulses normal to rapid, weak -fast pulse from symp tone and Low SV BP varies Pulmonary Rales LV failure Elevated jugular pulsations RV failure Kussmaul's signRV failure HepatojugularReflex Congestive Hepatomegaly Edema- symmetrical, pitting, dependent Pleural Effusion Ascites
What is charicteristic of the Cardiac Exam in Heart Failure?
Cardiomegaly- Apical impulse Down and left S3 universal S4 rare Pulsus Alternans Murmurs- Systolic: MR, AS, TR Diastolic: AI Cardiac Cachexia(wasting)
