Heart Failure Flashcards
T/F: the heart stores up lots of energy
FALSE
the heart matches its energy needs for its contractile activity with energy synthesis in real time
describe the importance of the O2 supply chain to cardiac activity
the heart generates almost all of its energy needed through aerobic metabolism
if O2 cannot be delivered to cardiac tissue, we will not have enough available for synthesis of energy and thus dysfunction occurs
what are the cardinal s/s of cardiac dysfunction?
- inappropriate fatigue and/or weakness
- dyspnea (SOB)
- exercise intolerance
- rapid or irregular heartbeat
- bilateral LE swelling
- persistent cough
explain how EF can remain unchanged despite changes in LVEDV or LVESV
relate it to the gas gauge in a smart car vs a truck.
their gas gauges may look the same but it doesn’t tell you the actual volume of gas in each car
what factors determine SV? HR? CO?
CO = SV * HR
HR → parasympathetic and sympathtic tone influence HR
SV → preload, contractility, and afterload all influence SV
what regulates coronary arteries?
- coronary artery pressure
- local metabolic signals
- signals from the endothelium
- neutral and hormonal molecules
define heart failure
a complex clinical syndrome that results from any structural or functional impairment of ventricular filling (preload) or ejection of blood (afterload)
The situation where the heart is incapable of maintaining a CO adequate to accomodate metabolic needs and venous returns
list some causes of heart failure
- CAD/ischemic heart disease (IHD)
- uncontrolled HTN (pulmonary or systemic)
- Valvular disease
- uncontrolled diabetes
- long standing ETOH abuse
- Hx of MIs
- Age
- Age associated increased ventricular stiffness
what are the s/s of HF?
- exertional dyspnea
- orthopnea (SOB in supine)
- Paroxysmal nocturnal dyspnea (SOB at night)
- fatigue
List common clinical signs of HF
- fluid retention
- ascites
- pleural effusions
- jugular venous distension (JVD)
- heptomegaly (enlargement of liver)
- pitting edema
- tachycardia
- S3 gallop (specific EKG change)
how is HF classified?
Right vs Left sided heart failure
congestive heart failure
HFpEF vs HFrEF
Functional
describe left sided HF
contractility of LV is reduced → LV does not pump as efficiently as a healthy heart
this results in:
- reduced SV, EF, and CO
- collectively blood flow to the body is reduced
- fatigue, exercise intolerance, SOB
what are some causes of left sided HF?
- HTN → cardiac hypertophy leads to cardiac remodeling and reduced contractility
- CAD → chronic ischemic damage to the myocardium leads to remodeling and scaring in myocardium which reduces contractility
- Arrhythmias
- decreased CO caused by impaired ventricular filling and decreased ventricular relaxation
describe the progression of left sided HF
- reduced LV contractility
- reduced LV SV and EF
- causes vascular congestion:
- increase in LVEDV and thus increase in LVEDP (pressure increase)
- specifically pulmonary congestion
- decrease in blood movement from LA to LV during ventricular diastole
- increase in blood accumulation in LA causing an increase in LA diastolic pressure
- decreased blood mvoement from lungs into LA
- increase in blood volume in pulmonary circulation (congestion)
- pulmonary edema
- hemoptysis → blood suptum
list s/s of left sided HF
- SOB, dyspnea
- fatigue, tiredness, exertional dyspnea
- waking up feeling like you are suffocating
- orthopnea
- paroxysmal nocturnal dyspnea
- decreased urine production
- cough that develops with reclining
- mitral valve regurgitation
describe right sided HF
contractility of RV is reduced → RV does not pump as efficiently as a healthy heart
impact:
- accumulation (congestion) of blood in RV, RA, and in systemic circulation resulting in systemic s/s
list s/s of right sided HF
- abdominal blotting/swelling/ascites
- kidney failure
- JVD
- weight gain
- dependent edema
- increased frequency of deep vein thrombi and PE’s
what is congestive heart failure (CHF)?
a clinical condition in which the heart is unable to pump enough blood to meet the metabolic needs of the body because of pathological changes in the myocardium
often used synonymously with left HF and right HF
T/F: CHF is the most common type of HF seen in clinic
TRUE
describe the clinical progression/changes that occurs with CHF
- Normal
- no symptoms, normal exercise, normal LV fxn
- Asymptomatic LV dysfunction
- no symptoms, normal exercise, abnormal LV fxn
- Compensated CHF
- no symptoms, decreased exercise, abnormal LV fxn
- Decompensated CHF
- symptoms, decline in exericse, abnormal LV fxn
- Refractory CHF
- symptoms not controlled with trx
how can HF be staged?
Stages A → D
describe stage A HF
people at high risk for developing HF in the future but no functional or structural heart disorder.
pre-heart failure
describe Stage B HF
a structural heart disorder but no symptoms at any stage
describe Stage C HF
previous or current symptoms of HF in the context of an underlying structural heart problem, but managed with medical trx
describe Stage D HF
advanced disease requiring hospital based support, a heart transplant or palliative care
describe acute HF
HF symtpoms appear suddenly or a rapid worsening of existing symptoms of HF occurs
sudden onset of dyspnea and limb and LE swelling
5 lb rule
what is the 5lb rule?
if you see an increase in 5lbs within 25 hrs call your physcian
describe systolic HF (also called HFrEF)
LV contractility is reduced in turn reducing EF and O2 delivery to the periphery
also called HF with reduced ejection fraction (HFrEF)
net effect reduced delivery of blood into systemic circulation and subsequent O2 delivery
describe diastolic HF (HFpEF)
reduced ability for filling of chambers
nearly half of all pts with HF have a normal EF
seen more frequently in:
- females
- older age
- HTN
- metabolic syndrome, renal dysfunction
- Obesity
describe the pathophysiology of diastolic HF
- the ventricles lose their ability to relax normally
- ventricles become stiffer and less compliant
- heart chambers cannot fill normally during diastole
- global loss of cardiac, vascular and peripheral reserve
- often have pulmonary HTN and exercise intoleranc
which type of HF impacts men more than women?
Systolic HF (HFrEF)
which type of HF impacts women more than men?
diastolic HF (HFpEF)
which type of HF results in more hospitalizations?
Systolic HF (HFrEF)
T/F: HF is recognized as a neuroendocrine disease
TRUE
what types of medications might your pt be on if they have HF?
- Diuretics
- Beta blockers
- ACE inhibitors/ARBs
- Calcium channel blockers
- Vasodilators
- Positive iontropes
HF is not an exclusive cardio-centric disease, what other organs/tissues can it impact?
- endothelial dysfunction
- skeletal muscle damage
- decreased systemic blood flow and accompanying increased total peripheral resistance secondary to excessive sympathetic stimulation causing vasoconstriction
- kidney dysfunction
T/F: we should not exercise a pt with HF
FALSE
exercise training is a key intervention for pts with HF
