Heart Failure-Malozzi Flashcards
Complex clinical syndrome that results from any structural or functional disorder that impairs the ability of the ventricle to fill with (HFpEF) or eject blood (HFrEF)
heart failure
heart failure w/ ejection fraction above 50%
HFpEF
heart failure with ejection fraction below 40%
HFrEF
reduced EF is what kind of dysfunction
systolic
preserved EF is what dysfunction
diastolic
most common cause of heart failure
CAD or MI
shortness of breath when lying down
orthopnea
dyspnea on exertion
orthopnea
fatigue
fluid retention
tachycardia
sx’s of HF
stage of HF where patient is at high risk for HF but without structural heart disease or sx’s
Stage A or I
stage of HF where there is structural heart disease but without sx’s
Stage B or II
stage of HF where there is structural heart disease WITH prior or current sx’s
Stage C or III
advanced heart failure; requiring specialized interventions
Stage D or IV
what acts as a compensatory mechanism in response to low CO and stroke volume
SNS
3 things SNS stimulates
- RAAS
- adrenal medulla
- hypothalamus
effects of B1 stimulation (Gs)
increase inotropy, lusitropy, chronotropy
effects of a1 stimulation (Gq)
increase in SVR, MAP
increase in preload
effect of RAAS stimulation
increased renin release
increased Na+ and water retention
effect of vasopressin
water reabsorption
peripheral vasoconstriction
maldaptive responses due to the short term compensations that improve CO (3 things)
- LV hypertrophy and remodeling
- RAAS and ADH continued expression
- downregulation/desensitization of B adrenergic receptors
what leads to reduction in myocardial contractility
LV remodeling
LV remodeling is in response to________
pressure or volume overload
LV hypertrophy (thickening) from pressure overload; systolic wall stress
Concentric
LV hypertrophy (dilation) from volume overload; diastolic wall stress
Eccentric
Overtime: dilation as failing compensatory mechanism
law of Laplace
engage more fibers what happens according to Frank-Starling curve
stronger contraction
stretch too far of fibers what happens according to Frank-Starling curve
decrease in contraction
sustained stimulation causes what to happen to beta receptors
sequestered into cell and degraded
effect of beta receptor downregulation
decrease in inotropy, lusitropy, and chronotropy
downregulation of beta receptors does what to NE
depletes NE stores overtime
with increased stretch of atria and ventricles what is released and what is the effect
ANP and BNP are released; increased Na+ and water excretion
effect of beta blockers
block NE/Epi from binding
decrease HR, inotropy, chronotropy; cause vasodilation; decrease renin release
beta blockers
main beta blocker used in HF
Carvedilol
go to drugs to start treatment of HF
ACEIs/ARBs
good drugs to use when treating HF symptoms
loop diuretics and K+ sparing diuretics
new drug used for HF that targets RAAS and natriuretic peptide mechanism
Neprilysin inhibitor (ARB)—> ENTRESTO
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