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!

See All 22 Episodes of "PA Study Sesh"