HFpEF Flashcards
what EF counts as PRESERVED
> 50%
where do we find objective evidence of HFpEF
elevated LV filling pressure on
ECHO or Cardiac Cath
what population is MC?`
elderly patient w/ asymptomatic HTN
mc in female patients
HFpEF progression to rEF
this is NOT present in absence of coronary dz/MI
only w/ MI or coronary dz will this happen
“options” to cause HFpEF
- diastolic dysfunciton
- LV remodeling
- Abnormal Ventricular -Arterial dysfunction
- R sided HF
- Chronotrophic Incompetence
- CAD
- Comorbidities
Diastolic dysfunction
shifting up to left in pressure volume = small increase in volume causes MAJOR change in BP
results in increased wall thickness and fibrosis and inability to relax
LV ventricular remodeling
concentric remodeling (increased thickness and mass) due to increased systolic wall stress
parallel sarcomere addition
causes fibrosis, CHF, myocardial dysfunction
LV wall remodeling leaves which layer especially uneatable to ischemia
SUBENDOCARDIUM
subendocardial ischemia causes ___ dysfunction
BOTH systolic and diastolic
systolic: myocardial stunning, hibernation, and death
diastolic: concentric hypertrophy and fibrotic changes
healthy AV coupling
arterial and ventricular elasticity are matched to maintain efficiency
abnormal av coupling
increasing age causes ventricular stiffness that causes decreased contractility
susceptible to: HF, BP lability, decreased exercise tolerance
results in HIGH pulse pressure so susceptible to change in blood volume
right HF
hypertrophy and fibrotic stiffness cause backing up into LA and eventually pulmonary circuit
pulmonary HTN diagnostic criteria
mPAP > 255 mmHg
PCWP >15 mmHG
chronotropic incompetence
inability to increase HR during exertion which results in exercise intolerance
caused By resitrictive cardiomyopathy, severe LV hypertrophy and CAD
CAD
50% of pts concomitant
MI, ongoing ischemia or chronic dz causes hypertrophy and hyperdynamic functioning in healthy areas
calcium sequestration in diastole - impaired filling and relaxation
risk factors for HFpEF
Age
HTN
sleep apnea
comorbidities
age and pEF
almost all its w/ are elderly
age decreases diastolic filling rate causing atrial overload and pulmonary HTN
also causes AV stiffness which leads to decreased ability to accommodate positional changes and exercise
HTN and HFpEF
MOST IMPORTANT
causes LV hypertrophy = poor coronary flow and impaired relaxation
risk factor for CAD which complicates HFpEF (chronic ischemia = angina)
sleep apnea
increases LV hypertrophy and pulmonary HTN
increased fatigue = decreased exercise tolerance
signs and symptoms of pEF
exersize intolerance, JVD, s4
rales/wheezing, PND/orthopnea, edema/anasarca.ascities
exercise intolerance
decreased lung compliance due to increased pulmonary pressure
increased LV diastolic pressure limits subendocardial blood flow which increased demands = decreased diastolic fxn
blunted cardiac output
worsening myocardial perfusion
diagnostic studies in pEF
echocardiogram proBNP stress test (exercise or pharm) stress echo cardiac cath cardiac MRI
