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Cardio > Heart failure > Flashcards

Heart failure Flashcards

1
Q

Heart failure, what is it

A
  • heart can’t supply enough blood to meet the metabolic demands of the body
  • many of the ischemic diseases and valvular diseases can lead to inability of the heart to function properly, causing HF -> and death
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2
Q

List the different types of HF

A
  • Systolic HF
  • Diastolic HF
  • RHF
  • LHF (LHF+Systolic HF / LHF + Diastolic HF)
  • Low CO HF
  • High CO HF
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3
Q

What is the CO

A
  • the volume of blood the heart squeezes out each minute = CO
    CO usually around 5L/min
    CO = HR x SV
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4
Q

What’s normal CO, normal HR, normal SV

A

normal CO = 5L/min
normal HR = around 70bpm
normal SV = around 70ml of blood per beats

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5
Q

What is the ejection fraction

A

Ejection fraction: expressed as a percentage, of how much blood the left ventricle pumps out with each contraction.

EF = SV / Total volume

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6
Q

Ejection fractions measures:

A
  • between 50 and 70%: normal EF
  • between 40 and 50%: borderline
  • below 40%: Systolic HF
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7
Q

What is Systolic HF, and how is the EF altered

A
  • heart can’t pump hard enough and send enough blood to maintain the metabolic demands, EF is diminished (less than 40%)
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8
Q

What is Diastolic HF

A
  • the heart squeezes hard enough, but is not filling enough the left ventricle
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9
Q

How is the EF changed in diastolic HF ?

A
  • the heart doesn’t fill enough (reduced preload), so the SV will be low, but the total volume will also be lowered, so the EF remains normal

Ex: 44ml / 69ml = 64%

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10
Q

LHF + Systolic HF, def

A
  • usually due to systolic (pumping) dysfunction, most of the time because of damage to the myocardium
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11
Q

LHF + Systolic HF: state the different causes that could lead to LHF+Systolic HF

A
  • ischemic heart disease
  • long standing HTN
  • dilated cardiomyopathy
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12
Q

LHF + Systolic HF: C: Ischemic heart disease

A
  • Ischemic heart disease
    .Coronary atherosclerosis -> less blood to the myocardium -> damaged myocardium
    .Complete coronary artery blockage -> heart attack (MI)-> scar tissue formation -> no more contracting function to the affected area
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13
Q

LHF + Systolic HF: C: Long standing HTN

A
  • Long standing HTN: makes it harder for the LV to pump blood -> causes LV hypertrophy -> requires more O2 to the muscles + squeezes coronary arteries (making it even harder for the blood/O2 delivery) -> leads to weaker contraction -> systolic failure
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14
Q

LHF + Systolic HF: C: Dilated cardiomyopathy

A
  • Dilated cardiomyopathy: chambers grow in size -> attempt to fill the ventricles with larger amount of blood (preload) -> stretches the muscle wall -> increases the contraction strength (via the frank starling mechanism) -> over time the muscle wall gets thinner and weaker -> becomes so thin -> causes systolic HF
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15
Q

LHF + Diastolic HF: causes

A
  • long standing HTN
  • aortic stenosis
  • hypertrophic cardiomyopathy (genetic)
  • restrictive cardiomyopathy
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16
Q

LHF + Diastolic HF: long standing HTN, aortic stenosis, hypertrophic cardiomyopathy

A
  • Long standing HTN, aortic stenosis, hypertrophic cardiomyopathy -> all lead to concentric hypertrophy -> less room for filling -> diastolic HF
17
Q

LHF + Diastolic HF: C: restrictive cardiomyopathy

A
  • restrictive cardiomyopathy: wall is stiffer and less compliant -> wall can’t stretch out and fill blood -> can lead to diastolic HF
18
Q

HF body compensatory mechanism (kidney)

A
  • as the heart doesn’t pump out much blood -> there’s a decrease of blood to the kidneys -> which stimulates the renin-angiotensin-aldosterone system -> causing fluid retention -> which fills the heart a bit more during diastole and increases its preload -> which increases its contraction strength (because of the frank-starling mechanism)
    However, in long term, because of more fluid retention in the blood vessels -> leads to a large portion leaking in the tissues -> contributes to fluid buildup in the lungs and other parts of the body -> worsen the symptoms of heart failure
19
Q

LHF: signs and symptoms

A
  • pulmonary edema (congestion): because the blood can’t go forwards -> back up in veins and capillaries -> fluid goes to the interstitial space
  • Dyspnea: extra fluid in the alveoli makes the O2/CO2 exchange harder
  • Orthopnea: difficulty breathing when laying flat
  • crackles (rales) upon auscultation (because of the extra fluid)
20
Q

LHF: T

A
  • medications to help improving the blood flow:
    .ACEi -> dilates blood vessels
    .Diuretics -> reduces fluid build up
21
Q

Right HF: C

A
  • most commonly due to LHF -> which in this case will cause biventricular HF
  • isolated RHF can be due to a left to right shunt: arterial septal defect, ventricular septal defect
  • Chronic lung disease -> makes O2 exchange harder -> in response to hypoxia, pulmonary arterioles contract -> which increases pulmonary BP -> causes hypertrophy + HF, called COR pulmonale
22
Q

Right HF: compensatory mechanism

A
  • increased fluid volume on R side -> causes concentric hypertrophy, leads to:
    .myocardial ischemia -> systolic dysfunction
    .Smaller volume filling -> less compliant -> diastolic dysfunction
23
Q

Right HF: signs and symptoms

A

RHF -> blood backs up in the body -> congestion in systemic vein circulation

  • Jugular vein distention
  • Hepatosplenomegaly, painful
  • congested liver over a long period of time causes cirrhosis and liver failure (cardiac cirrhosis)
  • ascites: fluid excess found near the surface of the liver and spleen can go in the peritoneal space
  • pitting edema: fluid that backs up in the interstitial space of the tissues of leg -> tissue is swollen and when pressure is applied to it, leaves a pit
24
Q

Right HF: T

A
  • ACEi

- Diuretics

25
Q

Arrhythmias as a complication of heart failure

A
  • HF gets either stretched and thinner, or thicken and becomes ischemic -> either ways -> heart cells get irritated -> can cause arrhythmias

Arrhythmias -> ventricles can’t contract synchronically -> less blood pumped out -> worsen the situation

26
Q

Heart failure: Diagnosis

A
  • medical history
  • physical examination: BP, HR, auscultation, depends on which type of HF is present
  • blood test: Brain Natriuretic peptide (hormone secreted by the ventricles) can be used as a screening test for HF, cardiac markers, CRP
  • ECG
  • Echocardiography, doppler echocardiography: look for -> SV, EF, EDV, wall motion, valvular damage
  • Angiography

Cardio (35 decks)

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