What is HF
complex clinical syndrome resulting in insufficient blood supply/o2 to tissues and organs
What is ejection fraction?
amount of blood pumped by LV with each heart beat
How does HF effect the aging population
high incidence and prevalence*
What is the most common cause for hospital admission in adults over age 65?*
HF
HF and HTN
HTN - modifiable risk factor!
If properly treated and managed, incidence of HF can be reduced by 50%
HF primary risk factors
HTN, DM, metabolic syndrome, advanced age, tobacco, vascular disease, CAD
Primary causes of HF
conditions that directly damage the heart (MI)
precipitating causes of HF
conditions that increase workload of ventricles (anemia, infection, thyroid toxicosis, dysrhythmias, obstructive sleep apnea (ask about CPAP in assessment)
What is the most common form of HF?
Left sided HF
Left sided HF
results from inability of LV to empty adequately during systole and fill adequately during diastole
further classified as systolic, diastolic, or mixed
most common cause of mixed (systolic and diastolic) HF
mitral valve disease/prolapse
what happens in LSHF
blood backs up into left atrium and pulmonary veins
increased pulmonary pressure causes fluid leakage - leads to pulmonary congestion and edema
assessment for LSHF
auscultate lungs for crackles (fluid)!!!
another name for systolic HF
HFrEF - HF with reduced EF
systolic HF
inability to pump blood forward
causes of systolic HF
impaired contractile function
increased afterload
cardiomyopathy
mechanical abnormalities: valves
decreased LV EF
what is the normal EF
55-60 adult
EF level in systolic HF
usually <45 - can be as low as 5-10
another name for diastolic HF
HFpEF - HF with preserved EF
diastolic HF
impaired ability of the ventricles to relax and fill during diastole, resulting in decreased stoke volume and CO
what do therapies for diastolic HF target?
comorbidities
ejection fraction of diastolic HF
initially normal
diastolic HF diagnoses
echogram or cardiac cath - evidence of left ventricular diastolic dysfunction
diastolic HF causes
ventricular hypertrophy from HTN, older age, female, DM, obesity
mixed systolic and diastolic failure
may need pacemaker
seen in disease states such as dilated cardiomyopathy
poor EFs
high pulmonary pressures
biventricular failure
both ventricles may be dilated and have poor filling and emptying capacity
RSHF causes
right ventricle infarction, pulmonary embolism, cor pulmonale: RV dilation and hypertrophy
LSHF is most common cause
Right sided HF
RV fails to pump effectively
fluid backs up into venous system
fluid moves back into tissues and organs
What does ventricular failure lead to?
low BP (not enough blood in vascular system)
low CO
poor renal perfusion
why is poor renal perfusion seen in HF
blood not being perfused = not getting oxygenated
Renin-angiotensin-aldosterone-system (RAAS)
compensatory mechanism
homeostatic regulatory system
BP control and fluid and electrolyte balance
fluid and sodium retained in response to stress
causes vasoconstriction to increased BP
what is the goal of RAAS?
increase BP
what happens to fluid and sodium when RAAS is release
retained
neurohormonal response - RAAS
as CO falls, blood flow to kidneys is decreased and sensed as low volume
SNS is activated to increase BP and HR
release of aldosterone and adrenal cortex results in sodium and water retention
peripheral vasoconstriction and increased BP