Heart Failure

main causes hf

ischemic heart disease

cardiomyopathy

htn

clinical syndromes hf

• hf w/ reduced ef (HFREF)

• hf w/ preserved l ventricular ef (HFPEF)

• r ventricular systolic dysfxn (RVSD)

hf w/ reduced ef (HFREF) - causes

by ischemic heart disease, valvular heart disease and htn

hf w/ preserved l ventricular ef (HFPEF)

impaired diastolic ventricular filling → decreased CO

increased left ventricular thick, left atrial size

= diastolic hf

right ventricular systolic dysfxn (RVSD) is secondary to

chronic left sided heart disease + pul htn

dg of hf is based on

history, clinical, natriuretic peptide levels, l ventricular structure (echo shows l ventricular structure)

symptoms hf

exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue

signs hf

tachycardia, elevated jvp, cardiomegaly, 3+4 sounds, bi-basal crackles, pleural effusion, ankle edema, ascites, hepatomegaly

NYHA classification hf

1. nothing

2. mild limitation - fatigue, dyspnea + palpitations @ physical activity

3. marked limitation - gentle activity makes symptoms

4. symptoms @ rest, exacerbated by physical activity

what is cardiac catherization used to diagnose

ischemic hf

dg of hf is based on what conditions

clinical hf, reduced lv ejection fraction OR structural heart disease + mild reduced ef

what are cardiac biopsies used to diagnose

cardiomyopathies or follow up transplant

drugs for hf

acei, b blockers, arnis, diuretics, aldosterone antagonists, digoxin, vasodilators, ivabradine

adverse effects ace i

cough, hypotension, hyperkalemia, renal dysfxn

COs acei

renal artery stenosis, pregnancy, previous angioedema

what is indicated if intolerant to ace i

AT2 antagonists, hydralazine and nitrates

se spironolactone

gynecomastia

when is cardiac glycoside (digoxin) indicated

afib + hf

what do all patients require in hospitl

prophylactic anticoag

non pharma treatment

revasc, hibernating myocardium, myocardial stunning, cardiac resynchronization, transplant

complications cardiac transplant

allograft rejection or vasc disease, infection, htn

COs cardiac transplant

?60, drugs, uncontrolled psych illness or infection, renal/liver failure

acute heart failure

rapid onset symptoms and signs hf secondary to abnormal carfiac fxn, causing elevated cardiac filling

clinical picture acute hf

severe dyspnea, acute pul edema

causes of acute hf

ischemic heart disease, valvular regurgitation, htn w/ ‘flash’ pul edema, kidney disease, afib

clinical syndromes of acute hf

• acute decomp hf - mild features hf

• hypertensive ahf - pul edema

• acute pul edema - tachypnea, low sat

• cardiogenic shock - low systolic bp, low urine output

• high output hf - warm peripheries, pul congestion

• r hf - low co, elevated jvp, hepatomegaly

treatment acute hf

prophylactic anticoag, o2, furosemide, ventilation, morphine, glyceryl trinitrate, sodium nitroprusside, inotropes, nor/epi

how to treat hypertensive ahf

sodium nitroprusside

digoxin indication

if acute hf + afib

device for acute hf

ventricular assist device