# 24 HF Basics

## Pathogenesis

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/HF%20pathogenesis/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/201SyDy.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/6bOnrZz.jpg)

* 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

![](https://f001.backblazeb2.com/file/wikiFiles/LBGKskz.jpg)

* pump starts to fail, less water out
* water level rises

![](https://f001.backblazeb2.com/file/wikiFiles/VGvWqfz.jpg)

* pump really failed
* tank completely filled, overflow

![](https://f001.backblazeb2.com/file/wikiFiles/qJh1DD5.jpg)

* pump = heart

![](https://f001.backblazeb2.com/file/wikiFiles/v58Vkdg.jpg)

* tank = lungs/veins

![](https://f001.backblazeb2.com/file/wikiFiles/UwOPfIb.jpg)

* water = blood

![](https://f001.backblazeb2.com/file/wikiFiles/5vVp99M.jpg)

* chambers fail, blood left behind
* blood exert pressure on wall of heart chamber

![](https://f001.backblazeb2.com/file/wikiFiles/pfM7TK2.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/w5ifSqj.jpg)

* 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

![](https://f001.backblazeb2.com/file/wikiFiles/Huzrt8b.jpg)

* 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

![](https://f001.backblazeb2.com/file/wikiFiles/T0zP9qX.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/Tr9x2Iu.jpg)

* pulmonary capillary, Pc, hydrostatic pressure drives water out into interstitium

![](https://f001.backblazeb2.com/file/wikiFiles/2CBZ1aI.jpg)

* 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

![](https://f001.backblazeb2.com/file/wikiFiles/m4Nel80.jpg)

* domino effect: LV failure leads to high pressure in venous system, JVD and edema

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/HF%20water%20retention%20pathogenesis/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/r7IW5vU.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/ReBAEPy.jpg)

* CO falls, vasoconstrict to maintain perfusion and BP via Ang II and sympathetic 

![](https://f001.backblazeb2.com/file/wikiFiles/JxqQOY4.jpg)

* ECV still down even with high TBW

![](https://f001.backblazeb2.com/file/wikiFiles/Zg08zuu.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/XXE9cbT.jpg)

* not enough to overcome RAAS

![](https://f001.backblazeb2.com/file/wikiFiles/cG4kwC5.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/a053f19.jpg)

* 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

## Symptoms

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/HF%20symptoms,%20left%20and%20right.%20Backward%20and%20forward%20failure,%20lung%20biopsy,%20JVP)..

![](https://f001.backblazeb2.com/file/wikiFiles/LbKcMlR.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/kWRuIZt.jpg)

* 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

![](https://f001.backblazeb2.com/file/wikiFiles/2dOkh3P.jpg)

* RHF in isolation: high pressure only in pulmonary artery, etc.
* cor pulmonale: isolated RHF, normal LH

![](https://f001.backblazeb2.com/file/wikiFiles/qWmqBnW.jpg)

* 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

![](https://f001.backblazeb2.com/file/wikiFiles/pmMp6V2.jpg)

* can have clear CXR in chronic state

![](https://f001.backblazeb2.com/file/wikiFiles/CRLlwY7.jpg)

* RBC pushed out of capillaries, engulfed by macrophages in lung 

![](https://f001.backblazeb2.com/file/wikiFiles/iDAtO1S.jpg)

* find height of bounce, add 5 to it
* Normal = 6 = 1 + 5

![](https://f001.backblazeb2.com/file/wikiFiles/rEm2LoS.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/7CPZSnM.jpg)

* press on abdomen just below liver

![](https://f001.backblazeb2.com/file/wikiFiles/AjggYci.jpg)

* leaves pit behind

### Heart Sounds

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/heart%20failure%20heart%20sounds/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/IYbYfix.jpg)

* S3 in question: left heart failing, pressure high in LA
* S4: more often in diastolic HF

## Diagnosis

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/HF%20diagnosis/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/RxGMzhX.jpg)

* definitive: heart catheter