Intro to Heart Failure

cardiac output (CO)

volume of blood pumped by left ventricle per unit time

5

CO is usually ___ L/min in a 70 kg person.

Systemic vascular resistance (SVR)

-Force needed to push blood through the entire circulatory system

-Way to calculate the resistance of all systemic vascular

-SVR = [(MAP - CVP) / CO ] x 80

cardiac output

What are we focusing on in HF?

stroke volume (SV)

-Volume of blood pumped from the ventricle per beat

-Obtained by echocardiogram & used to calculate CO & EF

-Usually 70 mls in healthy 150 pound male

ejection fraction (EF)

-Percentage of blood pumped out the ventricle each beat

-> 55 % is considered normal; It can't be 100 %

Cardiac Index (CI)

-Way to relate CO to size of individual (standardization?)

-Used more in inpatient setting than outpatient tx

-Usual range is 2.6 - 4.2 L/min

-Less than 2.2 L/min usually indicates cardiogenic shock

increases

HF _____ with age.

african americans

What ethnic group is at higher risk for HF?

HF with reduced EF

HFrEF

HF with improved EF

HFimpEF

HF with mildly reduced EF

HFmrEF

HF with preserved EF

HFpEF

HFrEF

LVEF < or = 40 %

HFimpEF

previously lVEF < or = 40% but now is > 40%

HFmrEF

LVEF 41-49%

HFpEF

LVEF > or = 50%

heart failure with preserved EF

-Patient's EF is "normal," but they have signs & symptoms of HF.

-Stems from a different pathological process and is more of a stiffening of the ventricle

risk factors for HF

-familial (genetic)

-CV causes

-metabolic disease (obese, DM, hyperthyroidism)

-meds and toxins

-pregnancy

-infectious and inflammation (myocarditis and HIV/AIDs)

-BB

-Antiarrhythmics

-NSAIDs

-Dihydropyridine CCBs

-Amphetamines

-Na containing products

-Anthracyclines (chemo)

-steroids

What are the meds that worsen heart failure?

s/s of HF

-fatigue

-orthopnea and PND

-HA

-cough

-edema

-SOB and DOE

-JVD

echocardiogram, chest x ray, and brain natriuretic peptide

What are some ways to identify HF?

echocardiogram

-Gives 2D or 3D view of the structures and movement of the heart

-Can be transthoracic (TTE) or transesophageal (TEE)

-Can assess ventricular size, function, wall thickness, wall motion, & value issues

Chest X ray

can show heart enlargement and pulmonary edema

brain natriuretic peptide (BNP)

-Produced by myocytes when stretched (stress)

-Promotes diuresis, naturesis, and vasodilation

-Levels can be affected by the patient's age, sex,

and kidney function

-Usual levels = BNP < 100 pg/ml

-Not diagnostic by itself → used to guide therapy

Stage A

-high risk for developing CHF

-no structural disorder of heart

Stage B

-structural disorder of heart

-never developed symptoms of CHF

Stage C

-past or current symptoms of CHF

-symptoms associated with underlying heart disease

Stage D

-end stage disease

-requires specialized tx strategies

no

Once you increase to the next stage can you go backwards?

class 1

no limitation of physical activity

class 2

-slight limitation of physical activity

-comfortable at rest

class 3

-marked limitation of physical activity

-comfortable at rest

class 4

-inability to carry on any physical activity without discomfort

-symptoms present even at rest

yes

Once you go up in a NYHA class can you go backwards?

stages

structure and symptom based; can only worsen

classes

only symptom based; can go up or down

25-30%

What is the 1 yr mortality rate for HF?

50%

What is the 5 yr mortality rate for HF?

1 million

how many hospitalizations happen for HF per year?

cardiac arrhthmias

Why are deaths sudden in HF?

over 30.7 billion

How much money is spent on HF each year?