Chapter 53 Congestive Heart Failure and Acute Pulmonary Edema.pptVIP

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Chapter 53 Congestive Heart Failure and Acute Pulmonary Edema.ppt

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Chapter 53 Congestive Heart Failure and Acute Pulmonary Edema

Chapter 53Congestive Heart Failure and Acute Pulmonary Edema September 22, 2005 Epidemiology Leading cause of hospitalization among those 65 Up to 60% rehospitalized within 6 months due to recurrent decompensation Prevelance doubles each decade Cost of HF roughly double that of any cancer diagnosis Prognosis Once symptomatic, 2 year mortality 35%, 6 year mortality 80% men, 65% women 50% survive 1 year after pulmonary edema If cardiogenic shock, up to 85% die after 1 week Classification System NYHA classification system (Table 53-1) is used a prognostic scale AMA classification system (Table 53-1) uses risk factors to determine interventions AMA system recognizes early intervention as greatest potential for reducing morbidity and mortality Pathophysiology Acute pulmonary edema is a downward spiral of decreasing CO and rising SVR in the face of underlying cardiac dysfunction Small elevations of BP can result in decreased CO Decreasing CO triggers increased SVR, which further worsens CO Threats to CO trigger neurohormonally mediated cascade that activates renin-angiotensin-aldosterone system and the SNS Pathophysiology Levels of NE, vasopressin, TNF and endothelin (potent vasoconstrictor) are increased, correlate with mortality Natriuretic peptides (NPs) are the endogenous counterregulatory arm of the neurohormonal activation Three types are recognized: atrial NP, B-type NP (BNP) from ventricles and CNP, localized in endothelium NP’s result in vasodilation, natriuresis, decreased levels of endothelin and inhibition of RAAS and SNS BNP is the only NP for which an assay exists Classification Systolic or diastolic dysfunction, classified by EF Systolic HF defined by EF40%, most commonly from ischemic heart disease Diastolic HF, contractile function preserved, impaired relaxation, chronic HTN and LVH are often responsible Systolic vs Diastolic HF In systolic HF, impaired contractility leads to increased cardiac volumes and pressure, and afterload sensitivity With stres