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Systolic and Diastolic Heart Failure (Boards and Beyond) (High output…

- - - - Decreased compliance( stiff ventricles)
      - Myocytes become thicker, not longer
        
        sarcomeres added in parallel
      - response to pressure overload in ventricle
        
        seen in
        
        Aortic stenosis
        
        HTN
      - Often seen in diastolic HF
    - - Eccentric Hypertrophy leading to dilation
        
        myocytes are growing in size: longer
        
        sarcomeres are being added in series
        
        walls arent thicker
        
        Volume overload
        
        Chronic retention of fluid in cavity
      - systolic HF( red EF) w/ LV cavity dilation
    - - Seen only in end stage HF
      - Confusion
      - Cachexia
      - Cool extremities
    - - decreased in CO (in dia too)
      - LV contractility issue, can't get blood out
      - Contractility shifts ESPVR (end sys pressure vol relationship) line. Shifts Right.
        
        smaller SV
        
        Higher afterload (high ESV)
        
        Also rise in EDV
        
        EDV related to ESV (which is elevated)
        
        Slight increase in End dia pressure
    - - R shift in falling contractility
      - any given preload, lower contractility
    - - MI
      - CAD
      - myocytes replaced by scar
        
        ischemic cardiomyopathy
        
        reduced LVEF
      - Non-common
        
        50% idiopathic
        
        nonischemic
        
        Viral
        
        follow URI
        
        virus enters myocytes » myocarditis »cardiomyopathy
        
        often myocarditis is asymptomatic until systolic HF
        
        Cocksackie
        
        flu
        
        adenovirus
        
        Peripartum Cardiomyopathy
        
        late in preg. 3rd tri or early postpartum
        
        unknown etiology
        
        Women advised to avoid future pregnancy
        
        Chemotherapy
        
        anthracyclines
        
        Antitumor antibiotics
        
        Doxyrubicin
        
        Daunorubicin
        
        Gene mutations
        
        sarcomere proteins
        
        ßmyosin heavy chain
        
        a myosin heavy chain
        
        Troponin
        
        AutoDom, some AR XLR
        
        tachycardia mediated Cardiomyopathy
        
        constant rapid HR over weeks months
        
        leads to depression of LV systolic Fn
        
        reversible by treating arrhythmia and slowing HR
        
        Takotsubo Cardiomyopathy, Apical balooning
        
        Stress induced cardiomyopathy
        
        emotional stress: catecholamine stunning
        
        Leads to depressed LVEF
        
        Increased CK, MB, Troponin
        
        EKG changes
        
        Appears IDENTICAL TO ANTERIOR MI
        
        however no coronary disease on angiogram
        
        Resolve in 4-6 weeks
        
        what?
        
        Base of heart remains contractile, apex does not
        
        common in Japan: octopus trap
        
        Alcohol
        
        alcoholic cardiomyopathy
        
        toxic metabolites damage heart
        
        recovers w/ cessation
  - - - falling Lusitrophy (more stiffness)
        
        decreased CO
        
        stiffness causes blood to not come in as much
        
        LV end diastolic Pressure shifted left (raises)
        
        major difference (stiffness)
        
        leads to signs and symptoms of HF
        
        small decrease in SV
        
        notice difference btw Systolic HF
    - - unknown
      - concomitant w/ concentric Hypertrophy
      - Associations
        
        diabetes
        
        Age
        
        HTN
      - Other terms
        
        heart failure w/ preserved EF
        
        Diastolic Dysfunction
- - - - blood is thin
    - - pumping blood directly into a venous system