Cardiovascular-Renal 1: HF, ADHF, CAD, SIHD (Dr. Toth)

What is AHF?

acute HF

Rapid onset of symptoms due to abnormal cardiac function.

Life-threatening; requires urgent treatment.

Most severe = cardiogenic shock

What is CHF?

chronic HF

Adaptive responses (remodeling) driven by sympathetic activation and RAAS. Adaptive responses are deleterious on the long run.

Could associate with preserved or reduced EF

What is cardiac remodeling?

dilation, hypertrophy

What is HF?

set of clinical symptoms and signs due to the heart cannot pump enough blood to feed the rest of the body with enough oxygen

What is systolic HF?

cannot pump due to

increased preload, MI ↓ contractibility, remodeling, DCM

HFrEF

What is diastolic HF?

cannot fill due to increased afterload because of HTN

HFpEF

What increases left ventricular afterload?

§ HTN

§ Aortic valve smaller than normal (aortic stenosis)

§ Insufficient mitral valve

What increases right ventricular afterload?

pulmonary HTN

insufficient pulmonary valve

What are the symptoms of left side HF?

• Dyspnea

• Decrease exercise tolerance

• Cough

• Orthopnea

• Pink, frothy sputum

What are the symptoms of right side HF?

• Decrease exercise tolerance

• Edema

• Hepatomegaly

• Ascites

What is ADHF?

• Leading cause of hospital admission over age of 65.

• 60-day mortality rates approaching 20%.

• Most/all patient have previously established heart failure.

What is physiological cardiac remodeling?

no fibrosis, reversible, normal pump function, no myocyte cell death

What is pathological cardiac remodeling?

fibrosis, irreversible, decreased pump function, myocyte cell death

What is coronary circulation?

· During diastole

· Provides blood to the myocardium (heart muscle 99% aerobic metabolism)

· Highest capillary density

Define SIHD

stable ischemic heart disease (stable angina)

chronic condition where narrowed coronary arteries reduce blood flow to the heart, causing chest pain (angina) during exertion or stress

Define ACS

acute coronary syndrome

sudden and severe blockage of a coronary artery, leading to a heart attack (myocardial infarction)

What is stable angina (SA)?

o Precipitated by stress or exertion

o Typical chest pain: retrosternal that radiates into left jaw, left shoulder, left arm

oLasts < 20 minutes

o Relieved by GTN or resting

oMismatch between myocardial oxygen supply and demand

What are the 3 criteria for suspicious chest pain?

1. the presence of substernal chest pain

2. discomfort that was provoked by exertion or emotional stress

3. relieved by rest and/or nitroglycerin.

What are the types of suspicious chest pains?

Typical (3/3 criteria)

Atypical (2/3 criteria)

Non-cardiac (1/3 criteria)

What is capillary reserve?

blood supply in coronary circulation to compensate

Define ischemia

inadequate blood supply to an organ especially heart muscles

Define ischemic preconditioning

heart's ability to protect itself from a sustained, severe ischemic insult by being subjected to brief, non-lethal episodes of reduced blood flow (ischemia) followed by periods of reperfusion (restored blood flow)

What is CAD?

Coronary Artery Disease

atherosclerosis of the coronary artery

Why is ADHF so serious?

• Leading cause of hospital admission over age of 65.

• 60-day mortality rates approaching 20%.

• Most/all patient have previously established heart failure.

Define prinzmetal (variant) angina

uncommon pattern of episodic angina that occurs at rest and is due to coronary artery spasm

unrelated to physical activity, HR, or BP