Heart Failure - Brown Flashcards
Pitting Edema
- 1+: slight pitting, no visible distortion, disappears rapidly.
- 2+: somewhat deeper pit than 1+, disappears in 10- 15 seconds.
- 3+: pit is noticeably deep, lasts more than 1 minute, the dependent extremity looks full and swollen
- 4+: pit is very deep, lasts 2-5 minutes, extremity is grossly distorted.
Echocardiogram
Diagnostic Studies in Heart Failure Patients
identify:
- existence and extent of LV dysfunction
- valvular or pericardial disease
- amyloidosis
differentiate systolic versus diastolic heart failure
distinguish regional from global LV dysfunction
Stages of Heart Failure - C
Patients who have current or prior symptoms of HF associated with underlying structural heart disease
Prognosis of Heart Failure
- five year survival < 50%
- mortality rate in stage d > 30%/year
- men have poorer prognosis
- slight improvement due to use of ACE inhibitors and beta-blockers
Diagnostic Studies in Heart Failure Patients
- Chest X-ray
- EKG
- LAB: BNP
- Echocardiogram
- Cardiac catheterization
Systolic Heart Failure: Low Output
Classification of Heart Failure
- present with fatigue and loss of mean muscle mass
- present with dyspnea
Stages of Heart Failure - B
Patients who have developed structural heart disease that is strongly associated with the development of HF but who have never shown signs or symptoms of HF.
Systolic Heart Failure
Classification of Heart Failure
- most common form
- impaired myocardial contractility and low ejection fraction
- assoicated with: CAD, MI, idiopathic dilated cardiomyopathy, HTN, valvular disease
Physical Exam in Heart Failure Patients
not highly sensitive nor highly specific, most sensitive signs:
- S3 (systolic heart failure)
- distended jugular veins
- laterally displaced PMI
- pulmonary crackles that do not clear with cough
- peripheral edema
determining the severity of disease and etiology:
- narrow pulse pressure
- hypotension with cool extremeties
- pulsus alternans (regular rhythm but alternating strong and weak peripheral pulses)
Physical Exam in Heart Failure Patients
See chart below:
pathophysiology of heart failure
Compensatory Mechanisms: activated when CO falls maintain BP and perfusion to vital organs via
- Frank-Starling Mechanism
- Myocardial hypertrophy
- neurohormonal activation
- SNS
- Renin-Angiotensin-Aldosterone System
- Hormones
- vasopressin
- endothelium-derived relaxing factor (nitric oxide)
- natriuertic peptides
- cytokines
- endothelin
- prostaglandins
Systolic Heart Failure: Biventricular Failure
Classification of Heart Failure
- both systemic and pulmonary congestion present
- bilateral reduced contractility
Diastolic Heart Failure
Classification of Heart Failure
- compromised myocardial relaxation with NORMAL contractility and ejection fraction
- associated with: CAD, HTN, aging, infiltrative cardiomyopathy
Systolic Heart Failure: High Output
Classification of Heart Failure
- demand for blood exceeds capacity of a normal heart to meet demand
- anemia
- hyperthyroid
Electrocardiogram
Diagnostic Studies in Heart Failure Patients
Evaluate for:
- old arrhythmias
- old MI’s
- conduction delays
- left ventricular hypertrophy
- repolarization abnormality
define heart failure:
Complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.
Pathophysiology - factors that worsen heart failure
- increased metabolic demand
- increased afterload or preload
- drugs
- negative inotropic drugs
- disopyramide
- Ca blockers
- arrhythmias
- toxins
- hypothyroidism
- lack of compliance
Stages of Heart Failure - D
Patients with advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and who require specialized interventions.
Systolic Heart Failure: Right Heart Failure
Classification of Heart Failure
- Most common cause of right heart failure is left heart failure
- secondary to long-standing increase in pulmonary pressure caused by LV failure
- signs: **peripheral edema **
- other cuases
- mitral stenosis
- COPD
- sleep apnea
- pulmonary emboli
- pulmonary hypertension
B-Type Natriuretic Peptide (BNP)
Diagnostic Studies in Heart Failure Patients
- < 50 pg/mL HF is unlikely
- >150 pg/mL moderately helpful
- helps diagnose cardiac vs. non cardiac shortness of breath
- screening for asymptomatic LV dysfunction
- risk stratification and prognosis
- monitoring treatment
Goals of Heart Failure Treatment
- improve symptoms
- prolong survival
- halt progression of myocardial dysfunction
- reverse myocardial process
Systolic Heart Failure: Left Heart Failure
Classification of Heart Failure
- reduced left-sided contractility
- pulmonary congestion resulting in dyspnea
- etiology
- CAD
- HTN
- idopathic dilated cardiomyopathy
- toxin (alcohol, cocaine, meth)
- valvular heart disease
- congenital heart disease
- viral cardiomyopathy (coxsackie, HIV, CMV)
- obesity
- peri-partum cardiomyopathy
- vitamin/mineral deficiency
Stages of Heart Failure
At Risk for Heart Failure
- A: high risk of developing HF
- B: asymptomatic LV dysfunction
Heart Failure
- C: past or current symptoms of HF
- D: end-stage HF
emphasize the preventability of heart failure
can only move A to D due to cardiac remodeling
History in Heart Failure Patients
History is important to help
- establish HF as the cause of symtpoms
- determine etiology
- establish severity and functional class
