SM 138a - Heart Failure Physiology Flashcards
This graph represents grade _____ diastolic dysfunction.
How do you know?
What other indications might be present?
This graph represents grade I (mild) diastolic dysfunction.
-
Small E wave (E/A ration <1)
- Impaired ventricular relaxation = slow early filling
- E’ velocity is decreased
- In addition, LA size and pressure will be normal to increased
Describe the symptoms of left-sided heart failure
- Dyspnea
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Fatigue
- Diaphoresis
- Tachycardia
- S3 (Systolic)
- S4 (Diastolic)
A patient with symptoms and underlying structural heart disease has stage ___ heart failure
A patient with symptoms and underlying structural heart disease has stage C heart failure
Eccentric hypertrophy is associated with ______ heart failure,
while concentric hypertrophy is associated with ________ heart failure
Eccentric hypertrophy is associated with systolic heart failure,
while concentric hypertrophy is associated with diastolic heart failure
HF_EF is associated with systolic dysfunction,
while HF_EF is associated with diastolic dysfunction
HF_r_EF is associated with systolic dysfunction,
while HF_p_EF is associated with diastolic dysfunction
Describe key features of eccentric hypertrophy
Cause:
Organization of sarcomeres:
Effect:
-
Cause
- Volume overload
-
Organization of sarcomeres
- New sarcomeres are created in series with existing sarcomeres
- Myocyte elongation
-
Effect
- Dilation of the ventricle
- Increased wall stress
- Systolic dysfunction
- Mitral regurgitation
Describe Class I heart failure (NYHA)
No symptoms
How would you expect wall thickness to change in systolic heart failure?
Diastolic heart failure?
Systolic: Decreased wall thickness
Diastolic: Increased wall thickness
A patient with no symptoms has class ___ heart failure (NYHA)
A patient with no symptoms has class I heart failure (NYHA)
How would you expect end diastolic volume to change in systolic heart failure?
Diastolic heart failure?
Systolic: EDV increases
Diastolic: Normal EDV (but most likely with increased pressure)
Initially, neurohormonal activation helps patients with heart failure compensate for low CO by increasing BP.
In general, how can these compensatory mechanisms cause heart failure to worsen?
- Vasoconstriction (initially compensatory)
- Causes increased afterload
- Worse cardiac output
- Causes increased afterload
- Angiotensin II, Alsosterone
(initially compensatory to retain fluid)- Leads to cardiac fibrosis
- Adverse remodeling
- Eccentric hypertrophy -> Dilation of LV
- Concentric hypertropy -> Increased LV wall thickness
Which extra heart sound is likely present if there is diastolic dysfunction?
S4
A patient who gets symptoms with major exertion has class ____ heart failure (NYHA)
A patient who gets symptoms with major exertion has class II heart failure (NYHA)
Patients with ejection fraction less than ____ most likley have HFrEF
Patients with ejection fraction less than 40-45% most likley have HFrEF
Describe key features of eccentric hypertrophy
Cause:
Organization of sarcomeres:
Effect:
-
Cause
- Volume overload
-
Organization of sarcomeres
- New sarcomeres are created in series with existing sarcomeres
- Myocyte elongation
-
Effect
- Dilation of the ventricle
- Increased wall stress
- Systolic dysfunction
- Mitral regurgitation
A patient who has symptoms at rest has class ___ heart failure (NYHA)
A patient who has symptoms at rest has class IV heart failure (NYHA)
A patient experiencing heart failure has an initial compensatory neurohormonal response, initiated by the activation of ___________
A patient experiencing heart failure has an initial compensatory neurohormonal response, initiated by the activation of Baroreceptors
A patient with no symptoms but increased risk factors has stage ___ heart failure
A patient with no symptoms but increased risk factors has stage A heart failure
Describe Class IV heart failure (NYHA)
Symptoms with rest
This graph represents grade _____ diastolic dysfunction.
How do you know?
What other indications might be present?
This graph represents grade II (moderate) diastolic dysfunction.
-
E velocity is normal: E/A >1
- Looks about the same as the normal graph, but this is because increased atrial pressure is present in addition to impaired ventricular relaxation
- Increased LA size and pressure
- Decreased E’ velocity
Doppler echocardiography is used to determine diastolic dysfunction presence and severity.
What do the E and A waves represent in these graphs?
E wave: Early transluminal flow velocity (during ventricular relaxation with passive filling due to pressure gradient)
A wave: Late transluminal flow velocity (due to atrial contraction)
Not shown: E’: Early myocardial relaxation velocity
This graph represents grade _____ diastolic dysfunction.
How do you know?
What other indications might be present?
This graph represents grade III (severe) diastolic dysfunction.
- Increased E velocity (E/A >1)
- Despite impaired relaxation, due to very high atrial pressures
- E wave is narrow
- Early diastole is very short due to decreased ventricular compliance
- Very slow E’
- Increased atrial size and pressure
