Heart Failure Patho Flashcards

1
Q

Heat Failure(HF)

A

a decrease in cardiac output

Heat can’t meet the demands of the body

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2
Q

Cardiac output(CO)

A

The amount of blood leaving the heart

CO(mL/min)= Stroke volume(mL/beat)xHR(beats/min)

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3
Q

Right Sided Heart Failure

A

The right ventricle can’t pump enough blood to the lungs

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4
Q

Left sided Heart Failure

A

The left ventricle can’t pump enough blood to the tissues and organs that need oxygen

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5
Q

Right vs Left sided Heart Failure

Which is common ?
Which is rare?

A

Common(Left-sided HF)
Rare(Right-sided HF)

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6
Q

Systolic Dysfunction

weakened heart muscle can’t squeeze as well

A

Problem with Pumping
* Ventricles can fill,but can’t pump

AKA : Heart failure with reduced ejection fraction

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7
Q

Diastolic Dysfunction

stiff heart muscle can’t relax normally

A

Problem with filling
* Ventricles can’t fill, but can pump

AKA Heart failure with preserved ejection fraction

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8
Q

Ejection Fraction(EF)

EF=stroke volume/end diastolic volume

A

The % of blood that leaves your left ventricles when it contracts

N.B. normal EF is ~50-70% meaning 30-50% of the blood in your ventricle remains behind after it pumps

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9
Q

HFrEF

Heart failure with reduced ejection fraction

A

Your heart pump doesn’t work so <40% of the blood in your ventricle leaves when it contracts

EF <40%

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10
Q

HFmrEF

Heart failure with mildly reduced ejection fraction

A

HFpEF getting worse or HFrEF getting better

EF 40-50%

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11
Q

HFpEF

Heart failure with preserved ejection fraction

A

The LV doesn’t fill properly, but does contract , so the same % of blood leaves the ventricle, but from a smaller starting volume

EF >50%

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12
Q

Diastolic vloume

A

Amount of blood in left ventricle after diastole=~120mL

Normal amount of blood ejected=~70mL(stroke volume)
Ejected fraction=70mL/120mL=~60mL

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13
Q

Classification of HFrEF

Example

A
  • End diastolic volume: 120mL
  • Amount of blood ejected in HFrEF:~30mL
  • EF:30mL/120mL=25%
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14
Q

Classification of HFmrEF

A
  • End diastolic volume: ~100mL
  • Amount of blood ejected in HFrEF: ~45mL
  • Eejection fraction: 45mL/100mL=~45%
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15
Q

Classification of HFpEF

A
  • End diastolic volume :~80mL
  • Amount of blood ejected in HFrEF: ~50mL
  • Ejection fraction: 50mL/80mL=63%
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16
Q

What test /diagnosis is done to determine EF?

A

Echocardiogram(ECHO)

Evaluate EF w/ wall motion abnormalities
Evaluate chambers of heart
Evaluate valves

17
Q

Hypoperfusion

A

Not enough oxygenated blood moving forward from the heart to perfuse the vital organs

18
Q

Congestion

A

Blood backs up from the LV to the lungs, possibly the RV, and beyond

19
Q

Decrease cardiac output(Hypoperfusion)

A
  • Tachycardia
  • Fatigue
  • Cyanosis
  • Cold extremities
  • Organ dysfunction
    1. Increased Scr
    2. Increased LFTs
    3. Confusion/AMS
20
Q

Decreased cardiac output(Congestion)

A
  • Weight gain
  • SOB
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Pleural effusion on CXR
  • Crackles/rales on auscultation
  • S3 and S4
  • Peripheral edema(pitting)
  • B-type natriuretic peptide
  • Jugular venous distention(JVD)
21
Q

Echocardiogram

A

Estimates ejection fraction(EF) of the heart[diagnostic tool]

22
Q

Chest X-ray

A

Cardiac enlargement, pulmonary edema,pleural effusions

23
Q

ECG

A

May help you identify a cause for a HF exacerbation(ACS,arrhythmia)

24
Q

CBC/BMP

A

Hypoperfusion,hyponatremia,anemia

25
Q

B-Type Natriuretic Peptide(BNP) or NT-BNP

A
  • BNP >100ng/mL
  • NT-pro BNP >300ng/mL
26
Q

ACC Classification

A
  1. A—>At risk for heart disease; No symptoms
  2. B—> Heart disease present; No symptoms
  3. C—> Heart Disease present; Yes for symptoms
  4. D—> Heart disease present; Refractory symptoms
27
Q

NYHA Classification

A
  • I: No limitation with ordinary activity
  • II: Slight symptoms with activities of daily living
  • III: Extreme symptoms with activities of daily living
  • IV: Symptoms at rest
28
Q

What is the most common cause of Heart Failure?

A

Myocardial infarction

cut-off of blood supply to the coronary arteries

29
Q

What is the #1 cause of death in a patient with HF?

A

Sudden cardiac death from ventricular tachycardia/fibrillation

increase in beta-1 stimulation + ventricular remodeling–>ventricular arrythmia and sudden cardiac death

30
Q

Catecholamine Release

A

Short-term: stimulate B1 receptors in the heart—>increases CO
Long-term:
* Apoptosis/muscle burn out and ventricular remodeling
* Desensitized B1 receptor and changes in B1:B2 ratio from 80:20—->60:40
* Uncoupling of B1 receptors

31
Q

Juxtaglomerular Apparatus

A

Renin release—> stimulates AG II receptors
* Extremities:vasoconstriction
* Kidneys:Na and H2O retention
* Adrenals:NE and aldosterone release—->ADH results in more ventricular remodeling and promotes more K and Mg excretion
* Heart: stimulates abnormal growth/collagen deposition= worsens remodelling
* Posterior pituitary:ADH release—> holds on to more free water

32
Q

Sodium and H2O retention

A
  • Promotes K and Mg excretion
  • Hang on to additional fluid—->increase in preload
33
Q

Alpha-1 stimulation

A

Vasoconstriction and increase in afterload—->makes it harder for the LV to pump and overtime muscle hypetropies and remodels

34
Q

What is an exacerbation or ADHF?

A

Rapid onset of symptoms causing clinic,ED, hospital admission

35
Q

What causes an acute exacerbation?

A
  • Non-compliance(medications)–>abrupt withdrawal
  • Non-compliance(dietary)—>Possibly fluid and/or salt restricition, genrally 2g &2L
  • NSAID(naproxen,ibuprofen ,cold/flu medicines etc.) use–> fluid retention
  • Comorbidities—>Afib,MI, infection
36
Q

Classification of ADHF

A
  • Class I:Warm and dry
  • Class II:Warm and wet
  • Class III: Cold and dry
  • Class IV: Cold and wet

Increased perfusion: warm
Increased congestion: wet