Term
| heart failure definition and etiologies |
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Definition
• Clinical syndrome that evolves from any structural or functional cardiac disorder resulting in the inability of the heart to eject or fill with blood.
• Etiology
– CAD, HTN, Dilated Cardiomyopathy, Valvular Heart Disease |
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Term
| signs/symptoms of heart failure |
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Definition
• Exercise Intolerance
• Exertional Dyspnea
• Fatigue and Weakness
• Volume Overload
• LE Edema
• PND
• Orthopnea
• JVD
• Symptoms of another disorder |
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Term
| diagnosis of heart failure |
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Definition
• Exclude other common non-cardiac pathologies:
– COPD exacerbation or other lung pathology – Pneumonia
– PE
– Pleural effusion (post-op, etc.)
– Ca+2 channel blockers – Venous insufficiency |
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Term
| BNP elevated when? cleavage? stimulates? |
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Definition
– Increased myocardial wall stress due to volume or pressure overload activates the B-type natriuretic peptide (BNP) gene in cardiac myocytes, producing the intracellular precursor propeptide (proBNP).
– Cleavage releases the biologically active BNP and biologically inert amino- terminal fragment (NT-proBNP).
– BNP stimulates natriuresis and vasodilation with consequent afterload reduction, inhibits renin-angiotensin-aldosterone release and sympathetic nervous activity, reduces fibrosis. |
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Term
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Definition
| elevated in many cardiac and non cardiac diseases |
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Term
| labs to evaluate what in heart failure? |
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Definition
Renal Function- UA, electiolytes, assess intravscular volume status and renal perfusion
Hematologic studies- CBC for anemia which can exacerbate heart failure
Thyroid studies, esp if taking aminodarone |
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Term
| table for CXR stages of CHF |
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Definition
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Term
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Definition
stage I redistribution
-You can see in the slide, the part on the left, that's a patient in good condition. Everything looks fine. You can see with the blue arrow is, where the vascularity is kind of tapering off.
Now when you look at the picture on the right, that's somebody who's having acute congestive heart failure. So notice there's an increased width of what we call the vascular pedicle. That's in the red arrows.
And you can see the blue arrow now, which is showing you the same vessel as the other side, is a lot more dense. It's more pronounced. There's been a redistribution of fluid from the more base of the lung to more of the upper lobes and periphery of the lungs. So this would be a stage 1 kind of redistribution. This would be maybe a person with a mild congestive heart failure. |
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Term
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Definition
Stage II CHF Interstitial Edema
So the picture on the one side is normal. The right side shows somebody with stage 2. And those are the Kerley B lines. These are these horizontal fluid filled fissures. It's interstitial edema.
The space between the cells and the lungs get filled with fluid and you see these little horizontal lines. Those are called Kerley B lines. And they're pretty commonly seen in stage 2 congestive heart failure. Basically, when you see Kerley B lines, think heart failure. |
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Term
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Definition
stage III-alveolar edema
And then this is somebody with alveolar edema. You can just see this infiltrate looking appearance, this bilateral interstitial type of infiltrate you see in both lungs bilaterally. This person has stage 3. This person is probably really-- that's all fluid filling their lungs.
They're probably having a really hard time breathing, they're short of breath, any kind of exertion makes them more short of breath. That's due to all that fluid filling in the interstitial spaces in the lungs. |
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Term
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Definition
pleural effusion
Now you can carry it one step further with so much fluid in your lungs that you can actually develop pleural effusions. And this is showing a pleural effusion. Now in the diagnostic studies course, when we talked about chest X-rays, we went into more detail about pleural effusions, but just a couple of points here.
You notice you can't see the angles. You can't see the markings. I don't see the costophrenic angle over here. I don't see it over here. And you can actually-- this red arrow, showing a line right there-- that's the fluid level.
So below that red line I just drew is all the fluid, and then there's even a little bit more fluid between those two red lines. So it's really dense below it. Then there's a little less fluid. And then you finally get normal.
So that's all the fluid in the long, that due to gravity, it's just kind of draining down to the bottom of the lungs. And then this right here, all this white spot over here, all that area, that's the dome of the diaphragm.
So it's got-- depending on what side you're shooting from-- it's got the stomach, the liver you're shooting through, but remember, that diaphragm is kind of a dome. And fluid can collect around that dome. And that's what we're seeing here with the red arrow and my two straight lines. That's the fluid that's collecting around that dome of the diaphragm due to extra fluid in their lungs.
Usually to see fluid that goes around the dome of the diaphragm like that, you have to have fluid in your lung of around anywhere from 150 to 250, sometimes 500, CCs of fluid to be able to see that on chest X-ray. |
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Term
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Definition
• Atherosclerotic Disease
• Hypertension
• Valvular disease
• Diabetes Mellitus
• Obesity
• Dilated Cardiomyopathies (FDC representing 1/3rd of this group)
• Persistent tachycardia
• Alcohol/Cocaine use
• Cardiotoxicity related Cancer Therapies
• Other toxins/nutritional causes (anabolic steroids, L- carnitine deficiency) |
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Term
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Definition
• Pulmonary Emboli/Pneumonia
• Arrthythmias
• Non-Compliance with Medications and Diet
• Ischemia
• Cardiosuppressive Drugs/COPD exacerbations
• Stress (EmotionalorPhysiologic)/Systemic Illness
• High OutputStates/Hypertensive Crisis
• Infections
• Toxins |
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Term
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Definition
• Acute vs Chronic
• Right Sided vs Left Sided
• High Output vs Low Output
• Systolic vs Diastolic |
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Term
| systolic vs diastolic heart failure |
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Definition
systolic: all ages, dec EF, inc LV cavity, prior MI, S3
diastolic: frequently elderly, normal EF, normal LV cavity, HTN or DM, S4 |
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Term
| diastolic failure diagnosis and confirmation |
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Definition
• Diagnosis
– Required
• Signs and symptoms of CHF, • Normal LV ejection fraction,
• R/O non cardiac causes
– Confirmatory
• Abnormal diastolic function,
• Abnormal LV structure – Concentric remodeling – LA enlargement |
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Term
| heart failure class I-IV and A-D |
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Definition
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