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!