Heart Failure Patho Flashcards
Chronic Heart Failure types
-asx reduced EF
-HFrEF
-HFpEF
Heart Failure malignancy
-worse survival than most cancers except lung
-survival rate, 50% 5 years
-most common hospital discharge for pt >65
Heart Failure Definition
-heart can’t pump enough blood to tissues
-organs don’t function as well bc they not get enough oxygen
HF patho
-CAD, HTN, cardiomyopathy, valve disease leads to LV dysfunction
–> remodeling –> dec EF –> death
-pump failure, arrhythmia = death
-Na retention, neurohormonal activation, vasoconstriction = chronic HF
HF w reduced Ejection Fraction (HFrEF)
-systolic dysfunction
=dec contractility
-HF sx w EF < 40%
HFrEF causes
-dilated ventricle
-ischemic dilated CM (most)
-non-ischemic too
-HTN, obesity, stress, cardiotoxins, myocarditis, tachycardia, peripartum
HFmrEF
-mildly reduced
-EF: 41-49% w sx
-often pt first encounter w HFrEF
HFimpEF
-EF >40% from previous HFrEF
-tx
Determinants of LV performance (stroke volume)
-Preload (venous return, LV end-diastolic volume) = diuretics
-Myocardial Contractility (force generated at any given LVEDV) = not many drugs
-Afterload (aortic impedance and wall stress) = ACEs, BBs
Frank-starling curve (fluid and HF)
-stroke volume (CO) inc with fluid inc (preload)
-slide 12 graph prob need to know
HF patho chart
-slide 13
factors worsening HF
-lack of compliance
-HTN
-arrythmias
-environment
-bad tx
-pulmonary infection (get vaxxed!)
-stress
Drug types that induce HF
-Rx that reduce contractility
-Direct cardac toxins
-drugs w Na or cause retention
Drug-induced HF drugs that reduce contractility
-antiarrhythmics (disopyramide, flecainide)
-BB in high doses
-CCBs (verapamil, diltiazem)
-Itraconazole
Direct cardiac toxins that cause HF
-doxorubicin
-epirubicin
-daunomycin
-CYP
-trastuzumab
-bevacizumab
-5-FU
-blue cohosh
-Imatinib
-Lapatinib
-Sunitinib
-ethanol
-cocaine
-amphetamines
Drugs w Na/cause Na retention
-glucocorticoids, androgens, estrogens
-NSAIDs and COX-2
-rosiglitazone and pioglitazone
-Na containing drugs
Clinical presentation of Right Ventricle failure (systemic venous congestion)
-ab pain
-anorexia
-nausea
-bloating
-constipation
-peripheral edema
-JVD/HJR
-hepatomegaly
-ascites (fluid in abs)
Left Ventricular Failure (pulmonary congestion)
-Dyspnea on exertion (DOE)
-orthopnea (pillows)
-PND
-rales
-pulmonary edema
-bendopnea
Clinical presentation seen in both right and left ventricular faliure
-fatigue/weakness/exercise intolerance
-nocturia
-cardiomegaly = displaced PMI
Lab assessment of HF
-CBC, eletrolytes, BUN, Cr, TFTs
-ECG
-Xray
-Natriuretic peptides
-measure EF
-ECG
-nuclear testing (MUGA)
-cardiac catheterization
-MRI and CT
Natriuretic peptides
-rule out HF if low
-BNP >35
-NT-proBNP > 125
Ejection fraction
-(SV/EDV) * 100%
-normal range is 60-70%
HF class
-Stage A (no HF, but high risk)
-Stage B, class I (asx)
-Stage C, class II-III (sx on exertion)
-Stage D, class IV (sx at rest)
General measures for HF tx
-tx underlying cause
-remove precipitating causes
-exercise to inc HR 60-80% max of 20-60min 3-5 times/week
-Diet (Na < 2-3g)
-alcohol (abstain if HF is alc induced
-Fluid intake (restrict to <2L/day if hyponatremia (<130) or if diuretics not working
-weight
-smoking cessation
-immunization
-thyroid management
Drug therapy strategies
-reduce intravasc volume (diuretics, SGLT2i)
-inc contractility (digoxin if we must)
-dec ventricular afterload (ACE, ISDN/hydralazine, SGLT2)
-neurohormonal blockade (ACE/ARB/ARNI, BB, MRA, SGLT2i)
