Sorescu_ Heart Failure Pt presentation Flashcards
No matter the etiology of heart problems, in heart failure _________ always increases
end diastolic volume and pressure… can be either left, right, or both
diastolic LV dysfunction is caused by:
- stiff pump and or arteries (systolic pressure is normal)
diastolic RV dysfunction is caused by:
- pulmonary HTN, pulmonary vasoconstriction, etc.
define high cardiac output heart failure
- non cardiac heart failure; increased tissue demand of oxygen (hyperthyroidism, infection)… low systemic resitance
what is normal arterial capillary pressure?
- 25 mmHg
what is normal tissue pressure gradient?
- 8-15 mm Hg
define the starling forces of renal physiology
- glomerular filtration
2. tubular reabsorption
how does heart failure affect the startling forces?
at normal physiology, afferent arteriole blood flow via renal artery needs to stay high, and pressure back to right atrium via renal vein flow needs to stay low
- blood flow in afferent arteriole (via renal artery) is reduced OR peritubular capillary (renal vein) is increased
how to define left an d right sided heart failure based on capillary and venous pressure
what is the result of either of these?
- if left sided: decrased arterial capillary pressure
- if right sided: increase venous capillary pressure
- you get hypoxia and impaired oxygenation, and you get a wet lung (pulmonary edema)
what is the result of acute heart failure in terms of fluid levels and movement?
- shift of fluid to the alveoli… rales on ausculation… white perihilar butterfl pattern of Pulmonary edema on CXR
What happens in kidney during chronic heart failure?
- impaired GFR and tubular function causes chronic activation of Renin-angiotensin II via macula densa
- INCREASED SODIUM and WATER RETENTION, causing a volume overload and overworks the heart
Besides working on the kidney, what else does angiotensin II work on?
- efferent arteriole… increases the resistance and actually decreases blood flow to the kidney
what happens to the lung and fluid levels in chronic heart failure?
The mimatch in arterial capillary pressure/ venous capillary pressure gets back up of liquid into tissues;
- we get increased lymphatic drainage that shifts fluid from alveoli to lung interstitium and actually reduces the incidence of rales that we saw acutely
INSTESAD, we see vasccular congestion and pleural effusion
what is the main perpetuator of the cycle of increased SVR? what is the result?
- Renin and angiotensin system… leads to reduced cardiac output in patients that already have LOW cardiac output… gives a big cycle
Define acute heart failure
- cardiac output can be normal, high, or low
- NEED redistribution of intravascular volume to lungs
- Elevated SVR and LVEDP (except if you’re in high output cardiac failure)
acute heart failure: signs and symptoms of heart failing with evidence of elevation of LV or RV filling pressures (need that elevation of filling pressures)
what is the surrogate value for afterload
systemic vascular resistance
what is the most important value that contributes to SVR
MAP
SIgns/symptoms of right v left sided heart failure
etiology of right v left sided heart failure
right: elevated right side cardiac pressures (RAP ? 10)
left: elevated left side cardiac pressures (PCWP >18)
right: sleep apnea/intrinsic lung disease/PE/ LEFT SIDED HF
Left: intrinsic left heart disease
give most common symptoms of right v left sided HF
right: excessive peripheral edema
left: central edema (lung); can develop peripheral edema especially when L sided heart failure causes right sided heart failure
contrast acute and chronic HF in terms of:
- clinical detection
- degree of symptom presentation
- signs
- labs
- CXR
clinically noisy (rapid development) v clinically silent (slow, allows for compensatory mechanisms)
very symptomatic v relatively asymptomatic (only ina dvanced stage)
obvious signs v subtle signs (only present in advanced stage)
both have leevated BNP level, but in chronic it’s even more elevated
normal heart size but pulmonary congestion/edema v cardiomegaly only with no evidence of pulmonary congestion (can see kerly b lines though)
____ causes most symptoms from HF
- salt
- Heart failure causes salt retention, leading to water retention
Give progression of chronic heart failure
a: risk factors
B: echo diagnosis of dysfunciton
C: start to have sypmtoms of CHF
D: advanced
For stage c, what are the four classifications of activity/function
I: no problems with mobility
II: cannot go fast or up stairs
III: limited to house
IV: limited to bed
what is the difference in remodling of heart in diastolic heart failure and systolic heart failure?
- systolic: dilated heart
- diastolic: hypertrophied heart
Neurohormonal blockade targets what two hormones?
- RAAS inhibitor
2. Norepinephrine/catecholamines (SNS)
