heart failure the gift that keeps on giving Flashcards
3 Major Flavors of Symptoms
- ↓ Cardiac output
- ↑ Pulmonary venous pressure
- ↑ Central venous pressure
↓ Cardiac output signs
Symptoms of decreased organ perfusion
signs of ↑ Pulmonary venous pressure
(Left-sided)
Breathlessness
signs of ↑ Central venous pressure
(Right-sided)
Edema
signs of ↓ cerebral perfusion
Sleepiness, confusion
Symptoms of ↑ left-sided pressure
↑ Pulmonary venous pressure
signs of ↑ Pulmonary venous pressure
- Breathlessness (dyspnea)
- Dyspnea on exertion
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Acute pulmonary edema
Paroxysmal nocturnal dyspnea (PND)
- Delayed SOB, waking patients from sleep
- Classically patient gets out of bed and ambulates to relieve symptoms
- Relates to mobilization of edema from tissue through lymphatics back into blood stream
Symptoms of ↑ right-sided pressure
↑ Central venous pressure (RV failure)
signs of ↑ Central venous pressure (RV failure)
- Peripheral swelling / dependent edema
- Ascites
- Hepatic congestion
- Intestinal congestion (protein-losing enteropathy)
edema in HF
increased central venous pressure (CVP) upsets the balance of starling forces
Increased circulating volume (preload)
- Sodium load in diet
2. Renal failure
Increased pressure (afterload)
- Uncontrolled hypertension (LV)
- Worsening aortic stenosis (LV)
- Pulmonary embolism (RV)
What can cause Worsened contractility (inotropy)?
- Myocardial ischemia
2. Initiation of negative inotrope (beta-blocker or calcium channel blocker)
Increased metabolic demands includes?
- Fever,
- infection
- Anemia
- Hyperthyroidism
- Pregnancy