Heart Failure (CM) Flashcards
The single most expensive disease
Heart failure
Goal to decreasing cost of HF
Reducing the number of hospitalizations by ensuring complete treatment and correctly applying chronic HF management guidelines
Also doing better patient education and following up within a few days
Heart failure definition
Syndrome in which disease:
reduces cardiac output
increases venous pressures
and is accompanied by molecular abnormalities that cause progressive deterioration of the failing heart and premature cell death
HF rates are rising because of what two factors?
Improved survival of MI
Aging population
What can the RAAS lead to that can be harmful long term?
Vasoconstriction
Oxidative stress
Cell growth
Proteinuria
LV remodeling
Vascular remodeling
Salt and water retention short and long term effects
short term augments preload
long term leads to pulmonary congestion and anasarca
Vasoconstriction short and long term effects
Short term: maintains BP for perfusion of vital organs
Long term: exacerbates pump dysfunction (excessive afterload), increases cardiac energy expenditure
Sympathetic stimulation short and long term effects
Short term: increases HR and EF
Long term: increases energy expenditure
Key neurohormonal mediators in HF–bad
Norepinephrine
Angiotensin II
Aldosterone
Tumor Necrosis Factor
Vasopressin
These stimluate hypertrophy, remodeling, fibrosis, apoptosis, fetal gene expression, contractile abnormalities.
Lead to vasoconstriction, sodium and fluid retention, and endothelial dysfunction
Key neurohormonal mediators in HF–good
Natriutic peptides
Nitric Oxide
Prostacyclin
Antihypertrophic, antiproliferative, and vasodilatory
Causes of HF
Most common:
- Ischemia/Coronary Artery Disease (MC)
- HTN
- Valvular Heart Disease
Others:
- Congenital abnormalities
- Myocarditis (Viral/AIDS)
- Toxins (EtOH, chemo)
- Tachycardia/bradycardia
New York Heart Association Functional Classification
Class I: No sxs with ordinary activity
Class II: Slight limitation of physical activity. Ordinary physical activity results in dyspnea, angina, fatigue, palpitations. Comfortable at rest.
Class III: Marked limitation. Less than ordinary physical activity results in dyspnea, angina, fatigue, palpitations. Comfortable at rest.
Class IV: Unable to carry out any physical activity without symptoms. Symptoms may be present at rest.
Stages of HF
Aimed at promoting early recognition and treatment
Stage A: At risk for development of HF (HTN, valvular disease, hx of MI, etc)
Stage B: Asymptomatic left ventricular dysfunction (Class I)
Stage C: Mild to moderate heart failure sxs (Class II-III)
Stage D: Severe HF symptoms not responsive to medical therapy (Class IV)
Clinical Symptoms of Heart Failure
Dyspnea
- DOE, orthopnea, PND
- Cough, hemoptysis
Fatigue
**Edema **
Others:
- chest discomfort, postural lightheadedness, dec’d mental acuity, bloating/nausea, weight gain, anorexia/weight loss, palpitation
Physical Exam in HF
BP, HR, RR–variable
Distended neck veins
Heart–enlarged
- murmurs
- diminished tones
- gallop sounds
Lungs–crackles
- wheezes, rhonchi
- dullness to percussion
Abdomen–distended
- Liver enlarged, ascities
Extremities–edematous with diminished pulses
Pallor, tired appearing
Categories for rapid assessment of hemodynamic status
