Heart Failure Explained Clearly - Congestive Heart Failure (CHF)

Aug 26, 2023

Heart Failure Explained Clearly - Congestive Heart Failure (CHF)

An overview of heart failure by Dr. Roger Seheult of https://www.medcram.com/?utm_source=Y…
Includes symptoms, definitions, ejection fraction (EF), pathophysiology, ischemic heart disease, congestive heart failure (CHF), the role of hypertension (HTN) and more.

This is video 1 of 3 on heart failure (HF):

0:36 basic heart physiology
0:55 pulmonic circulation
1:04 systemic circulation
2:00 heart failure - congestion
2:35 reduced kidney function
2:55 reno-angiotensin system
3:04 anti-diuretic hormone
3:24 Cheyne-Stokes respiration
3:44 heart failure - pulmonary edema
3:55 heart failure - liver congestion (AST, ALT increase, nutmeg liver)
4:12 increased pulmonary artery pressure
4:23 heart failure - pedal edema
5:30 systole
5:38 diastole
6:15 systolic dysfunction
6:21 diastolic dysfunction
6:32 ejection fraction
9:01 heart failure - new classification
9:36 heart failure - reduced ejection fraction (HFREF)
10:19 heart failure - normal ejection fraction (HFNEF)
11:27 ischemic heart disease
12:11 hypertension

Speaker: Roger Seheult, MD
Clinical and Exam Preparation Instructor
Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine.

MedCram: Medical topics explained clearly including: Asthma, COPD, Acute Renal Failure, Mechanical Ventilation, Coronary Artery Disease, Cardiomyopathy, Oxygen Hemoglobin Dissociation Curve, Hypertension, Shock, Diabetic Ketoacidosis (DKA), Medical Acid Base, VQ Mismatch, Hyponatremia, Liver Function Tests, Pulmonary Function Tests (PFTs), Adrenal Gland, Pneumonia Treatment, any many others. New topics are often added weekly- please subscribe to help support MedCram and become notified when new videos have been uploaded.

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Produced by Kyle Allred PA-C

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Content

2.01 -> well welcome to another MedCram lecture we're going to talk about heart

5.43 -> failure today now sometimes this can be a little confusing because there's a lot

9.09 -> of different definitions this was known as congestive heart failure and there's

14.099 -> been some new definitions that have been introduced that have been a little bit

17.58 -> confusing as well and we're going to go over the basics first here in the first

21.72 -> lecture and tell you a little bit about the definitions and also the path of

26.22 -> physiology behind heart failure now generally speaking if you look at the

30.869 -> heart and we will symbolize that here with actual heart remember the heart is

36.96 -> just a pump and you've got blood going into it and by definition all blood that

44.91 -> goes to the heart must go to the heart via veins and then you have blood coming

50.76 -> out of the heart and by definition those are arteries now of course in the

56.879 -> pulmonic circulation the arteries have deoxygenated blood and the vein has

63.11 -> oxygenated blood and in the systemic circulation all of the arteries have

68.57 -> oxygenated blood and all of the veins have deoxygenated blood and we'll talk

73.83 -> about that a little bit later but as you can see the heart is meant to pump blood

79.14 -> and have it flowing in the correct direction generally speaking if you have

84.06 -> heart failure you're not going to get as much blood going forward and you're not

89.13 -> going to get as much blood going in and so as a result the two major types of

95.97 -> symptoms that you're going to see in heart failure is not enough forward flow

104.689 -> and because there's not enough forward flow blood stays in the heart and as a

112.86 -> result of that blood which should be entering the heart is not entering the

116.759 -> heart and as a result of that you're going to see congestion before it okay

126.09 -> this is like an accident on the freeway there is no traffic in front of the

130.11 -> accident because there's not enough forward flow but we certainly know

133.86 -> there's plenty of traffic before the accident and there is quite a bit of

138.21 -> congestion now things would be pretty simple in this situation if this is all

143.73 -> that we had and so we're gonna get into a little bit more detail but let's look

147.39 -> at how these symptoms manifest themselves not enough forward flow could

152.4 -> mean number one kidney function decreases just think about all of the

162.959 -> organs which are all of them that rely on blood perfusion and if the kidneys

169.05 -> are not getting enough blood you're going to have kidney function decreasing

172.739 -> that of course is going to activate the reno angiotensin system or the Rass

180.06 -> system it will also activate the anti diuretic hormone system of course this

188.85 -> is going to increase the amount of fluid retention that you have and that could

192.18 -> exacerbate your congestive heart failure number two think about your pulmonary

198.209 -> system and think of chain Stokes respirations okay so not enough carbon

211.049 -> dioxide is circulating and therefore you get chained Stokes ventilation where you

215.85 -> breathe fast and then you breathe slow a lot of the symptoms that you see are on

221.13 -> the congestion side and so certainly when you have congestion the first organ

225.959 -> that it goes to is the lung so think of pulmonary edema but if it keeps backing

234.36 -> up you know that the next organ it's going to go to is the liver so liver

238.26 -> congestion so you could see the ast and alt go up this is also known as nut Meg

247.83 -> liver because if you do a cross-sectional of the liver it would

251.85 -> look like there is nutmeg you would also get elevated pulmonary artery pressures

264.79 -> and also think of pedal edema

270.48 -> so these constellation of symptoms can be divided in problems associated with

275.74 -> poor output and problems associated with poor input or congestion and in any

282.34 -> heart failure you could see both of these types of symptoms now I want to

287.44 -> talk about the heart itself now the heart we set as a pump but it's not your

293.11 -> typical swimming pool pump which you just turn on and just runs continuously

296.77 -> it actually has two very distinct actions it has an action of active

303.67 -> contraction and it also has an action of active relaxation and it's this active

310.27 -> relaxation that is the most misunderstood and so there are two

314.8 -> phases of this pump if you will a two stroke pump where there is one phase

320.92 -> called systole and there is another phase called diastole now systole is

334.39 -> where there is active contraction

339 -> diastole is when there is active relaxation if you have a problem with

349.45 -> either of these two functions you could get congestive heart failure systole is

355.39 -> when the heart is pumping blood actively into the aorta and to the systemic

359.89 -> circulation and pulmonic circulation when it relaxes however blood enters

364.78 -> from the veins into the heart both the pulmonic vein and also the inferior vena

370.09 -> cava and allows the heart to fill if the heart can't contract you have something

379.48 -> called systolic dysfunction if the heart can't relax you have something called

385.35 -> diastolic dysfunction there is something that is known as the ejection fraction

393.33 -> otherwise known as the e F the ejection action is simply the size of the heart

404.95 -> @n diastole in other words the size of the heart when it's the largest - the

418.58 -> size of the heart at and systole in other words the size of the heart after

427.94 -> it contracts so in other words what we're looking at here is how much blood

431.66 -> was pumped out of the heart and we divide it by the size of the heart at

438.86 -> the end of diastole so what we're saying here is that the ejection fraction is

447.2 -> the proportion of blood that the heart can pump out in one contraction the

455 -> thing I want you to notice is that if the heart has a hard time contracting

459.76 -> this number up here is going to get smaller but this number is going to stay

468.86 -> the same let's review that again if there's a problem with systole if the

474.05 -> heart is too weak to contract then these numbers are going to be very similar and

480.23 -> therefore the difference between them is going to be very low this number will

485.12 -> not change however and so the ejection fraction will go

488.93 -> down in systolic dysfunction however in diastolic dysfunction

495.43 -> remember what the problem is the problem is is that the heart can't relax and as

502.31 -> a result of the heart not being able to relax this number will go down and as a

508.16 -> result when you have a small heart that can't relax there's not a lot of blood

514.219 -> that you can pump out of a small heart and so therefore what happens in this

518.479 -> situation is this will stay about the same or if it goes down this also goes

528.05 -> down and so as a result the ejection fraction and diastolic

534.54 -> dysfunction is about the same it doesn't change and this distinction

540.12 -> has been made with the new classification let's talk about that

543.36 -> officially speaking this is the new terminology there's something called

547.769 -> heart failure due to reduced ejection fraction and then there is heart failure

561.14 -> with normal ejection fraction now if you notice here is the reduced here is the

574.529 -> normal that's all you really need to look at you know that if you have a

578.19 -> reduced ejection fraction then you have systolic dysfunction

590.78 -> and the problem here is that blood cannot be ejected out of the heart blood

598.9 -> can't get out as a result of the fact that blood can't get out then

609.46 -> blood can't get in to the heart okay now with a normal ejection fraction what's

621.71 -> the problem here the problem is is that blood can't get into the hearts because

627.77 -> the muscles won't relax when the muscles don't relax they can't

631.97 -> relax enough to allow the blood to come into the heart during diastole and so

636.23 -> here the problem is is the blood can't get in and as a result of the fact that

642.8 -> the blood can't get into the heart the blood can't come out of the heart the

646.61 -> heart can't pump that blood out if it's not getting in blood can't get out

653.69 -> notice you have the same problems in both types of heart failure but the key

659.6 -> is is the why the reason why you have heart failure due to a normal ejection

665.15 -> fraction is because blood can't get in the reason why you have heart failure in

671.15 -> a reduced ejection fraction is because blood can't get out now what are some of

677.9 -> the causes of these things let's talk about reduced ejection fraction so

685.1 -> things that can cause reduced ejection fraction would be ischemic heart disease

693.19 -> so you haven't had enough oxygen going to the heart and as a result of that

698.3 -> tissue has died and it's no longer functional it's weak if parts of the

704.18 -> whole muscle die you can even have aneurysms of the heart muscle so ask

707.96 -> emic heart disease is classic think of this in coronary artery disease people

714.08 -> that have had cabbage people with diabetes okay so what's the problem in

720.31 -> normal each action fraction well remember here is that blood

724.61 -> and get into the heart and the reason why blood can't get into the heart is

728.829 -> because they've had hypertension for so long that their muscles are so thick

735.95 -> that they can't relax anymore so the big one here is hypertension almost

742.22 -> certainly so think of these in patients with a normal ejection fraction and

747.49 -> they've got thickened myocardium left ventricular hypertrophy these people

753.589 -> still benefit from lasix because remember blood can't get in

757.519 -> there for blood can't get out and if blood can't get in it's going to congest

762.23 -> into the pulmonary circulation so the key that I want you to remember here is

767.12 -> if you suspect somebody has congestive heart failure and you get an

770.81 -> echocardiogram and the ejection fraction is greater than 40 percent you really

776.24 -> can't say that this patient doesn't have congestive heart failure because they

780.17 -> very well certainly can they would have heart failure with a normal ejection

784.91 -> fraction we'll talk later about some of the other aspects of heart failure

788.57 -> please join us for our next video thanks for joining us

792.15 -> you

802.97 -> you

Source: https://www.youtube.com/watch?v=GwrinrcguyE