26 Heart Failure Flashcards
what is the role of the heart
to provide a continuous supply of oxygen to the body parts using blood
what is heart failure
clinical syndrome that affects the ability of the heart to provide sufficient blood to meet the body’s needs
what are the two main types of heart failure
acute or chronic
but also classified as systolic or diastolic
what can heart failure lead to
myocardial infarction
Describe the anatomy of the heart
the heart is split up into 4 compartments which can be catagorised as the atria and the ventricles. Further catagorising as the left and right atrium and ventricles.
Think of it as a 2x2 grid.
The vena cava (superior above inferior below) goes into the right atrium which then passes through the tricuspid valve into the right ventricle where it goes through the semi lunar valve to the pulmonary artery.
pulmonary vein then goes to the left artia which then goes through the bicuspid valve to the left ventricle then to the aorta.
describe the blood flow around the body
blood is pumped to the right atria via the vena cava once within it passes through the tricuspid valve into the right ventricle which then goes through the semi lunar valve as its pumped out to the pulmonary artery which takes blood to the lungs to exchange carbon dioxide for oxygen.
Pulmonary vein takes blood to the left ventricle which then passes through the bicuspid valve into the left ventricle which is then pumped through the semi lunar aortic valve into the aorta.
blood goes from the aorta to the artery to the arterioles to the capilaries to the venuoles to the veins to the inferior or superior vena cava back to the right atria.
what is systolic heart failure
heart fails to pump the blood out of the ventricles fully
due to the thin and weak cardiac muscles.
what is diastolic heart failure
heart doesnt fill the blood efficiently
due to larger cardiac muscles and thus reduced ventricle sizes
further classified as left and right side diastolic heart failure
failure of one part of heart leads to the dysfunction of other parts of the heart
usually the left side gets affected first and moves to the right.
What is the total amount of blood pumped out per minute
normally 5L per minute
what is stroke volume
amount of blood pumped out for every beat
how do we calc cardiac output
stroke volume x heart rate = cardiac output
how does compensation occur
increasing stroke volume or beating faster
how do we calculate ejection volume/ fraction =
% of blood ejected by each beat
describe systolic heart failure
systolic action contraction of cardiac muscle to eject blood which are weakened. so cant eject the blood properly anymore.
Mainly caused by cardiac muscle death, thinner muscles and enlarged ventricles
ejection fraction is reduced although the filling is unaffected.
what are the causes of systolic heart failure
coronary heart disease as reduced blood supply to cardiac myocytes
cadiomyopathy heart muscle diseases weakens the muscles
valve disease can lead to backward blood flow to the atria. Increasing heart beat to meet demands
stenosis narrowing of aortic and pulmonary valves leading to reduction of stroke volume getting reduced so heart beats faster
cardiac arrhythmias leading to irregular heartbeats
describe diastolic heart failure
diastolic action - filling blood in ventricles from atria, reduced ventricle size due to thickening of muscles therefore reduced blood volume in ventricles. Ejection fraction may be same due to the reduced ejected volume and filled volume.
what is hypertrophy
reduces the ventricle sizes
what is stiffening of muscles
due to lack of o2 and get hardened, affect the contraction
what are the causes of diastolic heart failure
hypertension (chronic) due to other metabolic diseases leading to smaller blood vessels make the heart to work harder to pump the blood. Thus increase the muscle growth reduces the size of the ventricles.
aortic stenosis restricts blood flow and makes harder to pump increasing muscle growth
cardiac myopathy, hypertrophyincreased muscle growth therefore more O2 needed
Stiffening of muscles affects the contractions
endocarditis - infection in endocardium
age
disease
alcohol
medications
describe the activation of sympathetic nervous system
induces sympathetic nervous system to enhance the cardiac activity
receptors mediated effects contraction and relaxation
prolonged activation leads to receptor desensitisation
how do we increase the preload
release aldosterone which increase the filling volume and stroke volume
increased muscle activity
cardiac hypertrophy
increase the muscle growth to increase ejection
what is decompensation
increased activity requires more O2 and if body can supply more blood leads to cell death
what are the symptoms of heart failure left sided
shortness of breath swelling of feet and legs chronic lack of energy difficulty sleeping at night due to breathing problems swollen or tender abdomen with loss of appetite cough with frothy sputum increased urination at night confusion and or impaired memory
what are forward failure symptoms
Tiredness & fatigue - heart is not supplying enough blood/O2 to the body parts
Decreased urination – due to lack of blood supply & reduce fluid loss
Irregular heart beats – to supply more blood
what are backward failure
Pulmonary oedema - fluid back up in lungs due (congestion) to reduced pumping
Difficulty breathing & coughing – due to congestion or fluid build up in lungs
Weight gain – due to fluid build up
what are symptoms of right sided forward failure
Tiredness & fatigue – reduced supply to the lungs and thus lack of oxygenated blood
Irregular heart beats – to supply more blood
what are symptoms of right side backward failure
Oedema - fluid back up in the body (congestion) extremities (e.g. legs) and jugular vein in the neck
Weight gain – due to fluid build up
Increased urination – due to more back up of blood
how can we diagnose heart failure
X ray
Echocardiogram
Blood tests
what are the 4 classifications of heart failure
asymptomatic - no symptoms and no impact on normal activities
Class 2 mild heart failure - mild symptoms + occasional oedema and somewhat limited ability to exercise
Class 3 moderate to severe heart failure - comfortable only at rest, noticeable limitations in exercise capacity
Class 4 severe heart failure - symptoms experienced at rest not able to exercise without discomfort
what are early stage treatments of heart failure
regular exercise
balanced healthy diet
anti hypertensive drugs
what are late stage treatments
anti hyper tensive drugs
ventricular assist device - directly connected to the affected ventricle and to the output blood vessel via a pump
cardiac resynchronisation therapy - pacemaker connected to affected atria / ventricles and make them beat at the same time with same rate
pacemaker connected to affected atria/ventricles and make them beat at the same time with same rate
pacemaker with defibrillator to delivers a shock and control the fibrillation
what surgeries exist for heart failure
coronary angioplasty
CABG
Heart transplantation
