heart failure
causes
ischemic heart disease: heart tissue compromised, unable to generate adequate pressure
hypertension leading to LVH: coronary circulation unable to meet demand, restrictive cardiomyopathy
cor pumonale: right sided heart failure due to pulmonary issues
cardiomyopathies: ischemic, dilated, restrictive, hypertrophic
dysrhythmias: irregular heart rhythm may precipitate failure, both tachyarrhythmias and bradyarrhythmias
cardiac infection: endocarditis, myocarditis
pulmonary embolism: acute RV failure due to increased pulmonary artery pressure
heart valve abnormalities
mitral regurgitation (insufficiency): may occur after transmural LV MI, valve does not close properly, backward flow into right atrium
aortic stenosis: LV must generate more pressure to eject blood, LVH develops
risk factors
age
ethnicity
family history
diabetes
obesity
sleep apnea
congenital heart defects
lifestyle
smoking
sedentary
mediations
anabolic steroids
viral myocarditis
alcohol abuse
kidney conditions
ventricular failure
LVF
can occur with both diastolic (can't fill) and systolic (can't eject) forms
forward effects
decrease perfusion
activate SNS, RAAS
backward effects
hydrostatic pressure backup into pulmonary circulation
crackles, orthopnea, paroxsymal nocturnal dyspnea (PND)
cerebral symptoms: confusion, memory loss, anxiety
constitutional symptoms: decrease blood flow to GI tract, muscle weakness, poor urinary output, cold and pale extremities
RVF
backward effects are most significant: JVD, increased central venous pressure, hepatomegaly, splenomegaly, ascites, hepatojugular reflex may be present, venous congestion of GI tract causing anorexia, nausea
hypoxia and cyanosis may develop
peripheral edema
treatments
lifestyle modifications
exercise, low sodium diet, smoking cessation
medications
diuretics: reduce fluid volume
aldosterone antagonist
ACE inhibitors: block angiotensin-converting enzyme, cornerstone of heart failure treatment
cardiac transplants
left ventricular assist device: pump that enhances LV ejections, helps pump blood into aorta
cardicac transplantation: based on age and presence or absence of comorbidities, compatibility of donor and recipient