CRITICAL CARE - HEART FAILURE
HIGH OUTPUT HF
vs LOW OUTPUT HF - ANSHeart failure that occurs when cardiac output remains normal or
above normal. It is usually caused by *increased metabolic needs* or hyperkinetic conditions
such as septicemia (fever), *pregnancy, anemia, and hyperthyroidism*.
This type of heart failure is different from left- and right-sided heart failure, which are typically
low-output states, and is not as common as other types.
Left heart failure vs Right heart failure
*CAUSES* - ANS*LV heart failure causes*
-MI, HTN, cardiomyopathy, aortic/mitral valve disease
*RV heart failure causes*
-LV heart failure is the most common cause
-also: right ventricular infarction, pulmonary HTN, PE, cor pulmonale
Left heart failure vs Right heart failure
*SYMPTOMS* - ANS*Left heart failure symptoms*
-pulmonary symptoms (low pulse ox readings, SOB, orthopnea, crackles, cough)
*Right heart failure symptoms*
-systemic symptoms (peripheral edema, JVD, hepatic distention, ascites, weight gain)
-elevated CVP
What is BIVENTRICULAR heart failure?
What are the symptoms? - ANSmany patients with chronic left heart failure eventually
develop biventricular failure (right and left heart failure)
these patients present with both pulmonary and systemic manifestations
LEFT HF and RIGHT HF forward effects: - ANSfatigue
oliguria
increased heart rate
faint pulses
restlessnes, anxiety
confusion
SYSTOLIC vs DIASTOLIC heart failure - ANS*SYSTOLIC HEART FAILURE*
-ventricular weakening
-low ejection fraction (less than 40%)
, *DIASTOLIC HEART FAILURE*
-ventricular stiffening
-ejection fraction normal or near-normal
Heart failure risk factors - ANShypertension (the single largest factor!!)
coronary artery disease
valvular disease
obesity
diabetes
kidney disease
aging
smoking
SEVERE HEART FAILURE
What are the dangers?
What are the signs and symptoms? - ANS*dangers:*
-rapidly deteriorating stroke volume and cardiac output leading to tissue hypoxia
-*CARDIOGENIC SHOCK* --hypotension and life-threatening loss of perfusion
*signs and symptoms:*
-weak pulses
-confusion and decreased LOC
-low urine output
-cool, clammy skin
NEW YORK CLASSIFICATION OF HEART FAILURE
I, II, III, IV - ANSI - asymptomatic
II - mild discomfort during activity; comfortable at rest
III - moderate discomfort during activity; comfortable at rest
IV - symptomatic and uncomfortable even at rest (*candidates for heart transplant*)
ACUTE vs CHRONIC vs ACUTE ON CHRONIC heart failure - ANS*ACUTE HEART
FAILURE*
-decompensated
-new and/or rapid onset of symptoms
*CHRONIC HEART FAILURE*
-compensated
-symptoms seem stable although gradually worsening
-compensatory mechanisms themselves are also the reason for deterioration
*ACUTE ON CHRONIC*
HIGH OUTPUT HF
vs LOW OUTPUT HF - ANSHeart failure that occurs when cardiac output remains normal or
above normal. It is usually caused by *increased metabolic needs* or hyperkinetic conditions
such as septicemia (fever), *pregnancy, anemia, and hyperthyroidism*.
This type of heart failure is different from left- and right-sided heart failure, which are typically
low-output states, and is not as common as other types.
Left heart failure vs Right heart failure
*CAUSES* - ANS*LV heart failure causes*
-MI, HTN, cardiomyopathy, aortic/mitral valve disease
*RV heart failure causes*
-LV heart failure is the most common cause
-also: right ventricular infarction, pulmonary HTN, PE, cor pulmonale
Left heart failure vs Right heart failure
*SYMPTOMS* - ANS*Left heart failure symptoms*
-pulmonary symptoms (low pulse ox readings, SOB, orthopnea, crackles, cough)
*Right heart failure symptoms*
-systemic symptoms (peripheral edema, JVD, hepatic distention, ascites, weight gain)
-elevated CVP
What is BIVENTRICULAR heart failure?
What are the symptoms? - ANSmany patients with chronic left heart failure eventually
develop biventricular failure (right and left heart failure)
these patients present with both pulmonary and systemic manifestations
LEFT HF and RIGHT HF forward effects: - ANSfatigue
oliguria
increased heart rate
faint pulses
restlessnes, anxiety
confusion
SYSTOLIC vs DIASTOLIC heart failure - ANS*SYSTOLIC HEART FAILURE*
-ventricular weakening
-low ejection fraction (less than 40%)
, *DIASTOLIC HEART FAILURE*
-ventricular stiffening
-ejection fraction normal or near-normal
Heart failure risk factors - ANShypertension (the single largest factor!!)
coronary artery disease
valvular disease
obesity
diabetes
kidney disease
aging
smoking
SEVERE HEART FAILURE
What are the dangers?
What are the signs and symptoms? - ANS*dangers:*
-rapidly deteriorating stroke volume and cardiac output leading to tissue hypoxia
-*CARDIOGENIC SHOCK* --hypotension and life-threatening loss of perfusion
*signs and symptoms:*
-weak pulses
-confusion and decreased LOC
-low urine output
-cool, clammy skin
NEW YORK CLASSIFICATION OF HEART FAILURE
I, II, III, IV - ANSI - asymptomatic
II - mild discomfort during activity; comfortable at rest
III - moderate discomfort during activity; comfortable at rest
IV - symptomatic and uncomfortable even at rest (*candidates for heart transplant*)
ACUTE vs CHRONIC vs ACUTE ON CHRONIC heart failure - ANS*ACUTE HEART
FAILURE*
-decompensated
-new and/or rapid onset of symptoms
*CHRONIC HEART FAILURE*
-compensated
-symptoms seem stable although gradually worsening
-compensatory mechanisms themselves are also the reason for deterioration
*ACUTE ON CHRONIC*
