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Cardiovascular Core Conditions > 3+ Cardiac Failure > Flashcards

3+ Cardiac Failure Flashcards

1
Q

What is the definition of cardiac failure?

A

A clinical syndrome in which the heart is unable to pump enough blood to meet the metabolic needs of the body

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2
Q

What are some common causes of cardiac failure?

A
  • Coronary heart disease/MI
  • Diabetes mellitus
  • HTN
  • Valvular heart disease
  • Rapid arrhythmias
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3
Q

What are some risk factors for heart failure?

A
  • Smoking
  • Obesity
  • Haemochromatosis
  • Drug and alcohol use
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4
Q

What is the overall pathophysiology of heart failure?

A
  • The causal condition activates the SNS → tachycardia → increased myocardial contractility → increased myocardial oxygen consumption → peripheral vasoconstriction → activation of the renin-angiotensin system with salt + water retention
  • If the condition isn’t treated the myocardium becomes unable to maintain a cardiac output sufficient to meet the demands of peripheral circulation e.g. need to correct HTN
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5
Q

What bedside tests do you do when someone presents with suspected heart failure?

A

ECG: Left ventricular hypertrophy, past MI, arrhythmias

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6
Q

What laboratory tests do you do when someone presents with suspected heart failure?

A

FBC: anaemia worsens symptoms

BNP: increased

UEC: hyponatremia is a poor prognosis because demonstrates renal impairment

Troponin: likely elevated

BSL + HbA1c: screen for diabetes

TFTs: hypo and hyper can cause HF

LFTs: abnormal = poor prognosis

VBG: check for metabolic acidosis and lactate

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7
Q

What imaging do you do in a patient with suspected heart failure?

A

CXR: look for pulmonary congestion, pleural effusion, pulmonary oedema and cardiomegaly (C:T ratio >0.5)

Echocardiogram: to assess systolic + diastolic function in both the left and right ventricles and measure left ventricular ejection fraction (LVEF)

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8
Q

How is heart failure managed?

A
  • Fluid restriction (1.5-2L)
  • Hemodynamically unstable hypotensive: vasoactive drug + O2 supplementation
  • Hemodynamically unstable hypertension: vasodilator, loop diuretic, O2 supplementation
  • Monitor fluid weight gain and loss
  • Lifestyle: decrease salt, weight loss, exercise, smoking cessation
  1. Treat underlying cause or exacerbations
  2. ACE-I= Symptomatic and prognostic improvement
  3. Beta-blocker
  4. Aldosterone antagonist
  5. Diuretic if symptoms/signs of congestion
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9
Q

How is heart failure classified by ejection fraction?

A

Measure the left ventricular ejection fraction via echocardiography. Reduced is <35-40%

HFrEF (HF with reduced EF): have the signs of HF + loss of function. Often systolic dysfunction.

HF-pEF( HF with preserved EF): have clinical signs of HF with normal or near-normal left ventricular function + no significant valvular abnormalities. Often diastolic dysfunction.

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10
Q

What is the most common pathophysiology behind systolic dysfunction/HF-rEF?

A

Impaired ventricular contraction:

  • MI: loss/damage of myocytes
  • Chronic volume overload/increased preload (regurgitation of any valve)
  • Dilated cardiomyopathy
  • Arrythmias

Increased afterload:

LEFT:

  • Systemic HTN
  • Aortic stenosis

RIGHT:

  • Pulmonary HTN

Pulmonary stenosis

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11
Q

What is the most common pathophysiology behind diastolic dysfunction/HF-pEF?

A

Impaired ventricular relaxation + loss of compliance:

  • MI
  • Ventricular hypertrophy
  • Restrictive cardiomyopathy

Impaired ventricular filling:

  • Mitral or tricuspid stenosis
  • Pericardial constriction/tamponade
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12
Q

What is the etiology of right sided HF?

A

Increased ventricular afterload (pulmonary congestion)

Increased right ventricular preload (tricuspid regurgitation)

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13
Q

What are the symptoms of right sided heart failure?

A

Symptoms of fluid retention predominate:

  • Peripheral pitting oedema
  • Sacral oedema
  • Weight fluctuations
  • Nocturia
  • Hepatic venous congestion (abdo pain, jaundice, ascites, anorexia/weight loss)
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14
Q

What are some signs of right sided heart failure?

A
  • Raised JVP and Kussmaul sign (elevated with inspiration due to increased right arterial pressure)
  • Tricuspid regurgitation murmur
  • RIght ventricular heave (due to ventricular hypertrophy)
  • Pitting oedema
  • Gallop rhythm
  • Pulses alternans
  • Hepatosplenomegaly
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15
Q

What is the aetiology of left sided heart failure?

A

HF-rEF and HF-pEF typically develop left sided HF

Increased left ventricular afterload: arterial HTN or aortic stenosis

Increased left ventricular pre-load: aortic regurgitation

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16
Q

What are the symptoms of left-sided HF?

A

Pulmonary symptoms predominate:

  • Dyspnoea, orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • Cardiac asthma
  • Nocturia + Oliguria
  • Fatigue
  • Cough +/- frothy bloody sputum
17
Q

What are some signs of left sided heart failure?

A
  • Pulmonary crackles (bilateral basilar rales)
  • Laterally displaced apical heart beat (due to cardiomegaly)
  • Coolness + pallor of the lower extremities
18
Q

What are some features of HF on CXR?

A
  • Alveolar oedema
  • Kerley B lines (interstitial oedema)
  • Cardiomegaly
  • Dilated upper lobe vessels
  • Effusions: blunted costophrenic angles
19
Q

What are some features of LV hypertrophy on ECG?

A
  • Left axis deviation
  • ST depression and T wave inversion in lateral leads (V5/6)
  • ST elevation in V1-3
  • Markedly increased LV voltages: large R and S waves

Cardiovascular Core Conditions (10 decks)

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