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Heart Failure

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

1. preload
2. afterload
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

primary causes
precipitating causes

Precipitating causes

often increase the workload of the ventricles, resulting in acute condition that results in decreased myocardial function

Systolic failure

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)

Diastolic failure

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.

Pulmonary Edema

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

Symptoms of
Dependent bilateral edema
Right upper quad pain
Gi Bloating

manifestations of RIGHT sided HF

Symptoms of
Weakness/ Fatigue
Anxiety/ depression
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

Signs of
RV heaves
Jugular venous distention
Edema (pedal, scrotum, sacrum)
Weight gain
Increased HR
Anasarca (massive generalized body edema)
Hepatomegaly (liver enlargement)

Clinical Signs of RIGHT sided HF

Signs of
LV heaves
Pulsus alternans ( alternating pulses:strong, weak)
increased HR
PMI displaced inferiorly and posteriorly (LV hypertrophy)
decreased Pa02, slight increase PaCO2 (poor 02 exchange)
Crackles (pulmonary edema)
S3 and S4 heart sounds
Pleural effusion
Changes in mental stat
Restlessness, confusion

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.

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