Heart Failure Flashcards
Definition
inability of heart to pump sufficient blood to meet needs of the body
Most common hemodynamic disorder
Heart failure
Prevalence
Rises sharply in old age (80 and older especially)
Most common in older women
AA prevalence is 25% higher than caucasians
Most common STRUCTURAL correlate to Heart failure (Heart Failure is a Functional syndrome)
MI
Risk factors
- CAD
- Smoking
- HTN
- Overweight
- Diabetes mellitus
- Valvular Heart Disease
Acute HF or Chronic HF more common?
Chronic
Most frequent cause of Chronic HF
old MIs (usually multiple)…“ischemic cardiomyopathy”
Causes of acute HF
- -CAD
- -acute MI or even acute myocardial ischmia that isn’t an infarction yet
Cause of HF…impaired contractility
CAD
Cause of HF…excessive afterload (exceeding ability of heart to compensate)
Severe hypertension
Stenosis of the aortic valve
Causes of HF that lower ejection fraction
aortic stenosis
severe hypertension (Decompensated)
CAD
Causes of HF that usually preserve the ejection fraction
**Compensated HTN left ventricular hypertrophy resstrictive cardiomyopathy pericardial disease Sometimes transient myocardial ischmia --if impairs O2 and nutrient delivery needed for early diastolic relaxation
Typical signs of HF
- -cardiomegaly (dilation of the chambers rather than thickening of the walls…exacerbates problem b/c increases stress)
- -
Most common symptom of HF
dyspnea
When pulmonary venous pressure goes from 8 to 20mmHg…
transudate passes from veins to interstitium…
interstitial edema compresses bronchioles and alveoli
HF presentation
dyspnea Paroxysmal nocturnal dyspnea (PND) orthopnea (dyspnea w/ laying down) fatigue weakness
Two most specific symptoms of HF
PND
orthopnea
Two most common symptoms of HF
Dyspnea
Fatigue
Signs of HF
tachycardia tachypnea Hypotension pulmonary crackles pulmonary wheezing diaphoresis gallops Dulled mental status oliguria
Pulmonary crackles are associated w/…
pulmonary alveolar edema
When pulmonary venous pressure goes over 25mmHg…
transudate passes into interstitium AND airspace, as the junctions b/w capillary endothelial and alveolar lining epithelial cells are pulled open by pressure
crackles
- -inspiratory sounds
- -attributed to popping open of small airways occluded by edema b/w inspirations
–first heart at lung bases (where vascular hydrostatic pressure is highest)
Cardiac asthma
wheezing due to edema around large airways
Diaphoresis is sign of HF due to…
sympathetic nervous stimulation…a compensatory response
When is S3 heard?
early diastole
How does S3 sound?
dull, low-pitched
“Kentucky”
What causes S3?
rapid filling
Is S3 always pathologic?
no…can be normal in children and young adults
Diagnosis of HF
Hx
Physical
CXR
echocardiography
CXR findings
cardiomegaly
pulmonary vascular congestion
interstitial or alveolar edema
echocardiography
can be diagnostic
estimate of ejection fraction
What correlates w/ severity of HF?
EF
levels of BNP
compensatory mechanisms for heart failure?
increased BNP secretion
How do we differentiate dyspnea/pulmonary edema due to lung disease from HF?
- -elevated BNP levels=HF
- -
serum B-type natriuretic peptide
biomarker of HF
