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3: MED1 Y3 - Cardiovascular [2] > [1] Heart Failure REDO > Flashcards

[1] Heart Failure REDO Flashcards

1
Q

Define heart failure

A

State where the body fails to maintain an adequate circulation for the needs of the body, despite adequate filling pressure

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2
Q

Does heart failure affect one or both sides of the heart?

A

Can be either, however right heart failure rarely occurs on its own

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3
Q

What is it called when both ventricles are affected in heart failure?

A

Congestive heart failure

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4
Q

What can left heart failure be divided into?

A

Systolic and diastolic heart failure

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5
Q

What is systolic heart failure also known as?

A

Heart failure with reduced ejection fraction

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6
Q

What happens in systolic heart failure?

A

The left ventricle looses its ability to contract normally, so the heart can’t pump with sufficient force to push the blood into the circulation

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7
Q

What is diastolic heart failure also known as?

A

Heart failure with preserved ejection fraction

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8
Q

What happens in diastolic heart failure?

A

The left ventricle looses its ability to relax normally, so the heart can’t fill properly during the resting period between each beat

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9
Q

What does Starling’s Curve show?

A

It plots the filling of the heart, or end diastolic pressure, against the cardiac output

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10
Q

What does the force developed in the myocardium depend on?

A

The degree to which fibres are stretched, and so how much the heart is filled

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11
Q

What happens to the force generated by the myocardium in heart failure?

A

The heart can no longer produce the same amount of force for a given amount of filling

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12
Q

What are the risk factors for heart failure?

A
  • Hypertension
  • Coronary artery disease
  • MI
  • Diabetes
  • Some medications
  • Sleep apnoea
  • Congential heart defects
  • Valvular heart disease
  • Certain viruses
  • Alcohol use
  • Tobacco use
  • Obesity
  • Arrhythmias
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13
Q

What medications increase the risk of heart failure?

A
  • Some diabetes medication, such as pioglitazone and rosiglitazone
  • NSAIDs
  • Some cancer drugs, such as cyclophosphamide, fluorouracil
  • Immunomodulating drugs such as infliximab and etanercept
  • TCAs
  • Antipsychotics such as clozapine

As well as many others

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14
Q

What are the causes of left sided heart failure?

A
  • Ischaemic heart disease
  • Hypertension
  • Arrythmia
  • Valvular heart disease
  • Dilated cardiomyopathy
  • Restrictive cardiomyopathy
  • Hypertrophic cardiomyopathy
  • Pericardial disease
  • High output heart failure
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15
Q

What is dilated cardiomyopathy?

A

A disease of the myocardium of the left ventricle, where the heart muscle becomes stretched and thin, and so is unable to pump blood effectively around the body

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16
Q

What causes dilated cardiomyopathy?

A
  • Inherited
  • Viral infections
  • Uncontrolled hypertension
  • Valvular heart disease
  • Excessive alcohol
  • Pregnancy
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17
Q

What are the symptoms of dilated cardiomyopathy?

A
  • Oedema
  • Shortness of breath
  • Excessive tiredness
  • Palpitations
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18
Q

Is there a cure for dilated cardiomyopathy?

A

No

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19
Q

What is the aim of treatment in cardiomyopathy?

A

Reduce symptoms and prevent complications

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20
Q

What are the treatments for dilated cardiomyopathy?

A
  • Medications
  • Pacemaker
  • ICD (implantable cardioverter defibrillator)
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21
Q

What is restrictive cardiomyopathy?

A

When the myocardial cells become replaced by abnormal tissue, such as scar tissue, which causes the muscle wall of the ventricles to become stiff, restricting the movement of the heart

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22
Q

How does restrictive cardiomyopathy cause heart failure?

A

It does not usually affect the pumping action, but restricts filling of the heart, as the ventricular muscle does not relax properly

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23
Q

What causes restrictive cardiomyopathy?

A

Often unknown. Can be genetic, or can be caused by other conditions such as;

  • Scarring of the heart
  • Amyloidosis
  • Haemochromotosis
  • Some cancer treatments, such as radiotherapy
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24
Q

What are the symptoms of restrictive cardiomyopathy?

A

Symptoms may be mild or non-existent until heart failure develops

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25
Q

Can restrictive cardiomyopathy be cured?

A

No

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26
Q

What is hypertrophic cardiomyopathy?

A

An inherited condition where the myocardium becomes thickened, causing it to become stiff. This affects the pumping of the heart

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27
Q

What chamber of the heart is affected in hypertrophic cardiomyopathy?

A

The left ventricle is almost always affected, and in some patients, the right is also affected

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28
Q

What are the symptoms of hypertrophic cardiomyopathy?

A
  • Shortness of breath
  • Chest pain
  • Palpitations
  • Light headedness
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29
Q

What happens to the symptoms of hypertrophic cardiomyopathy with age?

A

They sometimes worsen

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30
Q

Is there a cure for hypertrophic cardiomyopathy?

A

No

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31
Q

What is the goal of treatment in hypertrophic cardiomyopathy?

A
  • Control blood pressure and arrythmias
  • ICD
32
Q

What is pericardial disease?

A

A term that includes several conditions of the pericardium

33
Q

What is the pericardium?

A

A thin fibro-elastic sac that surrounds the heart and separates it from surrounding mediastinal structures

34
Q

What conditions are included under the term ‘pericardial disease’?

A
  • Acute pericarditis
  • Pericardial effusion
  • Cardiac tamponade
  • Pericardial constriction
35
Q

What is acute pericarditis?

A

An inflammatory process involving the pericardium

36
Q

What is a pericardial effusion?

A

An increased amount of pericardial fluid

37
Q

What is cardiac tamponade?

A

When fluid accumulates in the pericardial space, causing an increase in pressure with subsequent cardiac compression and haemodynamic compromise

38
Q

What is pericardial constriction?

A

Abnormal scarring and loss of elasticity of the pericardium, resulting in impaired ventricular filling and decreased CO

39
Q

What is high output heart failure?

A

A condition that occurs when CO is higher than normal, due to increased peripheral demand

40
Q

What initially causes symptoms in high output heart failure?

A

The increased demand, as patients usually initially have normal systolic function

41
Q

What happens to systolic function over time in high-output heart failure?

A

The overload leads to systolic failure, ultimately reducing cardiac output to very low levels

42
Q

What can cause high output heart failure?

A

Conditions that significantly increase the bodys need for blood and oxygen, including;

  • Anaemia
  • Hyperthyroidism
  • Pregnancy
  • Arteriovenous fistula
  • Thiamine deficiency
  • Paget’s disease
43
Q

How is high output heart failure managed?

A
  • Correcting volume overload
  • Treating underlying cause
44
Q

What are the causes of right heart failure?

A
  • Most commonly secondary to left heart failure
  • Chronic lung disease
  • Pulmonary embolism
  • Pulmonary hypertension
  • Pulmonary/tricuspid valvular disease
  • Left to right shunts
  • Isolated right ventricular cardiomyopathy
45
Q

How does left sided heart failure give rise to right heart failure?

A

Left-heart failure raises the pulmonary artery pressure, leading to stress on the right heart and therefore right heart failure

46
Q

Why is the renin-angiotensin-aldosterone system (RAAS) activated in heart failure?

A

In an attempt to maintain cardiac output

47
Q

Where is renin released from?

A
48
Q

What stimulates the release of renin in heart failure?

A

The drop in blood pressure

49
Q

Describe the renin-angiotensin-aldosterone system

A

Renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II by ACE. Angiotensin II is a powerful vasoconstrictor, and promotes the release of aldosterone.

50
Q

What is the effect of RAAS activation in heart failure?

A

The vasoconstriction caused by angiotensin II, as well as salt and water retention caused by aldosterone, increases the blood volume, which has the effect of making an already struggling heart work harder

51
Q

How is the SNS involved in heart failure?

A
  • It causes vasoconstriction of the blood vessels via the alpha1 receptor. This increases the blood pressure, increasing the workload of the heart by increasing both preload and afterload on the heart
  • Sympathetic innervation of the hearts ß1 receptors will also cause an increase in chronotrophy and inotrophy
52
Q

How is heart failure classified?

A

Based on symptoms, from class I - IV

53
Q

What is class I heart failure?

A

No symptomatic limitation of physical activity

54
Q

What is class II heart failure?

A

Slight limitation of physical activity, with ordinary physical activity resulting in symptoms. No symptoms at rest

55
Q

What is class III heart failure?

A

Marked limitation of physical activity, with less than ordinary physical activity resulting in symptoms. No symptoms at rest

56
Q

What is class IV heart failure?

A

Inability to carry out any physical activity without symptoms. May have symptoms at rest, and discomfort increases with any degree of physical activity

57
Q

What are the symptoms of left sided heart failure?

A
  • Fatigue
  • Shortness of breath on exertion, or when lying flat
  • Peripheral oedema
58
Q

What are the signs of left sided heart failure?

A
  • Tachycardia
  • Cardiomegaly
  • 3rd or 4th heart sound
  • Functional murmur of mitral regurgitation
  • Basal pulmonary crackles
59
Q

What are the symptoms of right sided heart failure?

A
  • Peripheral oedema, and dependant pitting oedema
  • Fatigue
  • Dyspnoea
  • Anorexia
  • Nausea
60
Q

What are the signs of right sided heart failure?

A
  • Raised JVP
  • Tender, smooth hepatic enlargement
  • Ascites
  • Pleural effusion
61
Q

What causes normal tissue fluid to form?

A

The balance of Starlings forces pushes fluid out into the intersticium

62
Q

Why does oedema form in heart failure?

A

There is a loss in pumping efficiency, which causes obstruction of venous drainage, as the heart is already too full to accept more blood. This causes venous congestion, and an increase in venous pressure. This increase forces more fluid out into the intersticium, and results in oedema

63
Q

How is heart failure investigated?

A
  • ECG
  • Echocardiogram
  • Serum natiuretic peptides and blood tests
  • Lung function tests
  • Chest x-ray
64
Q

When might an ECG be useful in diagnosing heart failure?

A

When heart failure is caused by arrhythmias. It can also detect heart disease or an enlarged heart, which might indicate heart disease. It also might suggest other diagnoses.

65
Q

What is the purpose of an echocardiogram in diagnosing heart failure?

A

Used to evaluate heart muscle function, to see how well the heart is pumping, and to detect valvular heart disease. It can also be used to measure ejection fraction, which can help differentiate between systolic and diastolic heart failure.

66
Q

What is natriuretic peptide?

A

A substance that induces the excretion of sodium by the kidneys

67
Q

What synthesises and secretes atrial natriuretic peptide (ANP)?

A

Cardiac muscle cells in the atrium of the heart

68
Q

What secretes brain natiuretic peptide (BNP)?

A

The cardiac muscle cells in the heart ventricles (not the brain)

69
Q

What does NICE recommend, regarding serum natiuretic peptide measurement?

A

All patients presenting with acute or chronic heart failure have their serum natriuretic peptide measures

70
Q

What BNP measurement would rule out a diagnosis of heart failure?

A

Less than 100pg/ml

71
Q

What should happen to patients with suspected heart failure with a BNP of 100-400pg/ml?

A

They should be referred to have echocardiography and specialist assessment within 6 weeks

72
Q

What should happen to patients with suspected heart failure with a BNP level of over 400pg/ml?

A

They should be referred to echocardiography and specialist assessment within 2 weeks, due to the poor prognosis associated with very high levels of serum natiuretic peptides

73
Q

Why should peak flow/spirometry, chest x-rays, and blood tests be performed when investigating heart failure?

A

To evaluate possible aggrevating factors, and/or alterative diagnoses.

A chest x-ray may also be able to detect cardiomegaly

74
Q

What should blood tests done to investigate heart failure look at?

A
  • Electrolytes
  • Urea
  • Creatinine
  • eGFR
  • Thyroid and liver function
  • Fasting lipids and glucose
  • FBC
75
Q

How is heart failure managed?

A
  • Lifestyle changes
  • Medication
  • Devices implanted into chest
  • Surgery
76
Q

What lifestyle changes should be made in the management of heart failure?

A
  • Stopping smoking
  • Eating healthily
  • Moderating alcohol consumption
  • Reducing smoking intake
  • Regular exercise
77
Q

What happens in a heart failure rehabilitation programme?

A

Patients are taught about areas such as exercise, education, relaxation, and emotional support

3: MED1 Y3 - Cardiovascular [2] (19 decks)

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