Heart Failure Patho Flashcards
Heat Failure(HF)
a decrease in cardiac output
Heat can’t meet the demands of the body
Cardiac output(CO)
The amount of blood leaving the heart
CO(mL/min)= Stroke volume(mL/beat)xHR(beats/min)
Right Sided Heart Failure
The right ventricle can’t pump enough blood to the lungs
Left sided Heart Failure
The left ventricle can’t pump enough blood to the tissues and organs that need oxygen
Right vs Left sided Heart Failure
Which is common ?
Which is rare?
Common(Left-sided HF)
Rare(Right-sided HF)
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
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
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
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%
HFmrEF
Heart failure with mildly reduced ejection fraction
HFpEF getting worse or HFrEF getting better
EF 40-50%
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%
Diastolic vloume
Amount of blood in left ventricle after diastole=~120mL
Normal amount of blood ejected=~70mL(stroke volume)
Ejected fraction=70mL/120mL=~60mL
Classification of HFrEF
Example
- End diastolic volume: 120mL
- Amount of blood ejected in HFrEF:~30mL
- EF:30mL/120mL=25%
Classification of HFmrEF
- End diastolic volume: ~100mL
- Amount of blood ejected in HFrEF: ~45mL
- Eejection fraction: 45mL/100mL=~45%
Classification of HFpEF
- End diastolic volume :~80mL
- Amount of blood ejected in HFrEF: ~50mL
- Ejection fraction: 50mL/80mL=63%
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
- A—>At risk for heart disease; No symptoms
- B—> Heart disease present; No symptoms
- C—> Heart Disease present; Yes for symptoms
- 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
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
