Heart Failure Flashcards
What is heart failure?
What are the symptoms?
What are the ways the body compensates for heart failure?
A complex clinical syndrome that can result from any structural or functional cardiac disorder that results in the inability of the heart to eject blood to meet the demands of the body while maintaining normal pressures in it’s chambers and the lungs
symptoms include shortness of breath, fluid retention, fatigue, orthopnea, paroxysmal nocturnal dyspnea
compensation includes neurohormonal mechanisms (SNS and RAAS) to increase cardiac output; natriuretic peptides
What is the etiology of heart disease?
- Ischemic Heart Disease
- HTN
- Idiopathic cardiomyopathy
- infections (e.g viral myocarditis)
- toxins (alcohol or cytotoxic drugs)
- valvular disease
- prolonged arrythmias (Afib)
What are the neurohormonal effects of heart failure?
- kidney increases NA+/H2O retention to increase perfusion pressure due to decreased blood flow
- increase in vasoconstrictors and ANP (produced in heart for vasodilation) to restore organ perfusion
- increased RAAS system activity
What is the vicious cycle for heart failure?
- Ventricular dysfunction leads to decreased cardiac output
- decreased cardiac output leads to compensations such as increased SNS, RAS-aldosterone, and arginine vasopressin
- increased compensations lead to excessive vasoconstriction and NA/H2O retention
- excessive vasoconstriction. and NA/H2O retention leads to increased afterload and excessive preload
- increased afterload and excessive preload leads to ventricular dysfunction
What factors influence cardiac output?
- Pre-load: degree of myocardial distension prior to shortening, largely depends on the amount of ventricular filling
- Afterload: force against which the ventricles must act in order to eject blood, largely dependent on the arterial blood pressure and vascular tone
- contractile state
- HR
What is the difference between Systolic and Diastolic Heart Failure?
systolic is impaired contractile function of the heart and the most common etiology is ischemic heart disease, although many pts with DHF have coronary artery disease
Diastolic HF is impaired relaxation of the heart and is more common in females and HTN is a more common factor even though a lot of SHF patients have HTN as well
True or False: Clinical outcome for patients with systolic or diastolic heart failure are the same
True, patients usually have a combination of the two
What are the NYHA classifications for heart failure patients?
1=no limits to physical activity, ordinary physical activity does not cause undue fatigue, palpitation, dyspnea
2=slight limitation of physical activity, comfortable at rest, ordinary physical activity results in fatigue, palpitation, dyspnea
3=marked limitation of physical activity, comfortable at rest, less than ordinary activity causes fatigue, palpitation or dyspnea
4=unable to carry on any physical activity without discomfort, symptoms of heart failure at rest, if any physical activity is undertaken discomfort increases
What are the ACC/AHA stage guidelines for heart failure?
Stage A=patient at high risk for developing HF w/o structural disorders of the heart
Stage B=pt with structural disorder w/o symptoms of HF
Stage C=pt w/ past or current SxS of HF assoc. w/ underlying heart disease
Stage D=pt w/ end-stage disease who requires specialized treatment strategies
What are the options for medical examination for heart failure?
- Chest X-ray
- EKG
- Echocardiogram
- Assess coronary arteries (underlying ischemia)
- determine etiology
- interview and physical exam for SxS
- BNP
What is the difference between acute and chronic heart failure?
Acute-immediately life threatening, in acute pulmonary edema and acute ischemia, medical emergency, end sequela of an MI
- instant/sudden and lasts hrs or even days - Cause is usually an MI, pulmonary embolism, or HTN - no time to compensate, acute ischemia and edema
Chronic- can exist in compensated failure for many years, cardiac dilation, poor pump quality, chronic peripheral edema and congestion
-progressive and can last wks or months
-cause is HTN, myocardial fibrosis, or lung disease
-full compensation and present chronic
edema/congestion
True or False: vasodilator therapy, though it seems counter-intuitive, is effective for HF patients due to the highly significant change in the effect of afterload for SV
True
What is the gold standard exercise test for HF patients?
What is an alternative test?
cardiopulmonary stress test
Six minute Walk Test (which can predict morbidity and mortality in pts w/ HF 2 if under 300m)
What are the implications of an abnormal hemodynamic response to exercise?
- associated pulmonary disorders impair breathing
- reduced gas diffusion in lungs
- increase work of breathing
- contribute to dyspnea and fatigue
- exaggerated redistribution of blood flow away from the periphery and to the respiratory muscles during exercise (may contribute to the enhanced perception of fatigue in HF pts.)
What are the medical management options for HF?
Exercise
Pharmacology
Surgery
