Heart Failure + Ischemic Disease Flashcards
S/S of heart failure (4)
- Exertional dyspnea
- Orthopnea - SOB in supine
- Paroxysmal nocturnal dyspnea (SOB at night)
- Fatigue
Common Clinical S/S of HF
- Fluid retention
- Ascites
- Pleural effusion
- JVD
- Hepatomegaly
- Pitting edema
- Tachycardia
- S3 gallop
Classifications of HF
- Right sided HF
- Left sided HF
- CHF
- HFpEF
- HFrEF
what is Left sided heart failure?
reduced contractility of the left ventricle resulting in :
- reduced SV, EF, and CO
- reduced blood flow to body and reduced O2 delivery
- fatigue, exercise tolerance, and SOB
what are some causes of Left sided heart failure?
- HTN
- CAD
- Arrythmias
- decreased CO caused by impaired ventricular filling and decreased ventricular relaxation
describe how vascular congestion occurs with Left sided HF?
- reduced contractlity leads to increased LVEDV
- results in decreased movement from LA
- increased blood accumulation in LA
- decreased blood movement from lungs into LA
- increased blood volume in pulmonnary circulation = congestion
- pulmonary edema
- hemoptysis (bloody sputum)
mnemonic for Left sided HF S/S
DO CHAP
- Dyspnea
- Orthopnea
- Cough
- Hemoptysis
- Adventitious breath sounds
- Pulmonary congestion
what is right sided heart failure?
reduced contractility of R ventricle results in:
- accumulation of blood in RV, RA and systemic circulation
S/S of right sided HF
- abdominal blotting/swelling/ascities
- kidney failure
- JVD
- weight gain
- dependent edema
- increased frequency of DVT and PEs
AKJ WID
what is CHF?
the heart is unable to pump enough blood to meet the metabolic needs of the body b/c of pathological changes in the myocardium
often synonymously with left HF
describe the evoluation of the clinical stages of CHF
- normal → no symptoms
- asymptomatic LV dysfunction
- no symptoms
- normal exercise
- abnormal LV function
- compensated CHF
- reduced exercise ability
- decompensated CHF
- symptoms
- reduced exercise ability
- refractory CHF
- symptoms not controlled w/treatment
describe the NY heart associations HF classifications
- Class 1 → Cardiac disease, but no symptoms and no limitation in ordinary physical activity
- Class 2 → Mild symptoms and slight limitation during ordinary activity
- Class 3 → significant limitation in activity due to symptoms. comfortable only at rest
- Class 4 → severe limitations. symptoms even while at rest
Staging of HF
- Stage A → pre-heart failure
- Stage B → a structural heart disorder but no symptoms at any stage
- Stage C → symptoms exisit due to an underlying structural issue but it is managed with medical treatment
- Stage D → advanced disease that requries hospitalization and possibly a heart transplant or palliative care
what is acute HF?
HF symptoms appear suddenly or a rapid worsening of exisitng symptoms of HF occurs
- exacerbation
- sudden onset of dyspnea and limb and LE swelling
- 5 lb rule
what is systolic HF?
also called HFrEF
- left ventricular contractility is reduced in turn reducing EF (L/R) and O2 delivery to the periphery
- net effect-reduced delivery of blood into systemic circulation and subsequent O2 delivery
- reduced LV function is typical
what is diastolic HF?
HFpEF
- 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
- ventricles lose ability to relax normally
- ventricles becomes stiffer and less compliant
- results in reduced filling during diastole
- global loss of cardiac, vascular, and peripheral reserve
- often have pulmonary HTN and exercise intolerance
T/F: diastolic HF pts can exercise just fine
TRUE
these pts should be achieving or exceeding the guideline-recommended doses of physical activity
compare systolic HF to diastolic HF
- systolic HF (HFrEF)
- chronic comorbidities
- more men than women
- more frequent hospitalization
- diastolic HF (HFpEF)
- chronic comorbidities
- more women than men
T/F: HF can be recognized as a neuroendocrine disease
TRUE
HF is a response to a long-term hyperautonomic and/or chronic hyperinflammatory state
medications that a HF pt may be on (6)
- Diuretics
- Beta-blockers
- ACE inhibitors/ARB
- Ca channel blockers
- Vasodilators
- Positive ionotropes
define ischemia
a condition in which blood flow (and thus oxygen) is restricted or reduced in a part of the body
define hypoxemia
low oxygen content in the blood (low O2 sats)
define hypoxia
a condition in which the body or a region of the body or a region of the body is deprived of adequate oxygen supply at the tissue level
what is ACS?
Acute Coronary Syndrome
an umbrella term for a range of symptoms associated with sudden, reduced blood flow to the heart ie cardiac ischemia
what types of conditions are included with ACS?
- heart attack (MI)
- unstable angina
- ST segment elevation MI (STEMI)
- Non-ST segement elevation MI (NSTEMI)
diagnosis of ACS is dependent on what factors?
- Pt history
- chest or left arm pain
- hx of CAD
- Exam
- hypotension, diaphoresis
- pulmonary edema, rales
- ECG changes → ST-segment deviation
- Elevated cardiac biomarkers
- Tnl, TnT, CK-MD, Tn-Troponin I and T, CK-creatine kinase
what is IHD?
ischemic heart disease (aka coronary heart disease or coronary artery disease)
the most common specific diagnosis under the umbrella term of ACS
list some causes of IHD (4)
- Atherosclerosis of the coronary arteries (most common)
- Coronary thrombus or emboli
- Coronary spasm
- Complications of connective tissue disorders
common symptoms of IHD
- chest pain or discomfort, which may involve pressure, tightness or fullness
- pain or discomfort in one or both arms, the jaw, neck, back or stomach
- SOB
- feeling dizzy or lightheaded
- nausea
- diaphoresis
what is ischemic cardiomyopathy?
heart is chronically ischemic
which is a type of cardiomyopathy caused by a chronic narrowing of the coronary arteries which, in turns, diminishes blood supply to the heart
most common types of dilated cardiomyopathy
T/F: one can live with CAD for a long time
TRUE
what does ischemic cardiomyopathy ultimately leads to?
ulimately these pts develop clinical CHF
prognosis is largely determined by myocardial viability (the number of functioning myocytes)
how can RA impact the heart?
attacks the cardiac skeleton and result in:
- rheumatoid valvular heart disease
- rheumatoid myocarditis
- rheumatoid CAD
- rheumatoid pulmonary HTN
what is IHD: angina pectoris
intermittent chest pain caused by transient, reversible myocardial ischemia
can be stable or unstable
what is stable angina?
- caused by mismatch between O2 delivery and O2 need
- brought on by exertion or other form of stress
- occurs at predictable HR
- crushing or squeezing substernal sensation with possible radiation down the L arm
- reduction in stress reduces symptoms
- responds to NO
what is unstable angina?
- brought on by exertion or other forms of stress
- onset is predictable
- crushing or squeezing substernal sensation with possible radiation to the arm
- poor prognosis
- NO may be of benefit
list and describe the different classification of angina
list major ischemic syndromes
- angina pectoris
- stable
- unstable
- ischemic cardiomyopathy
- MI
- sudden cardiac death
list the stages of morphologic stages of MI inflammation and repair
- 0-6 hours → no change
- 6-24 hrs → early features of coagulation necrosis
- 1-4 days → coagulation necrosis with acute inflammatory response
- 5-7 days → macrophage activity (phagocytic removal of dead myocytes)
- 7-10 days → developing perihperal rim of granulation tissue
- 1-6 weeks → progressive organization of infart
- 1-3 months → progressive collagen deposition, mature replacement scar
- area of injury becomes a scar
what is a reperfusion injury?
tissue damage caused when the blood supply returns to tissue after a period of ischemia or lack of O2
associated with microvascular injury, particularly due to increased permeability of capillaries and arterioles that lead to an increased diffusion and fluid filtration into the tissues
