HF Pathophys

define heart failure

define heart failure

a clinical syndrome of dyspnea and fatigue caused by left ventricular dysfunction and activation of neurohormonal mechanisms

Define preload

volume in left ventricle, due to venous return coming back to the heart

define afterload

arterial pressure that the heart pumps against

define ejection fraction

amount of blood that’s pumped out with each heartbeat

HFpEF is more common in what gender?

women

LVEF in HFrEF

<40%

LVEF in HFpEF

50%

define refractory

pt’s with worsening HF requiring hospitalization

define decompensated

pt’s with new or worsening symptoms of HF that are usually caused by volume overload and/or hypoperfusion and leads to additional medical care such as ER visits and hospitalizations

define acute HF

pt’s with sudden onset of s/s of HF in the setting of previously normal cardiac function

describe stage A

at risk: without current or prior symptoms or signs of HF and without structural cardiac changes or elevated biomarkers of heart disease

describe stage B

Pre-HF: without signs and symptoms, but one of the following:

-structural heart disease

-abnormal cardiac function

-elevated natriuretic peptide or cardiac troponin

describe stage C

HF: current or prior symptoms and/or signs of HF caused by a structural and/or functional cardiac abnormality

describe stage D

advanced HF: severe signs and symptoms of HF at rest, recurrent hospitalizations despite GDMT, etc.

classify: LVEF <40%

HFrEF

classify: LVEF 41-49%

HFmrEF (mildly reduced)

classify: LVEF >50%

HfpEF

classify: HF with baseline LVEF <40%, a 10-point increase from baseline, and a second measurement >40%

HFimpEF (improved EF)

left-sided symptoms/signs

SOB

dyspnea on exertion

orthopnea

cough

paroxysmal dyspnea

anorexia

tachycardia

right-sided HF symptoms

weight gain

transient ankle swelling

abd distention

anorexia/nausea

edema

BNP levels and HF diagnosis

BNP <100: unlikely

BNP 100-500: maybe

>500: likely

cardiac index threshold

2.2L/min/m2

PCWP threshold

18mmHg

above 2.2 and below 15

1: normal; warm and dry

above 2.2 and above 18

2: congestion; warm and wet

below 2.2 and below 15

3: hypoperfusion; cold and dry

below 2.2 and above 18

hypoperfusion and congestion; cold and wet

causes of HFpEF

hypertrophic cardiomyopathy

restrictive cardiomyopathy

causes of hypertrophic cardiomyopathy

HTN, ischemia

causes of restrictive cardiomyopathy

amyloidosis, sarcoidosis

HFrEF cause

dilated cardiomyopathy

causes of dilated cardiomyopathy

ischemic disease and nonischemic disease (htn, structural damage)

myocardial remodeling

process by which ventricular size, shape, and function are regulated by mechanical, neurohormonal, and genetic factors. may be due to adaptive processes during growth and damage