Heart Failure – Part 2:Clinical Manifestations and Diagnosis Flashcards
3 major symptoms of Cardiac Failure
↓ Cardiac output
↑ Pulmonary venous pressure (Left-sided)
↑ Central venous pressure (Right-sided)
↑ Central venous pressure (Right-sided) causes
edema
- symptoms of Cardiac Failure
↑ Pulmonary venous pressure (Left-sided) causes
breathlessness
- symptoms of Cardiac Failure
↓ Cardiac output causes
Symptoms of decreased organ perfusion
- symptoms of Cardiac Failure
Symptoms of low flow
↓ cerebral perfusion
↓ muscle perfusion
↓ gut perfusion
↓ kidney perfusion
↓ cerebral perfusion (low flow) causes
Sleepiness, confusion
↓ muscle perfusion (low flow) causes
Fatigue, weakness
↓ gut perfusion (low flow) causes
Anorexia, Wasting (cachexia)
↓ kidney perfusion (low flow) causes
Reduced urine output
Progressive renal dysfunction
Symptoms of ↑ left-sided pressure
↑ Pulmonary venous pressure=
Breathlessness (dyspnea) Dyspnea on exertion Orthopnea Paroxysmal nocturnal dyspnea Acute pulmonary edema
Orthopnea or orthopnoea is shortness of breath (dyspnea) which occurs when _______
lying flat, immediate
Delayed SOB, waking patients from sleep
Classically patient gets out of bed and ambulates to relieve symptoms
Relates to mobilization of edema from tissue through lymphatics back into blood stream
Paroxysmal nocturnal dyspnea (PND)
Symptoms of ↑ right-sided pressure
↑ Central venous pressure (RV failure)= Peripheral swelling / dependent edema Ascites Hepatic congestion Intestinal congestion (protein-losing enteropathy)
Precipitating factors producing acute or worsening symptoms
**Increased circulating volume (preload)= Sodium load in diet
Increased pressure (afterload)
Worsened contractility (inotropy)
Arrhythmia (rate)
Increased metabolic demands
**Non-adherence with HF medications
Paroxysmal nocturnal dyspnea (PND)
Delayed SOB, waking patients from sleep
Classically patient gets out of bed and ambulates to relieve symptoms
Relates to mobilization of edema from tissue through lymphatics back into blood stream
Symptoms generally define the severity of the disease, ex?
Disease severity is one of the strongest predictors of death in heart failure.
Symptoms are often determine therapy e.g.
more aggressive therapies are indicated for more advanced disease)
Signs of low flow
Cool extremities
Tachycardia
Low pulse pressure (difference between systolic and diastolic pressure)
Tachycardia in HF is
Compensate for low stroke volume
Signs of ↑ left-sided pressure
Rales (pulmonary crackles)
Hypoxia
Tachypnea
Sitting bolt upright
Signs of ↑ right-sided pressure
Edema
Follow gravity (legs, sacrum, scrotum)
Hepatic congestion / hepatomegaly
Jugular venous distention (JVD)
S3 is thought to be caused by rapid expansion of the?
ventricular walls in early diastole
S4 is caused by atria contracting forcefully in an effort to?
overcome an abnormally stiff or hypertrophic LV
Co-existing conditions which predispose to HF
HEART DISEASE:
CARDIAC RISK DISORDERS:
ABSENCE OF NON-HF CAUSES OF DYSPNEA
Differential diagnosis for HF Signs and Symptoms
Pulmonary disease Sleep apnea Obesity Deconditioning Anemia Renal failure Hepatic failure Venous stasis / lymphedema Depression
Natriuretic Peptides (BNP)
B-type natriuretic is secreted by the myocardium in response to;
Primary: ventricular stretch (measure of preload)
Secondary: hyperadrenergic state, RAAS activation, ischemia
Diagnostic use of BNP
Elevations are most often due to HF
negative predictive value of BNP is more useful meaning
a low BNP makes HF unlikely as the cause of symptoms, + does not help when HF is already known
EKG in HF
No direct diagnosis of HF
Echocardiography Provides
LVEF (systolic function) Chamber size (dilation) LV wall thickness (hypertrophy) Measures of relaxation (diastology) Valvular anatomy and function Estimated filling pressures (LA, CVP) Estimated pulmonary pressures (pulmonary hypertension)
catheter introduced thru veins &then “floated” through the r. heart to pulmonary a
Has a balloon on the end of it to help blood flow carry it into the lungs
The balloon also allows a branch of the pulmonary artery to be occluded so that the downstream pressure can be measured, which is equivalent to the ______________
(Procedure: Swan-Ganz catheter)
left atrial pressure / left-sided filling pressure.
