Universal stages of Heart Failure (HF) - - At-risk for HF
- Pre HF
- HF
- Advanced HF
according to the universal definition, what is "at-risk for HF"? - - do not have HF, but at
risk
- no current or prior s/s
- no structural, functional, or biomarker evidence supporting HF
according to the universal definition, what is "HF" - - clinical syndrome
- current or prior s/s of HF
- caused by structural of functional cardiac abnormality
- elevated natriuretic peptide levels
- evidence of pulmonary or systemic congestion
who is most at risk for HF - black males and females; older women
two biggest causes of HF - 1. ischemic heart disease (CAD)
2. HTN
calculate EF - SV/LVEDV
synonym for inotropy - contraction (HFrEF)
synonym for lusitropy - relaxation (HFpEF)
two organizations for classification of HF - 1. American Heart Assocation (A,B,C,D) -
based on structure
2. New York Heart Association (None, I, I, II, III, IV, V) - based on physical activity
limitations
how to distinguish cardiac dysfunction versus cardiac HF - cardiac dysfunction has
structural abnormalities w/o symptoms
once a patient develops symptoms along with structural abnormalities, they have HF
compensatory mechanisms for HF - 1. Hemodynamics (Frank Starling Law) - can give
inotropes as short term use to increase contractility (long-term can cause mortality)
, 3. RAAS activation (angiotensin II binds to AT 1 Receptor - vasoconstriction)
two types of angiotensin II - 1. circulating
2. tissue-derived
effects of circulating angiotensin II on HF - - causes vasoconstriction
- increases secretion of ADH
- increase aldosterone secretion
- increases sodium reabsorption
are aldosterone levels high or low in HF? - 20x higher than normal
effects of aldosterone on HF - - increases sodium and water reabsorption
- decreased potassium and magnesium
- decreased baroreceptor reflex
- sympathetic activation
list the comprehensive risk factors of Coronary Artery Disease - - dyslipidemia
- genetic studies
- modifiable risk factors
- non-modifiable risk factors
- novel risk factors
what are two classes of medications an individual with HFrEF will be started on? - 1.
beta blocker (to counter SNS)
2. ACEi (to counter RAAS)
what hormones worsen HF - - Angiontensin II (RAAS)
- catecholamines (SNS)
- endothelin
- aldosterone
hormones that are good for HF - - natriuretic peptides (ANP, BNP, CNP)
- adrenmedullin
- bradykinin
- nitric oxide
blood flow of the heart from right side to left side - 1. deoxygenated blood from the
systemic system enters the superior/inferior vena cava
2. right atrium
3. tricuspid valve
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