Heart failure pt.1 Flashcards
What is heart failure?
A complex clinical syndrome that results from any structural or functional impairment of ventricular filling (elevated cardiac filling pressure) or ejection of blood (inadequate peripheral oxygen delivery) leading to cardinal manifestations of dyspnea, fatigue, and fluid retention
Types of heart failure
Types of HF include:
a. LHF (most common type).
b. RHF
c. biventricular heart failure
d. high-output heart failure (least common heart failure)
Can also be divided based on presentation into:
- Acute heart failure
- Chronic heart failure
Can also be divided into distinct phenotypes based on the measurement of left ventricular ejection fraction (LVEF):
HFrEF (<=40% of patients)
HFmr(mildly reduced)EF
HFpEF
Causes of left-sided heart failure
a. Ischemic heart disease, especially myocardial infarction
b. Hypertension
c. A ortic and mitral valvular disease
d. M yocardial diseases, such as cardiomyopathies and myocarditis
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HFrEF definition
Patients with a significant reduction in LV systolic function (LVEF ≤40%)
HFmrEF definition
Patients with a LVEF between 41% and 49% have mildly reduced LV systolic function
HFpEF definition
Patients with symptoms and signs of HF, with evidence of structural and/or functional cardiac abnormalities consistent with the presence of LV dysfunction/raised LV filling pressures and/or raised natriuretic peptides (NPs), and with an LVEF ≥50%.
Causes of RV failure
- Main etiology is LV dysfunction-induced pulmonary hypertension
- Other causes include myocardial infarction, arrhythmogenic right ventricular cardiomyopathy, or valve disease
When does high output cardiac failure occur?
Occurs in states where demand exceeds normal cardiac output such as pregnancy, anemia and sepsis.
Chronic heart failure definition
Patients who have had an established diagnosis of HF or who have a more gradual onset of symptoms
Acute heart failure definition
Patients with a rapid onset of heart failure symptoms
HF recovery
- Some individuals with HF may recover completely [e.g. those due to alcohol-induced cardiomyopathy (CMP), viral myocarditis, Takotsubo syndrome, peripartum cardiomyopathy (PPCM), or tachycardiomyopathy]
- Other patients with LV systolic dysfunction may show a substantial or even complete recovery of LV systolic function after receiving drug and device therapy.
Etiology of heart failure
- Varies according to geography
- In Western-type and developed countries, coronary artery disease (CAD) (about 2/3rd of cases) and hypertension (present in 75% of cases) are predominant factors, diabetes also present in 10-40% of cases
- With regard to ischaemic etiology, HFmrEF resembles HFrEF, with a higher frequency of underlying CAD compared to those with HFpEF
- HIGH VIS is a useful acronym to remember some causes of HF:
Hypertension (common cause)
Infection/Immune: Viral (e.g. HIV), bacterial (e.g. sepsis), autoimmune (e.g. lupus, rheumatoid arthritis)
Genetic: Hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy
Heart attack: Ischemic heart disease (common cause)
Volume overload: Renal failure, nephrotic syndrome, hepatic failure
Infiltration: Sarcoidosis, amyloidosis, hemochromatosis
Structural: Valvular hear disease, septal defects
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Causes of systolic dysfunction
Causes of SHF include:
(a) ischemia caused by atherosclerosis of the CAs (the most common cause of SHF).
(b) post–myocardial infarction (MI), myocarditis, and dilated cardiomyopathy.
What is used to describe the severity of heart failure?
The simplest terminology used to
describe the severity of HF is the
New York Heart Association (NYHA)
functional classification
Disadvantages of New York Heart Association (NYHA)
functional classification for heart failure
This relies solely on symptoms and
there are many other better
prognostic indicators in
HF. Importantly, patients with mild
symptoms may still have a high risk
of hospitalization and death.
NYHA classification
Four classes:
- Class 1: No limitation of physical activity
- Class 2: Slight limitation of physical activity
- Class 3: Marked limitation of physical activity
- Class 4: Unable to carry on any physical activity without discomfort with possible symptoms at rest
CHF prevelance
- CHF prevalence is 1-2%, rising to 10% in over 70-year-olds
- More than 80% of cases are over the age of 70
Diagnosis of CHF requirement
- Requires the presence of symptoms and/or signs of
HF and evidence of cardiac dysfunction - Symptoms and signs lack sufficient accuracy
The lifetime risk of HF
The lifetime risk of HF at age 55 years is 33% for men
and 28% for women
The mortality rate for heart failure
- In primary care, the overall 5-year survival
following the diagnosis of HF is ~50%. For patients with severe HF, the 1-year mortality may be as high as 40% - Following an HF admission, mortality rates range from 8–14% at 30 days to 26–37% at 1 year to up to 75% at 5 years
- Readmission with HF is also common, ranging from 20–25% at 60 days to nearly 50% at 6 months
- With each subsequent admission, the risk of death rises
Symptoms fo heart failure
Symptoms of HF include those due to excess fluid accumulation (dyspnea, orthopnea, Paroxysmal nocturnal dyspnoea (PND) (pathognomic for HF), edema, pain from hepatic congestion, and abdominal discomfort due to distention from ascites) and those due to a reduction in cardiac output (fatigue, weakness) that is most pronounced with exertion
Clinical findings on CV examination in HF
- Tachycardia at rest
- Hypotension
- Narrowed pulse pressure
- Raised jugular venous pressure
- Displaced apex beat (due to left ventricular dilation)
- Right ventricular heave
- Gallop rhythm on auscultation (pathognomic for CHF)
- Murmurs associated with valvular hear disease (eg, an ejection systolic murmur in aortic stenosis)
- Pedal and ankle edema
What is paroxysmal nocturnal dyspnea in heart failure
Attacks of severe shortness of breath in the night that are relieved by sitting up (pathognomonic for CHF).
Clinical findings on respiratory examination in patients with HF
Tachypnea
Bibassal end-inspiratory crackles and wheeze on auscultation of the lung field
- Reduced air entry on auscultation with stony dullness on percussion (pleural effusion)
Clinical findings on abdominal examination in patients with HF
Hepatomegaly
Ascites
