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Cardiovascular System > 15. Heart Failure > Flashcards

15. Heart Failure Flashcards

1
Q

Define heart failure

A

Inability of heart to supply blood to tissues sufficient to meet their metabolic needs, or achieved at the expense of elevated filling pressures

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2
Q

Simply put what is heart failure?

A

Inability of the heart to keep up with demand

Leads to inadequate perfusion of organs

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3
Q

List the different types of heart failure

A

Left vs Right
Chronic vs Acute
HFrEF vs HFpEF

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4
Q

Describe left heart failure

A

Dysfunction associated with left ventricle
Ejection or filling issue
Blood backs up into the lungs causing congestion, increases pressure in lungs, hydrostatic pressure increased, fluid leaks into 3rd space, causes respiratory symptoms
(Breathlessness, coughing, dizziness)

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5
Q

Describe right heart failure

A

Dysfunction associated with the right ventricle
Ejection or filling issue
Increased afterload of the pulmonary circulation (pulmonary hypertension) means Right ventricle has to contract with more force, cardiac myocytes need more O2 which they don’t have. Causes cell death
Often secondary to left heart failure

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6
Q

Describe chronic heart failure

A

Slow onset

Infection, pulmonary embolism, myocardial infarction or surgery

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7
Q

Describe acute heart failure

A

Rapid onset

Symptoms similar to chronic HF, except the timing of onset and worsening is much more severe

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8
Q

Describe heart failure with reduced ejection fraction (HFrEF)

A

Abnormal systolic function: left ventricle unable to pump blood into aorta
Impaired contraction of the ventricles which despite an increase in HR results in decreased cardiac output
Typically, weakness is caused by damage or destruction of the ventricular myocytes
Weaker ejection leads to higher diastolic pressures

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9
Q

Describe EDV, SV and EF in HFrEF

A

EDV remains high/ increases
SV decreases
EF decreases

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10
Q

Describe heart failure with preserved ejection fraction (HFpEF)

A

Abnormal diastolic function
Normal contraction of the ventricle
Increased stiffness of ventricle, impaired relaxation or impaired filling
the reduced stroke volume is masked when looking at ejection fraction

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11
Q

Describe EDV, SV and EF in HFpEF

A

EDV inherently reduced (less space for blood to fill ventricles)
SV decreases (but is masked in EF because EDV also decreases)
EF stays normal/ mild reduces

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12
Q

Incidence of heart failure through ages

A

Increases >60
Peaks between 75-84
Then decreases

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13
Q

List 6 causes of heart failure

A

Valve disease (hardening of valve reduces ventricular filling or ejection)
Ischaemic Heart Disease (IHD) (narrowing of coronary arteries, causes ischaemia in myocytes)
Myocardial Infarction (significant occlusion in coronary artery, causes death of myocytes)
Hypertension (increases after load, decreased CO)
Dilated cardiomyopathy (dilated LV, reduces generable pressures, can’t eject blood out)
Hypertrophic cardiomyopathy (increased LV thickness, reduces internal volume, impedes filling)

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14
Q

Describe coronary artery disease (Ischaemic Heart Disease)

A 
Occlusion of coronary arteries
Less O2 to myocytes
Myocytes die
Less heart to perform same function
Need more O2 (which they don’t have)
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15
Q

List 3 presenting features of a patient with heart failure

A

Fatigue
Exertional breathlessness
Weight loss

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16
Q

List 4 clinical features of a patient with heart failure

A

Tachycardia
Pitting oedema
Increased jugular venous pressure (JVP)
Ascites

17
Q

Why is raised jugular venous pressure a hallmark sign of heart failure?

A

Increased pressure in right side of heart leads to pressures backing up into systemic veins, especially visible in jugular vein.

18
Q

What is pitting oedema? (a hallmark sign of heart failure)

A

Fluid accumulation in tissue (especially of lower extremities) leads to a pitting effect when physically depressed.
The indentation is visible for a short period

19
Q

Why is ascites a hallmark sign of heart failure?

A

Fluid accumulation in peritoneal cavity due to rise in hydrostatic pressure and fluid leakage into 3rd space
Causes increase in size of abdomen

20
Q

When and where is B-type natriuretic peptide (BNP) released?

A

from ventricular myocytes in response to stretch

21
Q

What BNP ranges for under and over 70s is suggestive of heart failure?

A

Under 70: >100pg/mL

Over 70: >300ph/mL

22
Q

What is the action of BNP?

A 
Reduces blood pressure:
Vasodilation of micro-vessels (reduction in afterload, ventricles don’t have to work so hard)
Reduced aldosterone secretion
Reduced sodium reabsorption 
Inhibits renin secretion
23
Q

What lifestyle changes are suggested to treat heart failure?

A

Weight loss
Stop smoking
Exercise
Less alcohol

24
Q

What are the 2 first line drugs used to treat heart failure?

A

ACE inhibitors: block aldosterone production

Beta blockers: Slow HR, Heart requires less energy and O2

25
Q

Why are diuretics used to treat heart failure? Give an example

A

Remove excess fluid
Decrease pressure
Afterload decreases
E.g. Spironolacetone

26
Q

Describe the ‘donkey’ analogy of treatment for heart failure

A

Diuretics and ACE inhibitors reduce the load

Beta-blockers reduce the speed, which saves energy and makes it easier

27
Q

Non pharmacological treatment for heart failure:

Fluid control

A

Haemofiltration
Peritoneal dialysis
Haemodialysis

28
Q

Non pharmacological treatment for heart failure:

Devices

A

Intra-aortic balloon pumping
Resynchronisation
VAD/ Total artificial heart

29
Q

Non pharmacological treatment for heart failure:

Surgical

A

Coronary artery bypass graft
Valve surgery
Transplantation

30
Q

Considering the Law of LaPlace, how does compensatory hypertrophy effect cardiac function

A

Wall thickness increases
Wall stress decreases
Less space for blood to pool in ventricles

31
Q

Considering the Law of LaPlace, how does dilated cardiomyopathy effect cardiac function

A

Wall thickness decreases
Wall stress increases
Heart unable to contract with enough force to eject blood

32
Q

Describe the hormonal changes that occur in heart failure (when the heart is beating less effectively?

A 
Reduced renal perfusion
Activates RAAS
Rise in aldosterone production
Causes vasoconstriction
Raises BP
Increases sodium retention
Increases water reabsorption
33
Q

How is the nervous system involved in regulating BP?

A

Aldosterone and mechanoreceptors stimulate sympathetic nervous system
Increases release of ADH
Increases heart rate and contractility

34
Q

Life of a person with heart failure

A

Breathless and tired
Heart is damaged and a less effective pump
QoL is poor
Life expectancy is reduced

35
Q

Progression in heart failure

A

Generally from mild to moderate to severe

Sudden death is rare

36
Q

What speeds up progression of heart failure?

A

Coronary events

Cardiovascular System (16 decks)

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