Heart Failure

Front 1

Definition of heart failure

Back 1

State in which either/or:

(1)heart is incapable of pumping a sufficient supply of blood to meet the metabolic requirements of the body

(2) requires elevated ventricular filling pressures to accomplish this goal

Front 2

Systolic Dysfunction

Back 2

EF <40%

Front 3

Cardiac Index

Back 3

CO/BSA (L/min/m2)

Normal is 2.5 - 4.0

Front 4

Determinants of SV

Back 4

Rhthym (sinus vs afib)

Preload

Afterload

Contractility

Front 5

Cardiac Output

Back 5

CO = HR X SV

Normal is ~ 5L/min

Front 6

Myocardial Wall Stress/Tension

Back 6

Tension directly proporotional to:

(1) Intraventricular Pressure

(2) Radius

Front 7

Determinants of MAP

Back 7

MAP ~= to SVR X CO

Front 8

Poiseuille equation for blood flow

Back 8

Flow is directly related to:

(1) Change in pressure

(2) radius to power of 4

Inversely related to:

(1) Vessel length

(2) Blood viscosity

Front 9

Primary disease processes leading to heart failure

Back 9

CAD

Cardiomyopathies

Myocarditis

Valvular heart disease

Pericardial disease

Pulmonary disease (e.g. COPD)

Front 10

High Output Heart Failure

Back 10

Supranormal cardiac output with that lead to neurhormonal activation and eventual heart failure

Front 11

Mechanism and causes of high output heart failure

Back 11

Front 12

NYHA Classification of Heart Failure Severity

Back 12

I. Asymptomatic on ordinary physical activity
II. Symptomatic on ordinary physical activity
III. Symptomatic on less than ordinary physical activity
IV. Symptomatic at rest

Front 13

Causes of acute exacerbations of CHF

Back 13

• Sodium and volume excess
• Systemic hypertension
• Myocardial infarction or ischemia
• Systemic infection
• Dysrhythmias
• Acute hypoxia or respiratory problems
• Anemia
• Pregnancy
• Thyroid disorders
• Acute myocarditis
• Acute valvular dysfunction
• Pulmonary embolus
• Excess exertion or trauma
• Pharmacologic complications

Front 14

Overview of management for acute CHF exacerbations

Back 14

Front 15

How does NIV help with cardiogenic pulmonary edema

Back 15

(1) Increased FRC leads to improved oxygenation and decreased WOB

(2) Reduced O2 demand and decreased adrenergic stimuli

(3) Improves V/Q matching

(4) Reduced afterload improved cardiac output

(5) Reduced preload

Front 16

AHA Stages of Heart Failure

Back 16

A: At risk of heart failure without symptoms nor structural heart disease

B: Structural heart disease without symptoms of CHF
C: Structural heart disease with symptoms of CHF

D: Refractory CHF

Front 17

Summary of Canadian Cardiovascular Society Recommended Treatments for CHF

Back 17

Front 18

Indications for cardiac resynchronization therapy

Back 18

LVEF < 35%
LBBB
NYHA class II, III, or IV
Sinus rhythm
QRS > 150ms

Front 19

Indications for ICD as primary prevention in heart failure

Back 19

EF < 35% and NYHA class Ii or III
EF < 30% and NYHA class I