is an abnormal clinical syndrome involving impaired cardiac pumping and/or filling
HF is associated numerous types of cardiovascular diseases like
long standing hypertension, coronary artery disease (CAD), and myocardial infarction
Primary risk factors for HF
CAD and advancing age
Other risk factors include
hypertension, diabetes, cig smoking, obesity, and high serum cholesterol
HF is classified in two different ways
systolic or diastolic failure or dysfunction
HF is caused by any interference with the normal mechanisms regulating cardiac output. CO depends on
3. myocardial contractility
4. heart rate
any alteration in these factors (preload,afterload, myocardial contractility, heart rate) can lead to
decreased ventricular function and the resultant manifestations of HF
HF is classified into two main subgroups
often increase the workload of the ventricles, resulting in acute condition that results in decreased myocardial function
results from inability of the heart to pump blood effectively.
Systolic failure is caused by
impaired contractile function (MI), increased after load ( high BP), cardiopulmonary, and mechanical abnormalities ( valvular heart disease)
What happens to the left ventrical during dystolic dysfunction?
it losses the ability to generate enough pressure to eject blood forward through the aorta. LV become dilated and hypertrophied.
What is the hallmark of systolic function?
decrease in the left ventricular ejection fraction (EF)
is the inability of the ventricles to relax and fill during diastole.
Decreased filling of the ventricles will result in
decreased stroke volume and CO
Diastolic failure is characterized by
high filling pressure due to stiff or non compliant ventricles and results in venous engorgement in both the pulmonary and vascular systems.
The diagnosis of diastolic heart failure is made based on
the presence of pulmonary congestion, pulmonary hypertension, ventricular hypertrophy, and a normal EF.
Diastolic failure is usually the result of
left ventricular hypertrophy from chronic hypertension ( most common), aortic stenosis, or hypertrophic cardiomyopithy
Diastolic failure occurs more often in
Older adults, women, and people who are obese.
Mixed Systolic and Diastolic Failure
is seen in diseased states such as dilated cardiomyopathy (DCM)
DMC is a condition
in which systolic function is further compromised by dilated left ventricular walls that are unable to relax. The pt will have very low EFs ( less than 35) high pulmonary pressures, and biventricular failure ( both ventricles are dilated and have poor filling and emptying capacity)
The pt will ventricular failure of any type may have
low systemic bp, low CO, and poor renal per fusion.
Left Sided HF
The MOST COMMON form of hf.
Left Sided HF results from
left ventricular dysfunction which prevents normal blood flow and causes it to back up into the left atrium and into the pulmonary veins.
(LSF) Increased pulmonary pressure causes
fluid extravasation from the pulmonary capillary bed into the interstitium and then the alveoli, which manifests as pulmonary congestion and edema.
Right Sided HF
causes a back up of blood into the right atrium and venous circulation.
(RSF) Venous congestion in the systemic circulation results in
jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the GI tract, and peripheral edema.
What is the primary cause of right sided HF?
:Left sided heart failure.
Left sided heart failure results
in pulmonary congestion and increased pressure in the blood vessels of the lung. (pulmonary hypertension)
Eventually chronic pulmonary hypertension (increased right ventricular afterload) results in
right sided hypertrophy and failure.
This is an acute life threatening situation in which the lung alveoli become filled with serogsanguineous fluid.
The most common cause of pulmonary edema
is acute left ventricular failure secondary to CAD
Chronic HF is characterized by a progressive worsening of
Ventricular function and chronic neurohormonal activation that results in ventricular remodeling
Ventricular remodeling involves changes in
size, shape, and mechanical performance if the ventricle.
Fatigue, limitation of activities, chest congestion/cough, edema, and shortness of breath) will help identify HF
Dependent bilateral edema
Right upper quad pain
manifestations of RIGHT sided HF
Shallow respirations up to 32-40/min
Paroxysmal nocturnal dyspnea
Orthopnea (SOB in recumbent position)
Dry, hacking cough
Frothy, pink tinged sputum (advanced pulmonary edema)
Manifestations of LEFT sided heart failure
Jugular venous distention
Edema (pedal, scrotum, sacrum)
Anasarca (massive generalized body edema)
Hepatomegaly (liver enlargement)
Clinical Signs of RIGHT sided HF
Pulsus alternans ( alternating pulses:strong, weak)
PMI displaced inferiorly and posteriorly (LV hypertrophy)
decreased Pa02, slight increase PaCO2 (poor 02 exchange)
Crackles (pulmonary edema)
S3 and S4 heart sounds
Changes in mental stat
Signs of LEFT sided HF
Shortness of breath
Caused by increased pulmonary pressure secondary to interstitial and alveolar edema
Paroxysmal nocturnal dyspnea (PND)
Occurs when pt is asleep.
Caused by reabsorption of fluid from dependent body areas when pt is recumbent. Pt awakens in a panic, has feelings of suffocation, and has a strong desire to seek relief by sitting up.