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!