L27-heart Failure Flashcards by engy Selim

What is heart failure

Failure of heart to pump blood at a rate commensurate with requirements of metabolizing tissues
Common end point for many cardiac diseases
Poor prognosis

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What are the 3 causes of heart failure

Inapp workload
Impaired myocyte contraction
Restricted filling of ventricles

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What are the 2 cases of inapp workload

1-volume overload

2-pressure overload

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Cases of volume overload

Hypervolemia

Regurgitation/incompetent valves

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Cases of pressure overload

Hypertension

Pulmonary/aortic stenosis

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What is dilated cardiomyopathy

causes the heart chambers (ventricles) to thin and stretch, growing larger leading to systolic heart failure

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Describe mitral stenosis

Restriction and narrowing of mitral valve

Impairment of left ventricular filling

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What is hypertrophic cardiomyopathy

disease in which the heart muscle becomes thickened (hypertrophied)

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What is restrictive cardiomyopathy

refers to a set of changes in how the heart muscle functions(impaired relaxation). These changes cause the heart to fill poorly (more common) or squeeze poorly (less common). Sometimes, both problems are present.
Fibrosis/amyloidosis

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What are the causes of restricted filling of ventricles

Mitral stenosis
Hypertrophic cardiomyopathy 
Impaired relaxation:
Restrictive cardiomyopathy 
Pericardial constriction(thickening)

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Describe ischemic heart disease

Coronary atherosclerosis

Damage to myocardium and scar tissue formation

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What causes systolic dysfunction

Inadequate myocardial contractile function:
Ischemic heart disease
Dilated cardiomyopathy 
Increased preload:
Mitral/tricuspid regurge
Aortic/pulmonary regurge

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What causes diastolic dysfunction

Restricted filling:
Mitral or tricuspid stenosis
Hypertrophic cardiomyopathy 
Impaired relaxation:
Restrictive cardiomyopathy 
Constrictive pericarditis

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Result of combined systolic and diastolic dysfunction

Increased after load:
Hypertension
Aortic valve stenosis
Concentric hypertrophy

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Difference between systolic and diastolic heart failure

Bp,myocardial hypertrophy,ESV,EDV

Systolic
Bp:low-normal-high
Myocardial hypertrophy:eccentric:longer muscle fibers
ESV:high
EDV:high

Diastolic:
Bp:low-normal-high
Myocardial hypertrophy:concentric:thicker muscle fibers
ESV:low
EDV:normal or low

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How does frank starling mechanism correlate to cardiac output

When EDV inc
Dilatation of ventricle occurs
Inc cardiac myofiber stretching
Inc force of contraction
Inc cardiac output

Describe compensated heart failure

▪️Patient may remain asymptomatic or minimally symptomatic
Mechanism of compensation:
▪️Inc in preload to restore resting stroke vol to normal levels
▪️Combination of sympathetic nervous system and renin angiotensin system
▪️Compensatory hypertrophy
▪️Limitation on ability to inc stroke vol above resting levels
▪️Manifests as exercise limitation

Describe decompensated heart failure

▪️When compensatory mechanisms fail to inc cardiac output
▪️Plateau:further inc in EDV does not produce a corresponding inc in force of contraction of ventricle resulting in ▪️inadequate cardiac output
▪️Patients develop symptoms
▪️Outcome:may rapidly lead to death

What are the outcomes of heart failure

▪️Right sided(cor pulmonale): pulmonary hypertension
Lung diseases
▪️Biventricular: right sided heart failure due to left sided heart failure
▪️Left sided: ischemic heart disease
Systemic hypertension
Mitral or aortic valve disease
Primary diseases of myocardium(ex amyloidosis)

Most common form of heart faiulre

Left ventricle systolic failure

Effects of left sided heart failure

Raised pulmonary capillary pressure
Raised left atrial pressure
Left ventricular preload is increased
Backward failure
Forward failure
inadequate cardiac output
Renal hyoperfusion 
Activation of renin angiotensin system
Hypoxic encephalopathy(irritability and coma)
Accumulation of nitrogenous wastes

What is backward failure

One of the ventricles fails to pump out all of its blood that comes into it. Thus, the ventricular filling pressure and systemic or pulmonary edema increase+dyspnea
Leads to hemosiderin laden macrophages

What is pulmonary edema

Dec gas exchange resulting in arterial hypoexmia

What are the morphological changes in left sided heart failure in lungs

Grossly:heavy and congested
Microscopically: accumulation of edema
Fluid in the alveolar spaces
Heart failure cells:alveolar macrophages phagocytose extravasated RBCs from leaky capillaries

What are the morphological changes in left sided heart failure in heart

Grossly:depend on underlying cause Left ventricular hypertrophy/dilatation No hypertrophy due to mitral stenosis or restrictive cardiomyopathies Microscopically: myocyte hypertrophy with interstitial fibrosis of variable severity

Clinical features of left sided heart failure

``` Onset is gradual but may be abrupt Dyspnea on exertion Orthopenea Paroxysmal nocturnal dyspnea Cough with blood tinged sputum Auscultation: Pulmonary crackles(edema) at base of lung Diminished s1+s2 and occurrence of s3 at apex Cyanosis ```

What is orthopnea

Dyspnea when recumbent | the supine position increases Venous return from the lower limbs and elevates the diaphragm

What is paroxysmal nocturnal dyspnea

Extreme dyspnea with the feeling of suffocation that wakes patient from sleep

What is cyanosis

Low organ perfusion decrease gas exchange

What are the effects of right heart failure

▪️Pressure back through the vena cava and peripheral veins and capillaries ▪️raised right atrial pressure ▪️combination of hepatic congestion and portal hypertension can lead to peritoneal transudates (ascites) ▪️backward failure ▪️pitting edema

Morphology of right sided heart failure in lung

▪️No pulmonary parenchymal edema or congestion | ▪️Systemic venous congestion due to right sided heart failure to transudates(effusions) in to pleural space

Morphology of right sided heart failure in heart

▪️RA dilation ▪️RV dilation ▪️RV hypertrophy ▪️In cor pulmonale,myocardial hypertrophy and dilation generally ▪️Systemic venous congestion due to right sided heart failure can lead to transudates(effusions) in the pericardial spaces

What happens to liver (morphology) in right sided heart failure

▪️Congestive hepatomegaly: heavy and congested liver ▪️Cut section:congested central areas surrounded by peripheral paler,non congested parenchyma:nutmeg liver ▪️In severe long standing right sided heart failure,the central areas become fibrotic creating cardiac cirrhosis ▪️can also lead to elevated pressure in portal vein and its tributaries(portal hypertension) ▪️with vascular congestion,the spleen becomes tense and enlarged(congestive splenomegaly)

Clinical features of right sided heart failure

``` ▪️distended jugular veins ▪️abdominal enlargement: Hepatic enlargement Splenic enlargement Ascites ▪️pleural/pericardial effusion ▪️peripheral/dependent/pitting edema Ankle swelling is specifically a characteristic of right heart failure(standing or seated) Sacral edema(supine) ```

Describe biventricular heart failure | RHF due to LHF

``` ▪️Raised pulmonary artery pressures ▪️Raised pulmonary capillary pressure ▪️Backward failure ▪️Raised left atrial pressure ▪️Left ventricular preload is increased ▪️ventricular and atrial septal defect ```

Clinical picture of biventricular heart failure

``` ▪️Dyspnea and fatigue ▪️Orthopnea ▪️Paroxysmal nocturnal dyspnea ▪️Cough with blood tinged sputum ▪️Pulmonary crackles(edema)at base of both lungs ▪️Diminished s1 and s2 and s3 occurs ▪️Cyanosis ▪️Distended jugular veins ▪️Abdominal enlargement: ▪️Hepatic enlargement ▪️Splenic enlargement ▪️Ascites ▪️Pleural/pericardial effusion ▪️Peripheral/dependent/pitting edema ▪️Ankle swelling ▪️Sacral edema(supine) ```