Heart Failure Diagnosis Flashcards
3 Major Symptoms of Heart Failure
1) decr cardiac output due to decr organ perfusion
2) incr pulm venous pressure (left sided) –> breathlessness
3) incr central venous pressure (right sided) –> edema
Symptoms of Low Flow
1) decr cerebral perfusion (confusion)
2) decr muscle perfusion (fatigue)
3) decr gut perfusion (anorexia/wasting)
4) decr kidney perfusion (decr urine output and renal dysfunction)
Effect of low flow on Starling Curve
Shift curve downward due to decr SV for a given pressure
Symptoms of Left sided pressure/increased pulm venous pressure
1) breathlessness (dyspnea)
2) dyspnea on exertion
3) orthopnea
4) paroxysmal noctural dyspnea
5) acute pulm edema due to fluid retention/incr LA pressure so fluid from pulm vasculature enters interstitial space and then alveoli (hypoxia)
Effect of incr left sided pressure on Starling curve
given point shifts right due to incr pressure
Difference between orthopnea and paroxysmal noctural dyspnea
Orthopnea = immediate SOB lying flat
Paroxysmal Nocturnal dyspnea= delayed SOB wake from sleep and walk around
Why does walking around improve paroxysmal nocturnal dyspnea
Mobilizing edema from tissue through lymph back into blood stream
Why does orthopnea occur?
lost venous pooling of blood in the legs
Symptoms of incr right sided pressure/incr central venous pressure
1) peripheral edema in lower extrem (older)
2) ascites (younger)
3) Hepatic congestion
4) intestinal congestion
Right sided failure = Effect of Edema in HF on Starling forces
Increased central venous pressure upsets balance between Starling forces
now increase oncotic P so pump more fluid into interstitum
Factors that lead to worse symptoms
1) incr circulating volume (preload) with sodium
2) increased pressure (afterload)
3) decr inotropy
4) arrhythmia
5) incr metabolic demands (fever, infection)
6) non-adherence with HF meds
examples of increased pressure (afterload) that can worsen symptoms
1) uncontrolled HTN
2) worse aortic stenosis
3) pulm embolism
examples of decr inotropy that can worsen symptoms
1) MI
2) beta blocker or Ca2+ channel blocker
NYHA class 1 2 3 4
1) asymptomatic
2) symptomatic with mod exertion
3) symptomatic with minimal exertion
4) symptomatic at rest
AHA/ACC HF stage 1
at risk for HF but not structural heart disease or symptoms
AHA/ACC HF stage 2
structural heart disease (prior MI, LVH and low EF) but no signs/symptoms of HF
AHA/ACC HF stage 3
structural heart disease with prior/current signs and symptoms (HFpEF) and (HFrEF)
AHA/ACC HF stage 4
Refractory HF
marked symptoms at rest
What is important about HF course?
variable course
episodic exacerbations and rarely single NYHA over time
but usually progressive decline over time
Physical exam
Signs of low flow
1) cool extremities - peripheral vasocosntriction to redirect flow to vital organs
2) tachycardia- compensate for low SV
3) low pulse pressure - low output
Physical Exam
Signs of elevated left sided pressure
1) rales due to wet alveoli opening
2) hypoxia
3) tachypnea
4) bolting upright
PHysical exam
signs of elevated right sided pressures
1) edema - follows gravity (legs, sacrum, scrotum)
2) hepatic congestion
3) JVD = central venous pressure
what does JVD measure
RA filling pressure
What is JVD a sign of
increased central venous pressure
right heart failure
