Heart Failure Pathophysiology Notes PDF

Perfusion PAT H O P H Y S I O LO GY EXEMPLAR: H E A R T FA I L U R E Danielle Yaffe RN MN CCNE CCSNE Based on work by Lisa Banman RN MN Student Learning Outcomes By the end of this presentation, you will be able to:  Describe risk factors and causes of heart failure Compare and contrast th...

Perfusion PAT H O P H Y S I O LO GY EXEMPLAR: H E A R T FA I L U R E Danielle Yaffe RN MN CCNE CCSNE Based on work by Lisa Banman RN MN Student Learning Outcomes By the end of this presentation, you will be able to:  Describe risk factors and causes of heart failure Compare and contrast the following categories and types of heart failure:  Heart failure with reduced ejection fraction (systolic heart failure) and Heart failure with preserved ejection fraction (diastolic heart failure) Right and Left sided heart failure Acute, chronic, and acute-on-chronic heart failure  Explain the main compensatory mechanisms of heart failure Summarize the clinical manifestations of heart failure (both left and right sided). Follow Along… Lewis Chapter 37 Gidden’s Concept 16 Perfusion  Heart Failure Definition: when the heart’s ability to pump blood has been compromised leading to ↓ CO Due to impaired cardiac pumping or filling, or both Results in accumulation of fluid in lungs and/or the periphery Can be acute or chronic Major reason for hospital admission in adults over 65 years https://www.cls.health/heart-failure/ Remember… L d Bo sided Lung y HF CO = SV X HR CO = 3-6 L /min s LA R 5 Factors Affecting CO A L Cardiac contractility V RV Heart rate Preload Afterload R Blood volume sided HF  5 Facto rs Affec ting CO Cardiac contract ility Why do people develop heart failure? Heart ra Preload Afterload te Blood vo lume Causes: Risk Factors: Chronic CAD CAD Cardiomyopathy HTN HTN DM Pulmonary disease Valvular Disease Smoking Obesity High Acute Acute MI cholesterol Myocarditis Hypertensive crisis Rupture of papillary muscle Dysrhythmias Check In What are the two major reasons that heart failure develops?  What are the 5 factors that influence CO? Where does the Right Ventricle drain into? What is a normal cardiac output? How does high blood pressure cause heart failure? Ejection Fraction Ejection Fraction: percentage of end-diastolic blood volume that is ejected Normal EF is 50-70% during systole https://www.nursingcenter.com/ncblog/august-2021/how-to-calculate-ejection-fraction  Pathology of Heart Failure HF with Preserved EF (Diastolic Dysfunction) HF with Reduced EF (Systolic - More complicated Dysfunction) Inability of left ventricles to relax and fill during diastole Most common form of HF Decreased filling results in decreased SV and CO (b/c ventricles = smaller or too stiff) Heart unable to pump blood effectively High filling pressure due to poorly compliant ventricles LV cannot contract strongly enough to Ventricular hypertrophy (increase in muscle mass and cardiac wall thickness -> from overworking and strain of the heart pump blood into aorta working too hard) common EF usually less than 40% Valvular disease Pumping Filling problem problem Mixed HF (both systolic and diastolic dysfunction) -> those who have this often have a extremally low EF -> indicative of a poor CO and SV and prognosis (poor outcomes) HF: Compensatory Mechanisms 1) SNS Activation: ↑HR, ↑contractility, peripheral vasoconstriction Counter Regulatory 2) Neuro-Hormonal Response (RAS): Na/Water Mechanism: retention, ↑ periph vasoconstriction, ADH causes Atrial Natriuretic Peptide & (BNP) water retention 3) Ventricular Dilation: enlargement of the heart chambers (usually LV), muscle fibres of heart stretch (initially good but over time stretch too far and ↓CO Ventricular Remodeling 4) Ventricular Hypertrophy: ↑ muscle mass and ventricular wall thickness Check In How come some types of heart failure can have a preserved ejection fraction? Why does the kidney release renin in a patient that is in heart failure? Which heart failure compensatory mechanism leads to an increased risk for arrythmias? Types of Heart Failure Acute vs Chronic Left vs Right Sided Acute comes on quickly (often Left sided HF symptoms due to ↓ pulm edema) CO or pulmonary congestion Chronic happens over years (neuro- hormonal activation) Right sided HF symptoms related Acute on Chronic Heart to ↑ systemic venous congestion Failure(long standing Heart failure Failure of one pump will that not develops iscima and backflow) eventually cause other pump to Both are equally life-threatening, fail= biventricular failure need intervention  Right-Sided Heart Failure General Symptoms Weight Gain(most Head to Toe reliable) Jugular vein distension (too much venous return) Increased Swollen hands and fingers BP Anorexia and nausea Distended abdomen (this will press on the stomach, decreasing the amount of space left for the food -> causing person to fell nauseous and not feeling like eating) Enlarged liver and spleen Polyuria at night Dependent edema (when people have been standing all day -> swealing in the feet -> might see it in the calfs, around the knees and even the tighs -> when they lie down -> fluid will disperse, going to the rest of the body -> goes to the kidneys -> increased urination -> edema in the sacrel might develop b/c of the lying down) Left-Sided Heart Failure P U L M O N A RY DECREASED CO CONGESTION Fatigue/Weakness Cough Confusion, Restless Tachycardia Dyspnea Angina Orthopnea Oliguria (less than Paroxysmal Nocturnal Dyspnea normal urine output -> < 400ml in 24 hour) Crackles/Wheezes Pallor, weak peripheral Frothy, pink-tinged sputum pulses, cool extremities (less perfustion) S3/S4 Gallop Check In  Is hepatomegaly a sign of left or right sided heart failure?  What does increased JVP indicate?  What causes crackles to be heart over the lungs when a patient is in heart failure?  What is the difference between pulmonary congestion and pulmonary edema?  Why do people with chronic heart disease get very short of breath at night?  Which symptom is more serious for a patient with HF, a wet cough or a dry cough?  What does rapid weight gain indicate in a patient with heart failure?  Name two reasons why a patient with heart failure is a risk for developing a blood clot? References Lewis, Sharon Mantik, et al. Medical-Surgical Nursing in Canada : Assessment and Management of Clinical Problems. Edited by Jeffrey Kwong and Dottie Roberts, Fourth Canadian edition., Elsevier Canada, a division of Reed Elsevier Canada, Ltd., 2019.