Heart Failure

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!