Heart failure I Flashcards
definition: heart failure
inability of the heart to pump sufficient blood to meet metabolic needs of body
definition: myocardial failure
defective myocardial contraction
definition: circulatory failure
condition in which an abnormality of some circulatory component (heart, vessels, blood volume) is responsible for inadequate CO
what is the prevalence of HF worldwide? in the US?
worldwide - 23 million
US - 4.7 million
what is the incidence of HF annually in the US?
3 million
what is the neurohumoral mechanism of HF?
- a series of compensatory adaptations normally preserve CO
- activation of SNS (with concomitant suppression of PNS)
- activation of renin angiotensin system
what is the result of the neurohumoral mechanism of HF?
peripheral arterial constriction
sodium / water retention
activation of inflammatory mediators of cardiac remodeling
what is the role of NE in HF?
increased circulating NE
decreased myocardial NE
what do sustained high levels of angiotensin II cause?
organ fibrosis
enhanced NE release
in HF, how do LV volume and SV relate? what is the significance?
LV volumes increase bu SV increases only slightly
what is backward HF?
LV failure leads to backup into lungs - pulmonary edema
what is forward HF? what is the result?
inadequate delivery of oxygen into arterial system (reduced CO)
results in decreased perfusion of vital organs with mental clouding, weakness, and sodium / water retention
does true congestive heart failure deal with left or right HF? this owes to what process?
left
central venous congestion
RV failure results in what type of congestion?
systemic
what is the most common form of HF?
abnormal systolic function
what are three features of systolic (LV) failure?
- abnormal systolic function
- high end diastolic ventricular volumes
- poor perfusion, sodium and water retained
what are three features of diastolic (LV) failure?
- abnormal diastolic filling
- high LV filling pressure
- eventual pulmonary and systemic congestion
what are the top three etiologies of HF?
- ischemia / infarction
- HTN
- arrhythmias
class I HF
no limitation
class II HF
slight limitation of activity
ordinary activity causes symptoms - dyspnea, fatigue, palpitations, angina
class III HF
marked limitation - less than normal activity precipitates symptoms
class IV HF
symptoms at rest
HF classification: no limitation
class I
HF classification: slight limitation of activity, ordinary activity causes symptoms - dyspnea, fatigue, palpitations, angina
class II
HF classification: marked limitation - less than normal activity precipitates symptoms
class III
HF classification: symptoms at rest
class IV
what is kussmaul’s sign? what is the cause?
paradoxical rise in JVP on inspiration
impaired filling of the RV due to either fluid in the pericardial space or a poorly compliant myocardium / pericardium
what is the prognosis for HF in the US for men and women? what is the 5 yr survival for men and women?
men - 1.7 years
women - 3.2 years
men - 25%
women - 32%
most people with HF die from what complications?
pump failure
tachyarrhythmias
what are the etiologies of high-output HF?
anemia AV fistula hyperthyroidism beri-beri paget's disease of bone
