Pathophysiology and Diagnosis of Heart Failure by Christina VanderPluym, for OPENPediatrics

Aug 26, 2023

Pathophysiology and Diagnosis of Heart Failure by Christina VanderPluym, for OPENPediatrics

In this video, Dr. Christina VanderPluym reviews the causes, classification and staging, clinical manifestations, and diagnosis of heart failure.

Initial publication: May 18, 2016
Last reviewed: November 23, 2020

0:00 Intro
00:59 Causes of Heart Failure
08:32 Classification and Staging
15:09 Clinical Manifestations
17:15 Diagnosis
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Content

6.94 -> [Music]

17.96 -> pathophysiology

19.119 -> and diagnosis of heart failure by dr

21.6 -> christina vanderplum

24.8 -> hello my name is dr christina vanderpump

26.72 -> and i am the director of the ventricular

28.4 -> assist device program in the heart

30 -> transplant and heart function program at

32.079 -> boston children's hospital

33.76 -> and today i'm going to discuss heart

35.12 -> failure in children in this two-part

37.28 -> series we're going to first start with

38.719 -> the pathophysiology and diagnosis of

40.64 -> heart failure in infants and children

42.879 -> we're going to start with the causes of

44.399 -> heart failure in infants and children

46.96 -> we're going to follow with the

48 -> classification and staging then

50.239 -> look at the clinical manifestations of

51.92 -> heart failure in infants and children

53.84 -> and finally end with a diagnosis which

55.76 -> consists of the initial evaluation

57.52 -> followed by further evaluation

60 -> causes of heart failure so there are

62.96 -> three main causes of heart failure in

64.799 -> infants and children

66 -> starting with ventricular pump

67.76 -> dysfunction otherwise known as systolic

70 -> dysfunction

70.88 -> so when we consider the heart with two

72.64 -> ventricles or even with some of the

74.08 -> complex congenital anatomies with only

76.32 -> single ventricles the heart functionally

78.32 -> is a pump

79.28 -> and if the pump has any dysfunction then

81.36 -> you're going to have a decrease in

82.4 -> cardiac output as well as sequelae of

84.64 -> backup of all that pressure

86 -> that results in pulmonary and systemic

87.92 -> venous congestion

89.68 -> another cause of heart failure in

90.96 -> infants and children is volume overload

93.36 -> and this can occur in the setting of

94.72 -> both preserved ventricular function as

96.72 -> well as

97.6 -> in settings of ventricular dysfunction

100.32 -> this is otherwise known as increased

101.92 -> preload when there's just an additional

103.6 -> amount of volume within the heart

105.52 -> and these have physiological

106.88 -> consequences of backing up of this fluid

109.439 -> into both the lungs as well as your

110.88 -> systemic venous circulation as well

113.439 -> the last is pressure overload and this

115.84 -> can occur once again in the setting of

117.52 -> preserved ventricular function or

119.439 -> in the setting of ventricular

120.64 -> dysfunction this is otherwise known as

122.96 -> increased afterload or increased

124.719 -> pressure that the heart must work

126.079 -> against

127.2 -> so starting with ventricular pump

128.64 -> dysfunction we

130.239 -> categorize it into both structurally

132.16 -> normal hearts and then congenital

134.16 -> abnormality of hearts

135.84 -> so in considering structurally normal

137.68 -> hearts we have cardiomyopathies

139.68 -> of which there's dilated hypertrophic

142.319 -> restrictive

143.04 -> non-compaction and arrhythmogenic right

144.959 -> ventricular dysplasia

146.72 -> now these different types of

147.72 -> cardiomyopathies just describe the

149.599 -> appearance of the heart

150.8 -> dilated cardiomyopathies are those where

152.879 -> the heart itself

154.08 -> is dilated and enlarged generally the

156.56 -> the wall of the ventricle is thinned out

158.879 -> and associated with the dilation of the

160.4 -> ventricle you get stretching of the

162 -> annulus resulting in either tricuspid or

164.08 -> mitral regurgitation which further

165.84 -> exacerbates the dilation and the

167.44 -> dysfunction

168.64 -> in hypertrophic cardiomyopathy you

170.72 -> actually have preserved

172.08 -> size of the ventricle and if anything

174.48 -> the ventricle cavity becomes small

176.4 -> because of hypertrophy or thickening of

178.319 -> both the ventricular free walls and the

180.4 -> septum

181.599 -> this hypertrophy is generally more

183.599 -> pronounced in the left than the right

185.36 -> however you can get

186.56 -> cases of biventricular hypertrophy the

189.599 -> most severe cases of

191.04 -> hypertrophic cardiomyopathy result in

192.959 -> significant left ventricular outflow

195.04 -> track obstruction which can have

196.319 -> disastrous consequences

198.319 -> of complete cessation of blood flow out

200.64 -> of the heart which can result in either

202.4 -> syncope or ventricular arrhythmias

205.36 -> another cause of ventricular dysfunction

208.319 -> is restrictive cardiomyopathies

210.239 -> this is a unique case of cardiomyopathy

212.48 -> in which the systolic function

214.159 -> i.e the pumping of the heart is actually

216.48 -> preserved however the relaxation of the

218.64 -> heart is dramatically impaired

220.72 -> this impairment and relaxation results

222.799 -> in a build up in pressure in the

224.08 -> ventricle which is then transduced into

226 -> the atriums if it's in the left

228.08 -> ventricle this pressure is then

229.519 -> transduced into the pulmonary

230.959 -> vasculature

231.92 -> which can result in pulmonary edema and

234 -> pulmonary vascular congestion

235.84 -> and this presents clinically as

237.439 -> significant tachypnea

238.959 -> and inability to tolerate any dramatic

241.36 -> changes in their volume status

243.68 -> if it presents on the right side it

245.28 -> results in systemic venous congestion

247.2 -> which manifests as enlarged organs such

249.92 -> as hepatomegaly and splenomegaly

252.959 -> ultimately the appearance of the heart

254.72 -> is very abnormal because the ventricles

256.959 -> stay

257.359 -> a relatively normal size however the

259.6 -> atriums dilate dramatically to

261.519 -> accommodate the increased pressure

263.28 -> and so the appearance of the heart is

264.96 -> that of a mushroom

266.639 -> another cause of cardiomyopathy is

268.56 -> non-compaction

269.68 -> non-compaction is also unique

271.28 -> cardiomyopathy in that

273.44 -> embryologically the myocardium did not

276 -> compact down

277.28 -> as the name states non-compaction and it

279.52 -> appears very spongy and dysfunctional

281.919 -> it's a spectrum of a disorder in which

283.759 -> there are certain cases that are

284.88 -> dramatic

285.84 -> and very severe where the ventricle

288 -> itself is completely disorganized

290.56 -> versus more subtle cases where it just

293.12 -> appears more spongy with increased

294.84 -> trabeculations

296.56 -> and lastly erythrogenic right

298 -> ventricular dysplasia is a type of

299.759 -> cardiomyopathy that

300.96 -> more than often affects the right

302.639 -> ventricle with a pronounced arrhythmia

305.12 -> of ventricular arrhythmia of the right

306.72 -> ventricle

308.32 -> there are also acquired causes of

310.08 -> ventricular dysfunction

311.36 -> myocarditis being the most common

313.68 -> myocarditis is an

314.8 -> infection and inflammation of the

316.56 -> myocardium as the name

318.56 -> states it can be either due to viral

320.72 -> bacterial or

321.759 -> rheumatological abnormalities there are

324.16 -> also certain immunological features that

326.4 -> play a role in myocarditis

329.36 -> and then there are arithmogenic causes

331.36 -> so persistent arrhythmias

333.919 -> such as ventricular or supraventricular

335.84 -> arrhythmias can cause

337.36 -> abnormalities and dysfunction of the

339.52 -> myocardium

340.4 -> that persist even after cessation of the

342.88 -> arrhythmia

344.32 -> and then there's ventricular pump

345.6 -> dysfunction with congenital heart

347.28 -> disease

348.16 -> there are a multitude of complex

349.6 -> congenital heart diseases in which the

351.68 -> myocardium itself

352.96 -> may be dysfunctional there are also

355.12 -> complex congenital heart disease that

356.8 -> have undergone

357.52 -> surgical repairs or palliations and

360 -> following these palliations and repairs

362.16 -> there may be induced dysfunction

364.639 -> secondary to the repair itself

366.639 -> or due to the cardiopulmonary bypass

369.919 -> now as many children are getting

371.36 -> palliated with even more and more

372.96 -> complex anatomy we are seeing children

374.96 -> who are growing up with single ventricle

376.88 -> circulations who have undergone a

378.4 -> multitude of different surgeries

380 -> who later in life also can develop

381.759 -> ventricular dysfunction

383.84 -> the second cause of heart failure in

385.6 -> infants and children can be attributed

387.199 -> to volume overload

389.039 -> i.e increased preload and this occurs

391.84 -> primarily

392.639 -> in situ in two situations of congenital

395.199 -> heart disease

396.319 -> first left to right shunting there are

398.56 -> multitude of different

400.16 -> anatomical defects that can result in

402.08 -> left to right shunting

403.6 -> large ventricular septal defects

406.88 -> patent ductus arteriosus

410.16 -> large atrial septal defects

412.8 -> aeritopulmonary windows

415.52 -> atrioventricular septal defects and

418.88 -> single ventricle circulation with

420.56 -> unobstructed pulmonary blood flow

422.4 -> will all result in increased volume load

424.479 -> to the ventricle

425.84 -> in these circumstances the ventricle

427.84 -> must accommodate this increased volume

430 -> by increasing its ability to squeeze or

432.96 -> its systolic function

434.56 -> it also increases its systolic function

437.84 -> through increasing its heart rate this

439.599 -> results in tachycardia

441.759 -> now in circumstances where the

443.28 -> ventricular function is not normal

445.599 -> its ability to compensate by increasing

447.84 -> its squeeze is impaired and as such it

449.759 -> must

450.08 -> compensate by increasing its heart rate

452.16 -> and so you see a disproportionate amount

453.919 -> of tachycardia in these patients

456.8 -> another cause of volume overload is

458.8 -> valvular regurgitation so this occurs in

461.039 -> the setting of aortic regurgitation

465.12 -> vital regurgitation

468.96 -> and pulmonary regurgitation where once

471.12 -> again there's increased volume

473.039 -> that goes backwards back into the

474.56 -> ventricle the third cause of heart

476.96 -> failure on infants and children

478.08 -> is pressure overload or increased

480 -> afterload once again this is a

481.84 -> circumstance where the ventricle must

483.44 -> now

483.759 -> press or contract against higher

486.4 -> afterload pressures or more distal

488.24 -> pressures

489.199 -> this can occur on both the left and the

490.879 -> right side of the heart

492.56 -> left-sided lesions include aortic

494.4 -> stenosis

498.72 -> or coarctation of the aorta where you

500.639 -> have a fixed obstruction against

502.4 -> which the left side of the heart must

503.919 -> contract in order to extract blood

506.16 -> out of the heart and then there's

508.16 -> right-sided lesions such as pulmonary

509.84 -> stenosis

513.2 -> classification and staging

517.76 -> now let's move on to classifications and

519.76 -> staging of heart failure

521.599 -> in order to fully appreciate the degree

523.919 -> of heart failure you must have some sort

525.6 -> of system in which to identify

527.36 -> and classify patients into the severity

529.92 -> of their heart failure symptoms

532.399 -> over time there have been a multitude of

534.16 -> different classification systems of

535.68 -> heart failure

536.64 -> and because heart failure is a much more

538.32 -> common problem in adults than in

539.92 -> children the majority of our

541.04 -> classification systems were initially

543.519 -> extracted from adult studies the most

546.16 -> well-known classification system for

547.68 -> heart failure is that of the new york

549.2 -> heart association class system

551.04 -> classes one through four the

552.959 -> classification system is actually

554.48 -> relatively simple with class 1 patients

556.72 -> being the least severe and class 4

558.56 -> patients being the most severe

560.56 -> class 1 patients are generally those who

563.2 -> have really

564 -> no symptoms at all these are patients

565.92 -> who are able to conduct most physical

568 -> activities

568.959 -> with little to no exertion and no

571.12 -> symptoms

572.48 -> so class 2 patients are those who only

574.399 -> have slight limitations of physical

576 -> activity these patients are generally

577.68 -> comfortable at rest and complete most

580 -> physical activities with minimal to no

582.16 -> symptoms at all class 3 patients are

584.8 -> those who have marked

586.24 -> limitations with physical activity these

588.48 -> are patients who are comfortable at rest

590.32 -> however less than ordinary activity will

592.72 -> cause symptoms affect

594 -> fatigue palpitation shortness of breath

596.24 -> or anginal pain

598 -> now class 4 patients are the most severe

600.16 -> these are patients who have symptoms

602.32 -> that may be present even at rest and

604.24 -> that their symptoms are aggravated with

605.839 -> even minimal activity

607.6 -> these types of patients generally

608.959 -> require more advanced cardiac therapy

611.12 -> such as iv medications including

613.04 -> diuretics and inotropes

614.64 -> and these are patients who we may

616 -> consider even for heart transplantation

617.92 -> or mechanical circulatory support

620.16 -> because children require a different

621.92 -> classification the roth classification

624.48 -> was created

625.68 -> this classification primarily was used

627.839 -> for infants and small children who

629.44 -> cannot

630 -> exhibit their symptoms as clearly as

631.839 -> adults

633.44 -> once again similar to the new york heart

635.12 -> association class system class 1 are the

637.279 -> least severe patients and class 4 the

639.279 -> most severe patients

640.88 -> class 1 patients would be asymptomatic

643.44 -> class 2 patients

644.88 -> may have mild symptoms such as shortness

647.279 -> of breath or diaphoresis with feeding

649.6 -> but would otherwise be comfortable at

651.2 -> rest older children may also have

653.68 -> shortness of breath when they're doing

655.2 -> some mild activities

656.48 -> class iii patients may have marked

658.399 -> tachypnea or diaphresis with feeding

660.64 -> in small children they also may have

662.8 -> prolonged feeding times and an inability

664.88 -> to grow

665.839 -> with failure to thrive older children

668.16 -> may exhibit symptoms of marked shortness

669.92 -> of breath on exertion with activity

672.64 -> and class 4 patients similar to the new

674.64 -> york heart association classification

676.399 -> will have

676.88 -> marked symptoms even at rest such as

679.519 -> tachypnea

680.32 -> shortness of breath on exertion and in

683.2 -> infants and small children with feeding

685.68 -> another way to look at heart failure is

687.44 -> in stages

688.8 -> many patients may progress through

690.56 -> stages over time

691.92 -> starting with least severe stages and

693.92 -> then progressing to more end

695.6 -> stage forms of heart failure where

697.44 -> advanced therapies are required

699.519 -> different stages of heart failure

700.88 -> require different interventions and

702.24 -> different treatments

703.12 -> and so organizing heart failure in this

705.6 -> manner is helpful

706.72 -> in considering therapeutic strategies in

709.6 -> this system which was adopted from the

711.12 -> america heart association

713.04 -> we look at four stages with stage a

715.279 -> consisting of patients who may have an

717.44 -> underlying risk of cardiac disease but

719.519 -> who currently

720.399 -> have no signs or symptoms of heart

722.88 -> failure an example of this type of

724.48 -> patient

724.959 -> may be a child who is exposed to a

726.639 -> chemotherapy which is known to cause

729.12 -> some form of chemotoxicity-induced

731.04 -> cardiomyopathy

732.399 -> that said this patient would exhibit no

734.639 -> symptoms of heart failure at this time

736.639 -> and on echocardiogram may have normal

738.639 -> cardiac function

740.48 -> another example of this would be a

742 -> patient in whom there is a family

744.24 -> history of a genetic cardiomyopathy

746.639 -> but at this time exhibits no symptoms or

749.519 -> evidence of cardiac dysfunction

752 -> most stage a patients only require

754.079 -> increased surveillance and monitoring

755.68 -> over time but no therapeutic

757.36 -> interventions

759.12 -> stage b patients are those with

761.36 -> functional heart disease

762.959 -> or anatomic heart disease however they

765.76 -> currently have no symptoms of heart

767.6 -> failure

768.88 -> some of these patients may have a

771.12 -> decrease in the ventricular function

773.279 -> however they exhibit no signs or

775.92 -> symptoms of heart failure as evidenced

777.839 -> by normal vital signs and a normal

779.76 -> growth velocity

782.079 -> stage c patients are patients with

784.24 -> structural or functional heart disease

786.32 -> who have had in the past or who

788.24 -> currently do have

789.36 -> signs and symptoms of heart failure and

791.92 -> finally stage d

793.04 -> are patients with end-stage heart

794.56 -> failure in considering the stages of

796.639 -> heart failure

797.519 -> one can look at the different

798.56 -> therapeutic strategies that can be used

800.24 -> at each stage

801.519 -> for stage a these are patients who have

804.48 -> potential exposure or increased risk of

806.639 -> heart disease but who have currently no

808.399 -> evidence of ventricular dysfunction or

810.639 -> signs and symptoms of heart failure

812.48 -> these patients would only warrant

813.839 -> increased surveillance and observation

815.76 -> over time

816.48 -> but no actual therapies stage b patients

820.32 -> could potentially benefit from

822.079 -> medications such as an ace inhibitor

824.48 -> if they had systemic ventricular

826.079 -> dysfunction an example of this type

828 -> of patient would be someone with a mild

829.8 -> cardiomyopathy be it dilated

832.32 -> or other familial types of

833.839 -> cardiomyopathies in which their

835.519 -> ventricular function may be mildly

837.44 -> impaired but they exhibit no signs and

839.199 -> symptoms of heart failure

840.72 -> the role of an ace inhibitor is to

842.56 -> decrease the afterload such that the

844.48 -> heart must work

845.36 -> less and consume less oxygen in order to

848.32 -> push against

849.199 -> low against those afterload pressures

851.92 -> the goal of this would be to prevent

854.16 -> maladaptive fibrosis as well as other

856.56 -> maladaptive sympathetic activation that

858.88 -> occur

859.68 -> in more advanced forms of heart failure

862.24 -> stage

862.8 -> c patients may require more medications

866.56 -> this is because these patients not only

868.48 -> exhibit functional

870 -> or anatomic heart disease but they also

872.24 -> have symptoms

873.36 -> some of these medications could include

875.199 -> ace inhibitors aldosterone antagonist

877.519 -> and beta blockers

878.8 -> for the positive benefits of reverse

880.639 -> remodeling but also

882.399 -> low dose digoxin and diuretics for

884.639 -> symptomatic relief

886 -> and lastly stage d patients are those

888.24 -> with end-stage heart failure

889.76 -> who not only have significant functional

892.32 -> heart disease

893.279 -> but who are symptomatic due to that

896.079 -> heart disease

897.12 -> these patients need not only medical

899.839 -> therapy

900.56 -> but may go on to require more invasive

902.48 -> therapies such as positive pressure

904 -> ventilation

904.8 -> mechanical circulatory support and even

907.199 -> heart transplantation

910.32 -> clinical manifestation

914.399 -> now let's move on to the clinical

915.76 -> manifestations of heart failure

918.32 -> heart failure can present in a variety

920.079 -> of different ways and since we're

921.92 -> considering

922.72 -> infants all the way up to adolescence

924.639 -> its presentation can be very variable

927.36 -> the most important thing to start with

929.12 -> in considering the clinical

930.079 -> manifestation is the history

931.92 -> you may get a very varied history

933.759 -> depending on the age of the patient and

935.519 -> it's important to ask specific questions

937.92 -> that are age appropriate for the patient

941.12 -> in infants a common presentation of

943.36 -> heart failure is tachypnea

945.199 -> poor feeding and diaphoresis their

948.079 -> inability to feed adequately

950.079 -> results in poor weight gain and as such

952.24 -> many of these patients present with

953.759 -> failure to thrive in cachexia

956.639 -> in younger children their presentation

958.399 -> can be very variable and

959.92 -> many times heart failure is mistaken for

962.24 -> either a viral syndrome

964.079 -> or for asthma signs and symptoms can

966.88 -> include

968.56 -> malaise fatigue vomiting gi pain and

971.6 -> recurrent cough

973.44 -> in older children once again many

975.839 -> symptoms of heart failure can be

977.199 -> mistaken

977.92 -> for viral symptoms or for asthma

981.04 -> they usually present with exercise

982.639 -> intolerance abdominal pain

984.639 -> recurrent vomiting wheezing cough

987.68 -> edema and palpitations the physical exam

990.72 -> is also a very important aspect of

992.56 -> identifying heart failure

994.24 -> and trying to stage its severity signs

996.72 -> can include

997.519 -> tachycardia tachypnea diminished pulses

1000.959 -> such as cool extremities

1002.72 -> that can appear mottled and hypotension

1005.6 -> on cardiac auscultation you may also

1007.839 -> hear an

1008.32 -> s3 otherwise known as a gallop which is

1010.72 -> secondary to volume and pressure

1012.32 -> overload

1018.8 -> signs of pulmonary congestion include

1021.279 -> wheeze

1021.839 -> rails tachypnea and there can also be

1024.48 -> signs and symptoms of systemic venous

1026.559 -> congestion which include

1027.919 -> edema generally pedal edema and older

1030.88 -> children

1031.439 -> and ascites or abdominal distention in

1034.319 -> younger children

1036.839 -> diagnosis moving on to the diagnosis

1040.559 -> generally we first start with a more

1042.319 -> thorough initial evaluation

1044.24 -> and depending on the results of the

1045.6 -> initial evaluation we can then move on

1047.919 -> to further tests

1049.6 -> the initial evaluation not only consists

1052.24 -> of the history and the physical exam

1054.16 -> but also some investigations such as the

1056.559 -> chest radiography

1058 -> chest x-ray is important in identifying

1060.08 -> cardiomegaly which may be evident in

1061.919 -> patients with dilated cardiomyopathy

1064.4 -> increased pulmonary vascular markings

1066.32 -> which can be a sign of pulmonary

1067.84 -> congestion or left atrial hypertension

1070.559 -> and by atrial enlargement biatrial

1072.96 -> enlargement

1073.76 -> is evident in patients with restrictive

1075.6 -> cardiomyopathy

1076.799 -> who have atrial dilation due to the

1078.72 -> increased pressure in the ventricles

1081.6 -> the electrocardiogram can also be

1083.44 -> helpful in identifying heart block

1086.24 -> or increased voltages which is evident

1088.559 -> in patients with hypertrophy

1090.64 -> decreased voltages is also seen in

1092.48 -> patients with myocardial edema or

1094.24 -> effusion

1095.039 -> which is evidenced in patients with

1096.72 -> myocarditis

1098.24 -> as well as seeing st segment changes

1101.44 -> the echocardiogram is likely your most

1103.52 -> helpful diagnostic tool in heart failure

1106.48 -> not only will it provide a complete

1108.08 -> anatomical survey

1109.52 -> of the patient it also can provide a

1111.679 -> functional assessment of both the right

1113.52 -> and the left ventricle

1115.28 -> blood tests include a complete blood

1117.12 -> count to assess for any

1118.88 -> evidence of anemia or even compensatory

1121.84 -> increase in hematocrit which may be seen

1123.679 -> in patients with chronic low output or

1125.679 -> cyanosis

1127.44 -> serum electrolyte abnormalities blood

1129.84 -> urea nitrogen and creatinine for

1131.76 -> evidence of any renal dysfunction

1133.6 -> and liver function tests additional

1136 -> blood tests

1136.799 -> include troponin creatinine kinase

1140.24 -> and c-reactive proteins these are

1143.12 -> inflammatory markers as well as markers

1145.44 -> that are directly released by the

1146.88 -> myocardium

1148.08 -> they can be helpful in the

1149.12 -> identification of myocarditis or other

1151.28 -> inflammatory induced myocardial diseases

1154.24 -> another important biomarker is brain

1156.72 -> natural peptide

1158.16 -> otherwise known as bnp bnp has been

1161.6 -> extensively evaluated an adult

1163.52 -> population as a sensitive and specific

1165.919 -> biomarker

1166.96 -> for patients with heart failure it can

1169.6 -> correlate with the severity of the

1171.12 -> disease with an increase in bnp

1173.2 -> correlating with patients with worse

1175.6 -> ejection fraction and more

1177.12 -> severe heart failure symptoms its

1179.76 -> utility in the pediatric population is

1181.919 -> expanding greatly

1183.28 -> and there are multitude of studies that

1184.96 -> now show that bnp can be used as a very

1187.679 -> important diagnostic tool

1189.52 -> in deciphering and discriminating

1191.679 -> patients with heart failure symptoms

1193.52 -> versus other types of respiratory

1196 -> diseases such as asthma or restrictive

1199.039 -> pulmonary disease

1200.4 -> following the initial evaluation there

1202.32 -> are further modalities to identify the

1204.64 -> cause

1205.2 -> as well as characterize the severity of

1206.96 -> heart failure these include

1208.96 -> magnetic resonance imaging that can not

1211.28 -> only help with identifying complex

1213.2 -> anatomy

1213.919 -> and understanding ventricular dimensions

1215.84 -> and function but can also have more

1218.24 -> sophisticated

1219.6 -> tests which can look at distinguishing

1222.64 -> types of cardiomyopathies

1224.159 -> such as restrictive from constriction

1227.52 -> identifying edema or hyperemia which is

1231.039 -> commonly seen in patients with

1232.48 -> myocarditis

1233.679 -> having a better evaluation of rv

1235.6 -> function as well as characterizing the

1237.84 -> degree of myocardial fibrosis

1240 -> with a type of imaging such as late

1242.48 -> gadolinium

1243.44 -> mri cardiac catheterization is also a

1246.72 -> helpful test in the armamentarium of

1248.64 -> identifying and characterizing heart

1250.64 -> failure

1251.52 -> not only does this help identify the

1253.6 -> etiology of heart failure by doing an rv

1255.919 -> endomyocardial biopsy that can be then

1258.08 -> sent for histology and genetic testing

1261.2 -> but direct hemodynamic measurement of

1264.4 -> pressures within the heart allows for

1266.64 -> calculation of systemic and pulmonary

1268.64 -> vascular resistance as well

1270.64 -> as determination and direct measurement

1272.96 -> of cardiac output

1274.559 -> so this concludes the pathophysiology

1276.96 -> and diagnosis of heart failure in

1278.64 -> children

1279.44 -> and infants please help us improve the

1283.039 -> content by providing us with some

1288.84 -> feedback

1296.72 -> you

Source: https://www.youtube.com/watch?v=GZAnIF0dO0U