3. Heart Failure (Cardiac SOB) Flashcards
Define heart failure
Failure of the heart to maintain the cardiac output required to meet the body’s requirements
- Cardiac Output Low
OR
- High Cardiac Output State
NB: LHF and RHF often come together –> CHF –> mixed signs
Cardiac Output =
Heart Rate x Stroke Volume
Chronic Vs Acute HF
Chronic Heart failure is a long term condition
Develops and progresses slowly
Arterial pressure maintained until later/decompensation
Acute Heart failure is decompensation/exacerbation of chronic disease, or can be new onset Develops and progresses rapidly Needs urgent treatment Evidence of peripheral hypo-perfusion Peripheral/pulmonary oedema
Aetiology of LHF (4 Categories)
HEART VALVES:
- Aortic valve disease (AR – regurg., AS - stenosis)
- Mitral Regurgitation
HEART MUSCLE:
- IHD/MI
- Cardiomyopathy: hypertrophic (HOCM), dilated, restrictive
- Myocarditis
- Arrhythmias e.g. AF
Systemic:
- HTN
- Amyloidosis (RARE)
Drugs: Alcohol, Cocaine
Aetiology of RHF (3 Categories)
Lungs
- PE
- Pulm HTN
- Chronic Lung Disease: CF, ILD, pulm fibrosis
LHF
Heart valves:
- Tricuspid Regurg
- Pulm valve disease
Define Cor Pulmonale
Enlargement and failure of RV due to increased pressure in the lungs/vascular resistance
High output state
Increased systemic demand –> requires more O2 –> heart strain
High output state causes (8)
Nutritional - B1/thiamine def = beri beri
Anaemia
Pregnancy
Malignancy e.g. multiple myeloma Endocrine e.g. hyperthyroidism AV malformations (abnormal connections b/t A and V) Liver cirrhosis (GI/general) Sepsis
Risk factors for Heart Failure (6)
Older men PMH of Heart disease – MI is strongest risk factor Diabetes Family history of heart disease Dyslipidaemia Drug abuse
Epidemiology of heart failure
10% of >65 year olds, 1-3% general population
LHF symptoms (6)
- Exertional Dyspnoea
- Orthopnoea
- Paroxysmal Nocturnal Dyspnoea (attacks of SOB/cough, may wake pt up)
- Nocturnal cough (+/- pink frothy sputum)
- Fatigue
- Wheeze (cardiac asthma)
LHF signs
Cyanosis
Confusion
Restlessness
Heart
- Increased HR (May be Irreg Irreg)
- Displaced Apex Beat
- S3 Gallop Rhythm -
- Murmur (AS, MR)
Lungs:
- Wheeze
- Bibasal Crackles
- Increased RR
S3 HS
- Kentucky
- Best heard at apex
- Use bell
- L Lateral decubitus position
Produced by blood coming into contact with a compliant ventricle
Normal: Young adults, children, pregnancy, athletes
Abnormal: adults and elderly - severe MR/TR, cardiomyopathy, HF
S3 is low pitched, the split S2 is high pitched
RHF symptoms (6)
Fluid congestion in system -> peripheral symptoms:
- Swelling – ankles, face, abdomen (ascites)
- Fatigue
- Weight gain (oedema)
- Reduced exercise tolerance
- Anorexia + GI distress e. g. Nausea
- Nocturia
RHF signs
- Face/Neck:
- Increased JVP (distended jugular veins)
- Facial swelling - Heart/Chest:
- Parasternal heave
- TR murmur
- Increased HR and RR - Abdomen
- Ascites
- Hepatomegaly/Splenomegaly - Other
- Pitting oedema in ankles/sacrum (dependent oedema - gravity related)
Increased peripheral venous pressure