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State of impaired cardiac pumping ability; the heart cannot keep up with oxygen demands; results in dyspnea & fatigue, ↓ exercise tolerance, fluid retention, pulmonary congestion, peripheral edema

  • Etiology: CAD, HTN, abnormal myocardium (MI, cardiomyopathy, hypertrophy, conduction changes), valve abnormalities, arrhythmias, congenital deformities
  • Clinical syndrome: results from defects in ventricular filling (diastolic HF), or ↓ ventricular contractility (systolic HF); both lead to ↓ stroke volume & ↓ CO
  • Precipitating factors for exacerbation → MI/ischemia, Medication (noncompliance, inappropriate/inadequate therapy); Anemia; Drugs (negative inotropes (antiarrhythmics, β-blockers, non-DHP CCBs, etc.)), Diet (nonadherence to Na+/H2O restrictions); Hypertension; Arrhythmia (atrial fibrillation); Thyroid; Toxic (ethanol, cocaine, doxorubicin, methamphetamines, etc., or infection); Embolism; Renal failure → MMADDHATTER
  • Terminology
    • Acute decompensated HF (ADHF) → abruptly worsening or new-onset HF; associated with volume overload
    • Systolic HF → large dilated heart, ↓ pumping ability, ↓ LVEF, ↓ O2 perfusion → SOB, fatigue, exercise intolerance, BP normal or ↓, S3 gallop, poor prognosis
    • Diastolic HF → small LV, concentric hypertrophy, impaired LV relaxation/filling (↑ preload: severe HTN, valvular disease, ischemia, etc.), normal or ↑ EF, ♀ > ♂, S4 gallop, therapy not well established, prognosis not as poor as systolic HF
    • Left-sided → LV dysfunction (systolic or diastolic) → pulmonary edema
    • Right sided → RV dysfunction  → systemic volume overload; JVD, peripheral edema, hepatic congestion, often caused by left-sided HF
    • Congestive symptoms → “congestive HF” & “CHF” nonpreferred terminology; refers to symptoms of fluid retention, SOB, pulmonary or systemic edema, JVD, rales
  • Compensatory mechanisms—physiological pathways intended to maintain CO during ↓ in BP/renal perfusion; persistent ↓ CO → long-term compensation, causing functional, structural, biochemical, molecular changes; adaptive responses become harmful & contribute to disease progression

Table 2-1 Heart Failure Classification & Staging
Table 2-2 Compensatory Responses to Decreased Cardiac Output

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