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it is the inability of the heart to pump effectively (or at a rate that is too slow) that causes the heart to be unable to meet the metabolic demands of the body (or decreased tissue perfusion)
What is the principle pathophysiology of CHF?
- -an inability to empty or fill the ventricle or
- -decrease CO which leads to
- -decreased tissue perfusion
What is acute heart failure??
a sudden onset
a sudden change in the s/s of HF requiring emergency treatment
Define chronic heart failure..
long standing heart failure, accompanied by venous congestion but with adequate blood pressure (basically the heart is compensating for failure maintaining adequate BP to sustain normal ADLs)
can be left or right sided heart failure
What are the 3 clinical entities of Acute Heart Failure??
- 1. worsening heart failure
- 2. new onset (hf that is caused by cardiac valve rupture, large MI, severe HTN crisis, etc)
- 3. terminal heart failure (nonresponsive to refractory therapy)
What is systolic heart failure??
heart failure due to decreased systolic wall function
What is diastolic heart failure??
heart failure due to abnormal relaxation and compliance of the heart
What are some characteristics of systolic heart failure??
- POOR LV FUNCTION --from book
- increased preload
- decreased EF (hallmark) <40%
- increased diastolic volume (due to decreased EF)
- increased HR (expected with SHF with low EF)
SV is fixed in systolic heart failure..therefore any change in CO has to be due to ___.
List some characteristics of diastolic heart failure...
- Normal or nearly normal LV systolic function
- decreased CO
- decreased preload
- decreased BP
What is very important to focus on when treating a patient with diastolic heart failure who has an increased HR?
an increased HR can decrease CO due to decreased filling time..therefore rate control is imperative with diastolic heart failure.
if you don't fix the increased HR, CO will be further decreased
Diastolic heart failure is more common in...
- patients of increased age
- patients with hx of obesity, HTN and DM
What is low output heart failure??
heart failure that is often difficult to diagnosis because a patient can have a normal cardiac index but experiences inadequate responses to stress or exercise
what is high output heart failure??
the heart fails due to the increased burden placed on the heart plus direct muscle damage (cardiac toxicity) and complete deprivation of oxygen supply to the heart (anoxia)
The Frank Starling Relationship states that SV is directly related to .....
ventricular end diastolic volume
The greater the stretch of the cardiac muscle fibers = the greater the ____.
increased contraction = increased ??
When the heart is trying to compensate for a decreased CO that occurs with heart failure what is the bodies natural response???
the decreased CO causes increased SNS stimulation and release of catecholamines
Decreased CO and renal perfusion stimulates the Renin Angiotension Aldosterone System...what does this system do to compensate for the symptoms associated with HF?
- vasoconstriction will occur causing increased BP
- the body will hold onto salt and water to increase the vascular volume and ultimately increase CO
ANP is secreted by the ____ .
BNP is secreted by ____.
atria and ventricle
What is the purpose of ANP/BNP?
they are released when there is increased pressure in the heart to protect the heart from the effects of increased volume and pressure.
they counter balance the effects of the SNS on the heart by allowing the heart to become an "endocrine" organ
What are the effects of increased ANP/BNP??
they cause diuresis, block hypertrophy and inflammatory responses and inhibit the SNS and RAAS
Increased workload causes the heart to ____.
this causes the heart to have an increased contractile force
however this increased force causes the heart to require more O2.
What is the hallmark sign of decreased cardiac reserve and decreased CO???
fatigue and weakness
List some signs of Left sided HF?
- pulmonary crackles
- increased RR
- moist rales
all stems from pulmonary venous congestion
What are the most common causes of L sided HF?
MI and HTN
List s/s of R sided HF?
all stems from systemic vascular congestion
- lower extremity edema
- liver engorgement
- anorexia and nausea (abd. pain from engorgement of liver or prerenal azotemia)
A BNP of <100 means...?
HF is unlikely
BNP of 100 to 500 means ...??
HF is probable
BNP of >500 means???
HF is highly likely
What is prerenal azotemia and why does it occur??
high levels of waste in the blood
due to decrease RBF or disproportionate increase in BUN compared to CR
What is the most useful diagnostic tool for HF??
Should you continue beta blockers for surgery??
yes... thru surgery
Should you continue ACE's and ARB's before surgery???
no stop they 24-48 hours before surgery
When should you d/c diuretics for surgery???
the day of surgery
Transplanted hearts wont respond to ....
What is cardiomyopathy??
a heart muscle disease often of unknown causes
a disease of the myocardium that causes cardiac dysfunction