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Heart Failure
patho
| Question | Answer |
|---|---|
| heart failure is a complication of... | MI |
| cardiac arrest: | when the heart stops beating |
| is heart failure a complication of cardiac arrest? | no, but cardiac arrest can be from a complication of heart failure |
| left ventricular ejection fraction (LVEF): | defines heart failure; the % of blood propelled out of the left ventricle with each contraction |
| normal LVEF: | 55-70% |
| LVEF that indicates heart failure: | less than 40% |
| cardiac output (CO): | the amount of blood pumped out of the LV per minute |
| equation to find CO: | SV x HR |
| normal CO: | 5000mls/min |
| preload: | -the volume of blood in the heart at the end of diastole (EDV) -amount of blood returning to heart from the body per beat |
| an increase in EDV leads to... | an increase in SV |
| afterload: | amount of resistance the LV has to push against in order to pump blood out of the heart and throughout our body |
| increased afterload reduces... | CO |
| stroke volume: | the volume of blood pumped out of the LV during each systolic contraction |
| heart rate: | the number of heart beats per minute |
| inotropic: | things that affect the force of contraction, is influenced by amount of calcium available |
| positive inotropic agents (3): | -calcium and SNS -Digitalis |
| chronotropic: | things that affect HR |
| negative chronotropic agents (2): | digitalis and beta blockers |
| positive chronotropic agents (2): | epinephrine and SNS; increases HR AND force |
| hydrostatic pressure: | pushes fluid out of the capillary pores into the interstitial and intracellular spaces |
| oncotic pressure: | pulls fluid from the interstitial and intracellular spaces back into the capillary |
| explain RAAS: | -renin released into blood -renin reaches liver -angiotensin converts renin into is converted to angiotensin I and it circulates blood -when angiotensin I reaches the lungs, it is converted into angiotensin II by ACE -angiotensin raises BP |
| explain the 3 ways angiotensin II raises BP: | -adrenal release of aldosterone -ventricular remodeling -vasoconstriction |
| ANP is released when... | atria senses too much fluid |
| BNP is released when... | ventricles sense too much fluid |
| list the 3 ways ANP and BNP decrease BP: | -stimulates diuresis -blocks renin and aldosterone release -vasodilates |
| what inflammatory mediator has a negative impact on inotropic function? | TNF alpha |
| list the causes of left-sided ventricular heart failure (6): | -HTN -CAD -angina -MI -mitral valvular disease -aortic valvular disease |
| causes of right-sided ventricular heart failure (9): | -left sided ventricular heart failure -MI -pulmonary problems (COPD, fibrosis) -tricuspid valvular disease -pulmonic valvular disease -endocarditis -myocarditis -pericarditis -dysrhythmias |
| cardiomyopathy: | disease that targets the myocardium and can lead to heart failure |
| ischemic cardiomyopathy: | myocardial fibrosis due to CAD or MI |
| dilated cardiomyopathy: | -ventricles hypertrophy and become floppy/stretched out due to chronic injury -decreases contractility |
| restrictive cardiomyopathy: | ventricle is restricted and unable to fill during diastole due to myocardial fibrosis or pericardial effusion |
| hypertrophic cardiomyopathy | -septum in LV hypertrophies and stiffens due to genetics or chronic HTN -obstructs blood flow out of the heart |
| acute heart failure: | rapid, sudden development after a big MI or cardiogenic shock |
| chronic heart failure: | more common; heart weakens over time from something like HTN |
| systolic heart failure: | heart is UNABLE to pump blood due to stretched/weak LV |
| what EF value indicates systolic heart failure? | less than 40% |
| HFpEF (diastolic) heart failure: | ventricles are UNABLE to fill with blood |
| HFpEF (heart failure with preserved ejection fraction): | EF can be normal because the EDV is reduced |
| what EF value indicates diastolic heart failure? | > 50% |
| why is the EF value for diastolic heart failure high? | because there is less blood in the ventricle to begin with anyways |
| all types of heart failure result in... (2) | -decrease in CO -RAAS and SNS kick in |
| high output heart failure: | when CO cannot meet high circulatory needs |
| low output heart failure: | heart is unable to pump out an appropriate amount of blood to tissues and lungs |
| systolic LVHF occurs from... | damage to the heart (i.e. MI), preventing adequate pressure generation |
| diastolic LVFH occurs from... | HTN |
| how do backward effects of LVFH occur? | from blood backing up in the heart due to a weak pump |
| how to forward effects of LVFH occur? | blood cannot move out of the heart effectively to perfuse to the body |
| how does body compensate for forward effects of LVHF? | activating SNS, RAAS, and ADH |
| RVHF causes... | fluid backup from our right ventricle to the right atrium and then backup in the vena cavas and the rest of our body |
| backward effects of LVHF (6): | -dyspnea -orthopnea -paroxysmal nocturnal disease -cough -frothy sputum -crackles heard in lungs |
| forward effects of LVHF (7): | -CONFUSION -memory loss -anxiety -GI tract ischemia -muscle weakness -oliguria -cold and pale extremities |
| backward effects of RVHF (8): | -JVD -hepatomegaly -splenomegaly -ascites leading to abdominal distention -nausea -anorexia -peripheral edema -weight gain |
| a weight gain of __-__ pounds in 1 week is concerning for a heart failure patient | 2-3 |
| labs/diagnosis for heart failure (6): | -elevated BNP -echocardiogram -EKG -diluted electrolytes from fluid retention -CXR -weight gain |
| what information can we get from echocardiograms? (3) | -presence of LVEF -presence of valvular disorders -size of heart chambers |
| causes of high output heart failure (4): | -hyperthyroidism -anemia -obesity -sepsis |
| COPD and tricuspid regurgitation are causes of... | RVHF |
| right-sided heart failure caused by pulmonary issues is called... | cor pulmonale |
| HF is caused by ______ hydrostatic pressure | low |
| HFrEF (systolic) heart failure: | pump problem |
Created by:
akgross
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