Heart Failure Flashcards
heart failure
•Heart failure is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood.
A CLINICAL DIAGNOSIS All HF patients, regardless of ejection fraction status (EF value), have the clinical syndrome of heart failure (HF).
heart failure epidemiology
- In the US 6.5x 10⁶ have it
- Over age 65 years incidence: 10 per 1000
- > 68,000 die per year with HF as 1⁰ Dx
- 2.4-3.6 X 10⁶ hospitalized per year
- 40—50% annual mortality rate
- Women: More have it and more die of it than men
- blacks have the highest risk for HF
two most common underlying causes of HF
- coronary artery disease
- hypertension
- CORONARY ARTERY DISEASE 60-75%
- HYPERTENSION IN 75% INCLUDING THOSE WITH CAD
- CAD, HTN AND DIABETES INTERACT TO AUGMENT RISK
- 20-30% of cases of HFrEF cause is unknown = nonischemic or dilated or idiopathic cardiomyopathy
the two presentations of HF in terms of LVEF
LV EJECTION FRACTION = SV/EDV
HFrEF EF ≤ 50%
HFpEF EF ≥ 50% I
t is only in HFrEF that evidence - based pharmacotherapy has been demonstrated to confer morbidity and mortality benefits (M&M).
HFrEF
- EF≤ 40%
- Also referred to as systolic HF.
- Trials of pharmacotherapy have mainly enrolled subjects with HFrEF, and it is only in these patients that therapies with morbidity/ mortality benefits have been shown
- coronary artery disease
- HTN –> LVH –> increased O2 demand
HFpEF
- EF ≥ 50% Most common EF normal, SV low - not filling up enough, reduced preload
- Also referred to as diastolic HF.
- Various criteria have been used to further define HFpEF.
- The diagnosis is one of exclusion of other potential noncardiac causes of symptoms suggestive of HF.
- To date efficacious therapies have not been identified
- hypertension –> LVH –> less room
- aortic stenosis
- hypertrophic cardiomyopathy
- restrictive cardiomyopathy
- ABOUT 50% OF PERSONS WITH HF
- RELATIVELY NORMAL LV FUNCTION
- DIASTOLIC HF
- CARDIAC OUTPUT LIMITED BY:
- ABNORMAL LV FILLING
- DISORDERED VENTRICULAR RELAXATION DURING EXERCISE
- VENTRICULAR PRESSURES ELEVATED FOR A GIVEN VOLUME WITH: PULMONARY CONGESTION DYSPNEA PERIPHERAL EDEMA
- OLDER WOMEN WITH
a-FIBRILLATION
- HTN
–DM
-OBESITY CKD
• HYPERTENSION THE CAUSE IN ~ 60% TO 89%
other causes of HF
*Genetic defects Most are autosomal dominant
-Genes that encode cytoskeletal proteins
- Alcohol
- Cancer chemotherapeutic agents
-Trastuzumab (Herceptin®)
–Anthracyclines - Adriamycin
•Cocaine
associated disorders
DISEASES OF:
PERICARDIUM
MYOCARDIUM
HEART VALVES
GREAT VESSELS
PERIPHERAL VESSELS
METABOLIC ABNORMALITIES
clinical syndrome
DYSPNEA
FATIGUE EXERCISE INTOLERANCE
FLUID RETENTION
Sx 2 0 to impaired LV function
ECHO evidence of systolic and / or diastolic dysfunction
Pulmonary/splanchnic congestion & Peripheral edema
Exercise intolerance little fluid retention
Others c/o edema, dyspnea or fatigue
No single diagnostic test
A clinical Dx based on Hx & PE
All HF Patients, Regardless of EF value, Have the Clinical Syndrome HF
- Abnormal left ventricular (LV) filling dynamics
- Elevated LV diastolic pressure
- LV systolic and diastolic dysfunction
- Neurohormonal activation
- Impaired exercise tolerance, frequent hospitalization, and reduced survival.
The Clinical Manifestations of HF are Similar Regardless of the EF
- Reduced exercise tolerance
- Dyspnea on exertion
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Peripheral edema
- Pulmonary congestion apparent on chest radiographs or computed tomography (CT) scans
HF Classification
- NYHA A functional classification-Sx Classes I-IV
- ACC/AHA Stages using risk factors and structural abnormalities Stages A-D
Activation of the SNS
activation of the RAS
Homeostatic Responses to Impaired Cardiac Performance (Due in part to activation of the renin-angiotensin-aldosterone system (RAAS) and of the sympathetic nervous system).
