33. Heart failure Flashcards
What is cardiac failure?
Cardiac disorder that prohibits delivery of sufficient output to meet the perfusion requirements of metabolising tissues
What can cause cardiac failure?
Anything in the heart that can cause damage and prevent outflow to the tissues is a potential cause of cardiac failure:
Coronary artery disease
Hypertension (increased afterload and heart pumping against raised pressure
Cardiomyopathy
Valvular heart disease
Cardiac arrhythmias
What are the symptoms of heart failure?
These are very non-specific:
Fatigue (peripheral hypoperfusion)
Dyspnoea
Oedema
What are the signs of cardiac failure?
Cool skin - peripherally cyanosed
Fluid retention - increased JVP, basal crackles, ankle swelling, ascites
Increased sympathetic activity - tachycardia and sweating
Third heart sounds
What complications can heart failure lead to?
Intravascular thrombosis Infection Multi-organ failure Cardiac arrhythmias Sudden death
What is the relevance of an ECG in cardiac failure?
An ECG will always be done if suspected that there is a problem with the heart BUT in cardiac failure, the trace will be non-specific
Pathological Q wave is important - patient has had previous MI and now likely to have heart failure
What will a CXR show in cardiac failure?
Enlarged heart
Dilated pulmonary veins
Pulmonary retention - fluid in the lungs hence wet lungs
What is the gold standard investigation for cardiac failure?
Echocardiogram - can image just about all bits of the heart with this
What is the role of BNP in cardiac failure and how is this used?
Brain natriuretic peptide - BNP investigation is used to determine the presence of cardiac failure
BNP is secreted by myocardial cells in response to raised arterial pressure (opposite to angiotensin) and promotes vasodilation n
Levels >100 indicates heart disease
Also secreted from the ventricles when they are stretched and indicates overstretched or enlarged ventricles
What is the pharmacological treatment for the effects of heart failure?
The sympatho-adrenal pathway is activated SO prescribe BETA BLOCKERS to prevent the sympathetic symptoms
Renin-angiotensin pathway is also activated so prescribe ACE INHIBITORS and ARBs
What surgical treatment is available for cardiac failure?
Heart transplant - very last line of treatment - must have heart failure in the absence of major organ failure
What is diastolic heart failure and how does it differ from normal (systolic) cardiac failure?
Systolic heart failure - loss of efficient muscle contraction
Diastolic hearat failure - problem of the heart not being able to relax properly so cannot fill sufficiently
