On this week’s episode, we will be attacking heart failure and finishing off cardiomyopathies. Check out the congenital heart disease episode for information regarding hypertrophic cardiomyopathy here.
Heart Failure
* Systolic vs diastolic
* Systolic #1
* Heart isn’t strong enough to pump blood
* Decreased ejection fraction (aka HFrEF)
* Thin ventricular walls
* Dilated ventricles
* + S3 (passive ventricular filling)
* Etiologies
* s/p MI
* dilated cardiomyopathy
* valvular disorders
* Diastolic
* Heart can’t relax enough to allow chambers to fill
* Normal or increased ejection fraction (HFpEF)
* Thick ventricular walls
* Small VL chamber (small volume)
* + S4 (forced atrial contraction into stiff ventricle)
* Etio:
* HTN
* LVH
* Left vs Right
* Left
* #1 causes are CAD & HTN
* Symptoms
* Remember that left side of the heart takes blood from the lungs and pumps it to the body.
* Slow down that pump=fluid backs into the lungs
* Dyspnea
* Increased pulmonary venous pressure
* Pulmonary congestion
* Rales
* Rhonchi
* Orthopnea (how many pillows??)
* Paroxysmal nocturnal dyspnea (wake up gasping for air)
* Chronic, non-productive cough
* PINK, FROTHY SPUTUM
* CHF=#1 cause of transudative pleural effusions
* HTN
* Cheyne-Stokes breathing
* Deep/fast breathing with periods of apnea
* S3/S4 depending on systolic or diastolic
*
Picmonic
* Right
* #1 cause =left
* Right side is the “gentler” side of the heart
* Right side of the heart can’t work against the increased pressure created in the lungs
* Right side takes blood from body to lungs
* Slow it down=fluid backs into body
* Peripheral edema
* Pitting edema
* JVD
* GI/hepatic congestion
* Hepatosplenomegaly
* Many other GI symptoms
* Imagine you’re full.
*
Picmonic
* Diagnosis
* Echocardiogram #1
* Measures ventricular function & EF
* Normal EF =55-60%
* <35% need for defibrillator placement
* CXR
* Pleural Effusions (#1 cause of transudative effusion)
* Kerley B lines
* Butterfly pattern infiltrates
* B-type natriuretic peptide or brain natriuretic peptide (BNP)
* Released by ventricles during volume overload
* >100=CHF likely
* Management
* Acute (aka decompensated or congestive)
* LMNOP
* Lasix (loop diuretic)
* Morphine
* Nitrates
* Oxygen
* Position (upright decreases venous return)
* Maybe digoxin
* Chronic Systolic
* SWABD
* Sodium <2g/d
* Water <2L
* ACE/ARB 1stLine!
