HF - Pathology Flashcards
Average normal central venous pressure
6mm Hg
Average normal LVEDP
10mm Hg
Average normal LVEDV
150mL
Average normal SV
100mL
Normal Ejection Fracture
67%
LVEDP, LVEDV, SV, EF, LVESF in failing heart? (increases or decreases)
LVEDP increases, LVEDV increases, SV decreases, EF decreases, LVESV increases
Initial symptom of heart failure
dyspnea with exertion
Most heart failure patients are right fail, left fail, or both fail?
both
Threshold for heart failure- when symptoms begin
25% reduction in forward stroke volume
Surgical emergency associated with HF
severe acute uncompensated aortic regurg
Mitral valve regurg… cause or effect of HF?
can be either
Mitral regurg causes heart murmur during?
systole
Mitral stenosis causes heart murmur during
diastole
aortic regurg causes heart murmur during
diastole
aortic stenosis causes heart murmur during
systole
Left heart failure symptoms
- dyspnea on exertion, progressing to dyspnea at rest 2. Orthopnea 3. PND (paroxysmal nocturnal dyspnea) 4. Fatigue
Right heart failure symptoms
- Edema of feet, then ankles, then legs 2. Abdominal distention
Left heart failure signs
- bibasilar pulmonary crackles 2. Tachycardia 3. S3 4. Pedal, ankle, or leg edema
Right heart failure signs
- Pedal, ankle, or leg edema 2. JVD 3. Hepatomegaly 4. Ascites
Pulmonary capillary pressure that causes interstitial pulmonary edema
20mm Hg
Pulmonary capillary pressure that causes alveolar pulmonary edema
25 mm Hg
What other pathologic conditions can cause acute lung injury and pulmonary edema
septic shock and hemorrhagic shock
Septic shock has what pulmonary capillary pressure
normal
Hemorrhagic shock has what pulmonary capillary pressure
low
The pulmonary capillary wedge pressure is the same as…
the left atrial pressure and the LVEDP
Elderly patient with dyspnea, orthopnea, PND, crackles, and normal EF associated with?
Systolic Heart Failure
Long standing HTN, obesity, and concentric LVH associated with
Normal (I’m not sure what this means)
Noncompliant stiff LV with impaired diastolic function and filling with preserved EF associated with?
Diastolic heart failure
HF patients have tachycardia by what pathophys mechanisms?
- Sympathetic stim 2. Epi and Norepi from the adrenal
HF patients have what elevated peptide?
B-type natriuretic
What increases release of natriuretic peptides?
stretch or increase in cardiac chamber volume
What is the effect of BNP?
vasodilation, increased urinary sodium excretion (counterregulatory)
Clinical scenario for HF with preserved EF?
Elderly, HTN, obesity, concentric LVH, impaired compliance
Dysfunction with compensated HF w/ preserved EF?
diastolic
Dysfunction with decompensated HF and decreased EF?
systolic
HF progression of patients with large M.I.?
straight to HF with systolic dysfunction and decreased EF
Highest mortality HF hemodynamic profile? (congestion and perfusion)
Cold and wet (40% die)
What can cause heart failure by itself
Extreme fat-assness (morbid obesity)
Shock that causes vasodilation, making the capacitance of the vascular system too big for the amount of blood volume
distributive shock
shock that blocks enough of pulmonary circulation (i.e. T-E, cardiac tamponade)
Obstructive shock
biochemical sign of shock
elevated serum lactate
hemodynamic sign of shock
hypotension
Behavior of shock patient
disoriented, confused, obtundation
Skin of shock patient
mottled, cold, clammy, pale, cyanotic
urine in shock patient
decreased output
Nutmeg liver can be a sign of?
Right heart failure
Heart failure cells (siderophages) can be a sign of
Left heart failure
