Heart Failure Flashcards
define as a complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood, which in turn leads to the cardinal clinical symptoms of dyspnea and fatigue and signs of HF, namely edema and rales.
Heart failure
The overall prevalence of HF in the adult population in developed countries is
2%
HF prevalence
follows an exponential pattern, rising with age, and affects
6–10% of people over age 65.
True or false:
Although the relative incidence of HF is lower in women than in men, women constitute at least one-half the cases of HF because of their longer life expectancy.
True
In industrialized countries, _____ has become the predominant cause in men and women and is responsible for 60–75% of cases of HF.
coronary artery disease (CAD)
Hypertension contributes to the development of HF in how many percent of patients, including most patients with CAD.
75%
Etiology of heart failure with depressed ejection fraction <40%
CAD HTN Obstructive Valvular disease Regurgitation valvular disease Intracardiac shunting Extracardiac shunting Col pulmonale Pulmonary vascular disorder Non-ischemic dilated cardiomyopathy Toxic/drug induced damage Chaga's disease Chronic bradycardia or tachycardia
Preserved ejection fraction causes of HF
Secondary Hypertension Hypertrophic cardiomyopathy Restrictive cardiomyopathy Amyloidoisis Sarcoidosis Hemochromatosis fibrosis Endomyocardial disorders Aging
High output states causes of HF
Thyrotoxicosis (metabolic d/o)
Nutritional d/o (beriberi)
Excessive blood flow requirement
(Chronic anemia and systemic AV shunting)
____ emerging as the single most common cause of HF.
CAD
Community-based studies indicate that _____ of patients die within 1 year of diagnosis and ____ die within 5 years, mainly from worsening HF or as a sudden event (probably because of a ventricular arrhythmia).
- 30–40%
2. 60–70%
patients with symptoms at rest (New York Heart Association [NYHA] class IV) have a _____ annual mortality rate, whereas patients with symptoms with moderate activity (NYHA class II) have an annual mortality rate of ____
- 30–70%
2. 5–10%
Major determinant of Preload or VEDV
VENTRICULAR END DIASTOLIC VOLUME
Total blood volume
Distribution of blood volume
Atrial contraction
Major determinants
of AFTERLOAD
Systemic vascular resistance
Elasticity of arterial tree
Arterial blood volume
Ventricular wall tension
MECHANISM OF HFPEF
Diastolic dysfunction
Increased vascular stiffness
Impaired renal function
Cardinal symptoms of HF
Fatigue
And
Shortness of breath
Most important mechanism of HF
Pulmonary congestion which activates juxtacapillary J receptors that stimulates a rapid shallow breathing (cardiac dyspnea)
Etiologies of heart failure with preserved ejection fraction (>40-50%):
Hypertrophic CM Hypertension Restrictive cardiomyopathy Infiltrative d/o (amyloidosis, sarcoidosis) Storage diseases (hemochromatosis) Fibrosis, endomyocardial disorders Aging
Etiologies of heart failure with high output states:
Metabolic disorders: thyrotoxicosis
Nutritional disorders: BERI BERI
Excessive Blood flow requirements: systemic AV shunting, chronic anemia
Major cause of HF in AFRICA AND ASIA esp in the young
RHD
Known causes of DILATED CMP
Prior viral infection Toxin exposure (ALCOHOL, CHEMO) Genetic defect in cytoskeleton, muscular dystrophy
Most forms of familial dilated CMP
Autosomal dominant inheritance
Mechanisms that explains dyspnea in heart failure :
Pulmonary congestion Decreased pulmonary compliance Increased airway resistance Respiratory muscle or diaphragm fatigue Anemia
