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Heart Failure

a clinical syndrome that emerges when there is an impaired ability for the ventricals to fill with enough blood or eject enough blood to meet the body's demand

Causes of HF

hypertension, coronary artery disease, scare tissue from a previous MI

manifestations of acute Left Sides Heart Failure

Exertional dyspnea, orthopmea, parpxysmal nocturnal dyspnea, cough, blood tinged sputum, cyanosis, elevation in pulmonary capillary wedge pressure

manifestations of right sided heart failure

fatigue, dependent edema, distntion of the jugular veins, liver engorgement, ascites, anorexia and complaints of GI distress, cyanosis, elevation in peripheral venous pressure, nocturia

Backward effects of Left sided HF

decreased emptying of the left ventricle, increased volume and pressure in left vent, increased pressure volume in left atrium, increased volume on pulmonary veins, increased volume in pulmonary capillary bed transudation of fluid from capillaries to alveoli, rapid filling of alveolar spaces = Pulmonary Edema

Forward effects of left sided HF

decreased cardiac output, decreased perfusion in tissues of body, decreased blood flow to kidneys and glands, increased reabsorption of sodium and water from the increased secretion of the sodium and water retaining hormones, increased extracellular fluid volume and total blood volume

Backward effects of Right sided HF

decreased emptying of the right ventricle, increased volume and pressure in the right ventricle, increased volume and pressure in the right atrium, increased volume and pressure in the great veins, increased volume in the systemic venous circulation, increased volume in the liver and spleen, increased pressure at capillary line, hepatomegaly and splenomegaly, dependent edema and serous effusion

Forward effects of right sided HF

decreased volume from the right ventricle to the lungs, decreased return to the left atrium and subsequent decreased cardiac output, expansion of blood volume and all the forward effects of left sided heart failure

BNP test

can rule out pulmonary causes of dyspnea because the level rises as chronic heart failure symptoms worsen

BNP a neurohormone

secreted by the heart in response to expansion of ventricular volume and pressure overload

abnormal distended jugular veins

may signal increased right atrial pressure

flat jugular veins

a sign of hypovolemia

HF caused by MI

causes damage to the myocardial tissue

Interior Wall MI

causes damage to the right side of the heart

Anterior Wall MI

causes damage to the Left side of the heart

Aortic Valve Stenosis

means the aortic valve is not opening during systole so now the heart has to work harder to push the blood out of the smaller opening. This increases afterload to the left side of the heart f causes Forward Heart failure

Pulmonic Valve Stenosis

causes forward Heart failure on the right side of the heart

Coronary Artery disease

causes HF by slowly depleting the myocardium of energy and is the primary cause of HF

Valvular Heart disease

makes the heart work harder to pump blood through the stenosis valves and you have blood backing up into the chamber and it makes the heart pump harder to empty as well

Hypertension with Forward Heart Failure

means patient has an increase in afterload

Hypertension with Right Sided HF

means patient has pulmonary vascular resistance. the heart cannot push the blood forward because there is too much pressure. can treat with vasodilators or diuretics

Hypertension with Left Sided HF

means patient has systemic vascular resistance. treatment could be vasodilators or diuretics

Forward Heart Failure

means there is something in front of the heart preventing the blood from going forward (in creased afterload): increased blood pressure or a stenosed valve. the heart has to work really hard to push the blood out.

Backward/ Systolic Heart failure

has to do with the hearts ability to contract: and inhibits their ability to empty. It is ofter from an MI which impairs the contractility of the left ventrical. It cannot eject the correct amount of blood to the body.

Dyastolic Heart failure

has to do with the hearts ability to fill. this can happen from reduced preload or from a hypertrophic cardiomyopathy or it could be that there is not enough blood and so it is not filling adequately

Forward Heart Failure

Is inadequate delivery of blood to the arteial blood system. It can be caused from constricted arteries which increases afterload and could happen on the right or left side of the heart. the blood is backing up now into the lungs and pulmonary arteries

Increased Pulmonary vascular resistance

caused right side of the heart to not be able to push the blood forward from too much pressure being there

Systolic / Backward Heart Failure

happens from a problem with the pumping actions of the heart and it can be on the right side or left side of the heart

Positive Inotropes

medication treatment for the heart when there is a problem with the pumping.

increased afterload or preload

can cause forward right sided HF or backward right sided HF or systolic right sided HF

Diastolic Heart Failure

happens because the ventricles cannot fill properly. they maybe too stiff from a cardiomyopathy, maybe from in adequate preload, they may be too stretched out, or may not have enough blood to fill them from hypovolemic shock

Beta Blockers for diastolic HF

decrease the heart rate and so increase the filling time

Heart Failure definition

a chronic, progressive condition in which the heart muscle is unable to pump enough blood through the heart to meet the body's needs for blood and oxygen. the heart cannot keep up with its work load.

Preload

the pressure that is increased when venous return is increased. It is decreased during hypovolemia because there is less return of blood through through the venus system and therefor less ventricular filling

Increased Preload

happens when venous return is increased the end diastolic pressure for ventricular fillling is increased

Preload

the initial stretching of the caridiac myocytes prior to contraction

Frank Starling Law

the ability of the heart to change its force of contraction (stoke volume) in response to changes in venous return

Stroke Volume

the difference between the filled volume of the ventricals prior to contraction and the residual volume of blood remaining in the ventricle after each ejection

Afterload

the load that the heart must eject blood against to push it forward. it is closely related to the aortic pressure

Preload

the load of pressure from the venous return coming to the heart prior to filling

clinical signs of left ventricular failure

tachypnea, tachycardia, cough, blood tinged sputum, crackles, cyanosis, fatigue, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, elevated pulmonary wedge pressure

paroxysmal nocturnal dyspnea

respiratory distress that awakens patient from sleep

S3 sound is a ventricular gallop

occurs after S2 and is an early symptom of heart failure because they have a lot of left over blood in the ventricule

clinical signs of Right Sided Heart Failure

peripheral edema, hepatomegaly, splenomegaly, hepatojugular reflux, ascites, weakness, anorexia, indigestion, weight gain, mental changes

high risk for HF diseases

hypertension, diabetes, obesity

high risk for HF structural diseases

leeft ventricular remodeling, left vent hypertrophy, previous MI

left vent failure

increases the work load of the right ventricle and it must pump more forcefully in order to over come the increase pressure in the pulmonary vessels

right ventricular failure

cannot push blood forward so it goes back into the venus circulation and causes symptoms of right sided heart failure

decreased in Afterload

happens from the decrease flow of the blood out of the ventricles and causes hypoperfusion to vital organs

Inotropic State of the Heart

describes the contractility state of the heart

Backward HF

A pump problem. means the heart is not pumping properly and could be due to an injury to the heard`

Increased Afterload

Forward Heart failure because the blood cannot move forward properly

S3 Systolic Ventriclar Gallop

heard during backward heart failure when the heart is filling inadaquetely

Cor Pulmonare

a right ventricular infart from an obstruction in the right coronary artery. this is an inferior wall MI and is Systolic Heart Failure

a forward heart failure

happens when afterload in increased. usually related to hypertension or aortic stenosis which does not open during systole. this causes increase afterload of the left ventricle

pulmonic stenosis and increased pulmonary resistance

increases afterload to the right ventricle

ejection fraction

falls below 40% during backward HF because there is a failure of the vent to empty due to bacward/systolic failure.

right sided heart failure

develops from forward HF due to increase in afterload and blood is backing up into the lungs and plumonary artery

Inferior wall MI

is a right ventricular infarction and is systolic heart failure

Dyastolic HF

Preload is the problem

orthopnea

a pulmonary symptom. dyspnea (SOB) feels worse when lying down, so will sleep on multiple pillows. happens because of the increase in venus return (preload). the heart is having a hard time pumping the blood out.

pulmonary symptoms

sleep apnea, hemoctasis, wheezing, weight loss or gain, bloating, N&V, hepatomegly, deceased urinary output, noctoria, renal insufficiency

valve disease

increases afterload and causes forward heart failure

dyastolic heart failure

a preload problem and can occur in with either ventricle

paroximal nocturnal dsypnea

SOB that occurs several hours after falling asleep and it is eased by sitting up. this is a very late sign of severe HF

an MI causes

Systolic HF which is also know as backward HF

a Forward HF

caused by increased afterload from valve diseases

all heart failures

lead to decrease output, decreased systemic blood pressure and decreased perfusion

people with HF

always have increase levels of angiotension 2 and that changes the treatment

Hypertrophy of the left ventricle

one of the hearts first attempt to compensate for heart failure

blood volumen before the contraction

preload

blood amount after contraction that heart needs to push out

afterload

BNP (b-type natriuretic peptide) test

levels rise with heart disease severity. less than 100 is normal. it is secreted predominantly in the left ventricle in response to an expansion in ventriular volume and pressure overload. It normally helps to maintain homeostasis by promoting diureses and natriuresis (loss of sodium in the urine)

BNP levels

below 100 not HF, above 500 probably HF,above 700 compensating HF. this is released only when the heart is stretched in HF

normal ejection fraction

above 55% and is the fraction of the preload right before the heart pumps it out

HF triple drug coctail

ace inhibitors and Aldosterone blockers to to block sodium and water retention, beta blockers to reduce BP and increase contractility,

aldactone

diuretic drug of choice for fluid retention. is an aldosterone antagonist reduces fluid retention and so preload. a maintenence drug

adverse reactions to ace or arbs

hypotension or hyperkalemia

desired effect of ace inhibitors or arbs

decreases ventricular remoldeling

beta blockers

decrease work of the heart

internal devices for HF

internal cardiac defibulator and cardiac resycronization pacemaker (ICP or CRP)

Natricore

can only be given in hospital IV. it cause vasodilation so it decreases after load and decreases fluid in the lungs. BUT can cause severe HYPOTENSION!

cardias resyncronization pacemaker

increase the ejection fraction, decreases remodeling, increases quality of life, decreases hospitalizations, used for pts who have an ejection fraction of less than 35% (50 is normal)

Digoxin drug toxicity symptoms (normal range 0.8-2.0)

changes in HR, rythym, irregular pulse, tachycardia, palpataions, and arrythmias. AND:
visual changes: halos, increase salivation, fatigue, nightmares, gi disturbances, confusion and dizzyness.

Dobutrex and Milderone

big guns used to increase contractitliy but cause increase in mortality and are only used when nothing else works. they increase O2 demand of the heart and can cause lethal arrythmias.

Dopimine and Inacore

positve inotropes and increase heart contractility

Low potassium levels

get decreased from the loop diurectics and can increase digoxin risk of toxicity and cardia dysrythmias and this causes "paroxysmal atrial tachycardia with block"

high potassium levels

get increased from ace inhibotors and arbs

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