Heart Failure Patho Flashcards by Shaneka Johnson

Heat Failure(HF)

a decrease in cardiac output

Heat can’t meet the demands of the body

How well did you know this?

Not at all

Perfectly

Cardiac output(CO)

The amount of blood leaving the heart

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

How well did you know this?

Not at all

Perfectly

Right Sided Heart Failure

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

How well did you know this?

Not at all

Perfectly

Left sided Heart Failure

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

How well did you know this?

Not at all

Perfectly

Right vs Left sided Heart Failure

Which is common ?
Which is rare?

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

How well did you know this?

Not at all

Perfectly

Systolic Dysfunction

weakened heart muscle can’t squeeze as well

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

AKA : Heart failure with reduced ejection fraction

How well did you know this?

Not at all

Perfectly

Diastolic Dysfunction

stiff heart muscle can’t relax normally

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

AKA Heart failure with preserved ejection fraction

How well did you know this?

Not at all

Perfectly

Ejection Fraction(EF)

EF=stroke volume/end diastolic volume

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

How well did you know this?

Not at all

Perfectly

HFrEF

Heart failure with reduced ejection fraction

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

EF <40%

How well did you know this?

Not at all

Perfectly

HFmrEF

Heart failure with mildly reduced ejection fraction

HFpEF getting worse or HFrEF getting better

EF 40-50%

How well did you know this?

Not at all

Perfectly

HFpEF

Heart failure with preserved ejection fraction

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%

How well did you know this?

Not at all

Perfectly

Diastolic vloume

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

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

How well did you know this?

Not at all

Perfectly

Classification of HFrEF

Example

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

How well did you know this?

Not at all

Perfectly

Classification of HFmrEF

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

How well did you know this?

Not at all

Perfectly

Classification of HFpEF

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

How well did you know this?

Not at all

Perfectly

What test /diagnosis is done to determine EF?

Echocardiogram(ECHO)

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

Hypoperfusion

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

Congestion

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

Decrease cardiac output(Hypoperfusion)

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

Decreased cardiac output(Congestion)

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)

Echocardiogram

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

Chest X-ray

Cardiac enlargement, pulmonary edema,pleural effusions

ECG

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

CBC/BMP

Hypoperfusion,hyponatremia,anemia

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

* BNP >100ng/mL * NT-pro BNP >300ng/mL

ACC Classification

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

NYHA Classification

* 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

What is the most common cause of Heart Failure?

Myocardial infarction | cut-off of blood supply to the coronary arteries

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

Sudden cardiac death from ventricular tachycardia/fibrillation ## Footnote increase in beta-1 stimulation + ventricular remodeling-->ventricular arrythmia and sudden cardiac death

Catecholamine Release

*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

Juxtaglomerular Apparatus

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

Sodium and H2O retention

* Promotes K and Mg excretion * Hang on to additional fluid---->increase in preload

Alpha-1 stimulation

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

What is an exacerbation or ADHF?

Rapid onset of symptoms causing clinic,ED, hospital admission

What causes an acute exacerbation?

* 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

Classification of ADHF

* 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