Introduction and Pathophysiology of Heart Failure Flashcards
• Failure of the circulatory system
• 1) to provide adequate forward cardiac
output
• Or
• 2) to do so without operating at elevated
filling pressures
JVP estimates the pressure of the ___ atrium
of the right atrium, which very indirectly estimates the preload of the left ventricle.
right heart failure signs
elevated JVP
ascities
peripheral edema
weight gain
abdominal bloating/satiety
leg swelling
pulmonary hypertension heart failure signs
parasternal lift
palpable P2
loud P2
fatigue
dyspnea
left heart failure/high lest sided pressures signs
hypoxia, tachypnea, inspiratory crackles, S3
dypsnea, orthopnea, PND
what does S3 mean
rapid ventricular overfilling.
- could be due to higher preloads because of reduced EF compensation resulting in ventricular dilation
- could be due to ventricular hypertrophy causing normal volumes to still be “overfilling”
“Congestive” Heart Failure Typically Refers to A ___ Sided Problem- Traditionally A Problem Of LV Systolic Function (Heart Failure with Reduced___ ____)
“Congestive” Heart Failure Typically Refers to A LEFT Sided Problem- Traditionally A Problem Of LV Systolic Function (Heart Failure with Reduced EJECTION FRACTION)
- but it can also be heart failure with preserved ejection fraction
DDX for congestive heart failure (hint think of “left” parts of the heart that can go bad) congestive = left
- left ventricle failures: HFREF or HFPEF
- Mitral valve failure: MR or MS
- Aortic valve: AS or AI
- Aorta: Coarctation, severe hypertension
- pericardial construction– heart muscle is normal but pericardial stiffness causes heart unable to expaand
DDx of isolated right heart failure
- primary right ventricular dysfunction
- lung disease with secondary pulmonary hypertension
- pulmonary vascular disease
- pulmonic valve disease (PS, PR)
- tricuspid valve disease (TR, TS)
- percardial construction
note: in addition to left and right sided problems, heart failure can be due to:
1. congenital heart disaese
2. shunt lesions (ASD, VSD, pDA)
3. high output heart faiure: anemic, hyperthyroid, patient has a high CO and hard to deal with the volume.
note: even tho dyspnea might indicate a left sided pressure, it’s. a pretty broad symptom and can also indicate low cadiac output or pulmonary hypertension
outline the heart failure classifications
based on functionality basicaly
3 tools that can help diagnose heart failure
- CXR
- NT-proBNP
- echocardiography or cardiac catheterization
what are the arrows pointing to
Kerly B lines. indicative of congestive heart failure (left side)or pulmonary hypertension or both
peribronchial cuffing
key finding in this xray that can indicate chronic heart failure
cardiomegaly. the heart is over 50% of the diaphragm width.
BNP can help assess heart failure likelihood. It is ___ dependent.
it is age dependent.
T/f a normal ejection fraction can rule out heart failure
false. HRPEF is a thing
Look at this diagram
even though sodium and water retention “makes sense” why is actually a decompensatory compensation process in the long run?
NA and H2O retension occurs because the kidneys sense poor perfusion due to reduced cardiac output. CO is reduced because EF is reduced. The ventricle cant contract very well, leaving more blood in the heart and increasing prelaod. thus, there’s enoguh blood, but not enough blood flow cause the heart cant pump it everywhere. the body starts to keep fluid even though we already are fluid overloaded— increases further preload resulting in ventricular overdilation (global remodeling), s3 sound, and peripheral edema.
what 3 neurohormonal systems are activated by a low stroke volume and BP
- sympathetic nervous system
- renin angiotensin aldosterone system3
- adi/vasopressin
Why is increased vascular tone initially helpful but actually deterimental in the long run?
increased vascular tone is helpful initially because the body snesses the reduced EF resulting in reduced CO resulting in poor perfusion and low blood pressure. You need blood pressure to live. therefore, the body compensates by increase the resistance and thus increasing the afterload of the heart
- this maintains the BP initially, but increasing the afterload puts more pressure on the ventricle to eject blood, further reduceing the EF and SV and thus CO and also contributing to hypertrophy (global appearnce)
the sympathetic nervous system is turned on when the body sense a decrease in perfusion. why is it good in the short term but bad in the long term
chartcholamine release increases HR and thus CO.
- BUT it also causes the heart to beat faster and thus increases myocardial energy when the ventricle is already struggling with increased afterload, hypertrohpy, increased preload etc.
- it causes adverse remodelling with cardiac myocyte hypertroph and death.promotes arrhthmias
overall heart failure is a failure of the circulatory system to
- provide adequate cardiac output
- to do so only at the expernse of elevated filling pressures (causes S3 sound)
- and maladaptive neurohormonal responses lead to exaggerated sodium and water retention increased afterload chronic catecholamine stimulation progressive ventricular dysfunction
biggest cause of right heart failure
left heart failure
thats why someone with congestive heart failure (left problem) can still have peripheral edema which is a right heart syndrome
