24 HF Basics
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pump draining water from tank being filled with water from pipe
if pump is working, pumping water out, level of water in tank should be low
pump starts to fail, less water out
water level rises
pump really failed
tank completely filled, overflow
pump = heart
tank = lungs/veins
water = blood
chambers fail, blood left behind
blood exert pressure on wall of heart chamber
LV systolic pressure can be low in some heart failure
LVEDP: always high, hallmark of LHF
top arrow: peak, systolic pressure, may be high or low
bottom arrow: diastolic pressure, always high
systolic HF: less blood pumped out, more left behind
diastolic HF: stiff ventricle, higher pressure
closes MV at earlier point in time before LA empties, rise in LA pressure, LA begins to fail
then, pulmonary capillary pressure rises, classic symptoms
pulmonary capillary, Pc, hydrostatic pressure drives water out into interstitium
LA pressure = 5, pulmonary capillary pressure also 5
if LA P increase to 20 in heart failure, hydrostatic pressure in lung also becomes 20
increase driving force to push fluid out = pulmonary edema
domino effect: LV failure leads to high pressure in venous system, JVD and edema
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CO falls, vasoconstrict to maintain perfusion and BP via Ang II and sympathetic
ECV still down even with high TBW
not enough to overcome RAAS
One in a million: milrinone
Don't phoster disinterest: milrinone inhibits phosphodiesterase
CAMPaign: milrinone decreases breakdown of cAMP
Flexing arm: milrinone increases cardiac contractility
Dilated red donkey ears: milrinone causes arteriolar dilation and decreased afterload. Hypotension SE
Turn the tide: nesiritide
BuMP: nesiritide is a synthetic form of brain natriuretic peptide (BNP)
GruMP: nesiritide increases cGMP in smooth muscle
Dilated red ears and blue legs: nesiritide causes arteriolar and venous dilation, reducing afterload and preload
Salty peanut stream: nesiritide causes natriuresis
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sudden wakening in middle of night feeling SOB
insomnia and sleeping upright with pillows behind
backward failure: symptoms of blood backing up before ventricles, not symptoms from inability to push blood forward
RHF in isolation: high pressure only in pulmonary artery, etc.
cor pulmonale: isolated RHF, normal LH
forward failure: symptoms when LV not pumping blood forward
loss of appetite: poor perfusion to gut, weight loss (cardiac cachexia)
confusion: poor perfusion to brain
narrow pulse pressure: systolic pressure low
can have clear CXR in chronic state
RBC pushed out of capillaries, engulfed by macrophages in lung
find height of bounce, add 5 to it
Normal = 6 = 1 + 5
press on abdomen just below liver
leaves pit behind
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S3 in question: left heart failing, pressure high in LA
S4: more often in diastolic HF
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definitive: heart catheter
