heart failure

heart failure is characterized by

ventricular dysfunction

heart failure is a

syndrome, not a disease

HFrEF symptoms

reduced left ventricular ejection fraction

HFrEF caused by

impaired contractile function (MI)

inc afterload (hypertension)

heart muscle dysfunction (cardiomyopathy)

mechanical abnormalities (valve disease)

HFpEF symptoms

pulmonary hypertension, pulmonary congestion, ventricular hypertrophy

HFpEF is characterized by

impaired ability of ventricles to relax and fill during diastole, resulting in decreased stroke volume and C.O.

mixed systolic and diastolic failure is seen in

dilated cardiomyopathy

mixed systolic and diastolic failure symptoms

poor EF(<35%)

right sided heart failure caused by

systolic or diastolic failure in left ventricle

lung failure

right sided heart failure symptoms

increased pressure in pulmonary circulation

peripheral edema

jugular vein distension

hepatosplenomegaly

right sided heart failure is caused by ___, and causes ___

lung, systemic

in case of heart failure, SNS activation is

first and least effective mechanism

what does SNS activation do

release of catecholamines (epinephrine, norepinephrine)

endothelin

stimulated by ADH, catecholamines, angiotensin II

proinflammatory cytokines do what

depress cardiac function by causing cardiac hypertrophy, contractile dysfunction, and death of myocytes

dilation

enlargement of the chambers that occurs when pressure in left ventricles is elevated

natriuretic peptides are released in response to

inc. atrial volume & ventricular pressure

natriuretic peptides promote

venous and arterial vasodilation; reduce preload and afterload

chronic HF depletes

natriuretic peptides

natriuretic peptides enhance

endothelin

natriuretic peptides block

aldosterone effects

natriuretic peptides inhibit

cardiac hypertrophy development

nitric oxide is released from

vascular endothelium in response to compensatory mechanisms

NO effects

relax arterial sm. muscle, vasodilation and dec. afterload

left-sided HF will cause

backup of blood into left atrium & pulm vein

pulmonary edema/congestion

left-sided HF caused by

left ventricular dysfunction such as

• MI hypertension

• CAD

• cardiomyopathy

right HF backup where?

RA

right HF caused by?

lung failure

left HF

right HF symptoms

• JVD

• hepatomegaly

• systemic edema

• ascites

right HF risk for

Afib

left HF backup where?

LA

left HF symptoms

• SOB

• orthopnea, dyspnea

• pulm edema

• crackles

• pink frothy sputum

systolic Left HF is known as

HFrEF

systolic Left HF is where

LV cannot squeeze (dec contractility) blood out properly

diastolic Left HF is known as

HFpEF

compared to systolic LHF, diastolic LHF

contraction and EF is normal

ADHF early clinical manifestations

inc. resp rate

dec PaO2

ADHF late clinical manifestations

tachypnea

respiratory distress/failure

ADHF physical findings

orthopnea

dyspnea

tachypnea

use of accessory muscles

cyanosis

cold and clammy skin

cough with pink, frothy sputum (pulmonary edema)

crackles, wheezes, rhonchi

chronic HF clinical manifestations

fatigue

dyspnea, orthopnea, persistent, dry cough

dependent edema

nocturia

shiny and swollen legs with diminished hair growth

chest pain

what indicates exacerbation of chronic HF

sudden weight gain of >3lb in 2 days

Chronic HF mnemonic

FACES

Fatigue

Activity—decreased

Cough

Edema

Shortness of breath (dyspnea)

HF complications

pleural effusion

atrial fibrillation

severe hepatomagaly

renal insufficiency/failure

fatal dysrhythmias

HF BNP level

BNP above 900

normal BNP level

BNP below 100

troponin normal levels

0.04

NYHA HF stage 1

normal

NYHA HF stage 2

mild

NYHA HF stage 3

symptomatic

NYHA HF stage 4

severe

ACC/AHA HF stage A

at risk

ACC/AHA HF stage B

structural heart damage

ACC/AHA HF stage C

complication/symptoms

ACC/AHA HF stage D

refractory, need intervention

when ADHF, decrease what?

intravascular volume = venous return = preload

ADHF management

loop diuretics

ultrafiltration or aquapheresis (if loop doesn’t work)

IV nitroglycerin

IV sodium nitroprusside

morphine sulfate (dec preload)

nesiritide

what does IV nitroglycerin do

vasodilator, decrease preload

treat acute MI

side effect: low BP, headache

if patient does not respond to conventional pharmacotherapy

inotropic therapy

• digoxin for acute and chronic

• beta-adrenergic agonists (dopamine)

• phosphodiesterase inhibitors (milrinone)

new drug that reduce re-hospitalization and CV death by 20% compared to enalipril

sacubitril/valsartan (entresto)

nonpharmacologic therapies

• cardiac resynchronization therapy

• cardiac transplantation

• ventricular assist devices (VAD)

• destination therapy (VAD implant)

• EECP

chronic HF management

diuretics (thiazide, loop, spironolactone)

ACE inhibitors

angiotensin 2 receptor blockers

aldosterone antagonists

nitrates

beta-adrenergic blockers

chronic HF positive inotropic agents

digoxin + diuretics

cardiac transplant when

refractory end-stage HF

inoperable CAD

cardiomyopathy

if shortness of breath, which sided HF?

left sided

if peripheral edema, which sided HF?

right sided