HF - Part 1 Flashcards
what is heart failure? corroborated by what?
chronic progressive condition where the heart isn’t able to pump enough blood to meet to demand of the body
usualy at least one of the follwoing:
- elevated naturietics peptide levels
- evidence of cardiogenic pulomary systemic congestion
What is sytole
contraction and emptying
what is diastole
relaxation and filling
what kind of HF is linked to systole? Diastole
systole -HFrEF
diastole - HFpEF
Preload what is it? what happens when it increases?
preload what is it?
- amount of blood sitting in the ventricle at the end of diastole/filling
when we have increased preload usualying accoidng to Starling’s Law of hearts we can increase Co upto a certain point. However in HF we don’t increase Co we actually decrease it and there is more for the heart to pump
Afterload what is it? what happens when it increases?
the resistance of force against which the ventricle must work to eject blood
also called Total peripheral resistance
how is afterload estimated? how is it linked to BP?
Systemic vascular resistance (SVR)
BP = CO x SVR
starling’s law of the natural heart for after load
as afterload changes it doesn’y affect CO much
increased afterload?
the already weakened heart has to work harder and CO is decreased
Stroke volume depedns on what
preload, after load and myocardial contrcatiloty
cardiac output equation
CO = SV x HR
if dehydrated what happens?
decreased SV
what is ejection fraction
the amount of blood pumped out of left ventricle compared to amount there at the end of filling
what is normal EF
60-70%
what are the difererent ranges of HF
HFpEF - 50’s
HFmrEF - 40’ s
HFrEF - less then 40
what drugs can we use for HFpEf or HFmrEF
ARB, MRA - maybe
SGLT2i - yes
what are the 5 cause of HF
- primary cardiac
- pressure overload - HTN emergency
- volume overload
- bad compliance with diurtics
- renal or haptic dysfunction - high output
- CO is normal but body need more could be due to anemaia, shunt, sepsis, thrytoxiicosis - medications
- bet blaocker, CCB and antiarrhytmics are negative inotropes (reduce cardiac contratility)
- NSADIS - fluid retemtion
- thalizolindines ( fluid retention)
- doxorubicin (carditoxic)
SX of HF
when can you expect atypical presenttaions?
FED (fatigue, edema, dyspepsia)
- paroxymal nocturnal dyspepsia, orthopnea, cough, abdominal distentio, weight gain
atypical presntations in elderly, womeh and obese
left-sided symptoms
cough, dyspnea, PND, orthopnea, rales
right-sided Symtoms
weight gain, peripheral edema, nausea, abdominal pain, elevated jugular vein pressure (JVP), hepatomegaly
other symptoms
S3 and sometimes S4 heart sounds
lab
- BNPmore then 400
- NT-pro-BNP more then 300
- Scr may be reduced due to due to hypoperusion (diverted to essential organs)
- sodium level may be low less then 130
Classifiaction of HF
- sx only when higher then ordianry activity
- sx when doing some oridinary activity like longer wlaks
- sx when doing ordinary actity from room to room walk - short walks
a) dyspepsi at rest
b) no dyspepsia at rest - sx at rest
Distinguish between physiological features of preserved and reduced
reducesd
- large left ventrivle
- thin left ventricle wall
preserved
- small left ventricle
- thick left ventivle wall
common risk factors and co-morbidties for preserved and reduced HF
reduced
- male
- obese
- HTN
- DM
- kidney disease
- volume overload
- myocardiatis and myocardial infection
presevered
- female
- older age
Lots of co-morbidties
