9 - Congestive Cardiac Failure Flashcards
What is heart failure?
Heart failiure is a complex syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a physiological circulation
Symptoms of heart failure?
dycpnoea
peripheral oedema
elevated JVP
basal crepitations
enlarged liver
orthopnoea
What doe A,C,X,V,Y represent in the JVP wave?
A - Atrial contraction
C - Tricuspid valve urges into right atria
X - atrial relaxes, ventricle systole
V - venous return
Y - Tricuspid opens, atrial contraction
Why might JVP be raised?
Heart failure
Constrictive pericarditis - Kussmaul’s sign
Cardiac tamponade
Fluid overload
superior vena cava obstruction
How to describe a heart murmur?
Timing
Location and radiation
Shape
Pitch
Intensity
A heart mumur is heard through out sytole and diastole. What does this indicate?
Patent ductus arteriolsus
Which heart mumur radiates to the carotids?
Mitral stenosis
Which heart mumur radiates to the axila?
Mitral regurgitation
Which murmur is loud but is not palpable as a thrill?
Grade 3 mumur
Which mumu is faint and cannot be heard initially?
Grade 2 mumur
If a mumur is loud and palpable, what grade is it?
4
How can you atenuate mitral stenosis?
Mitral stenosis
3 most common causes of heart failure?
Ischeamia
HTN
daibetes - promots CAD,\ and cardiomyopathy
Other causes of aetiologies of heart failure?
valvular - AS and MR
Tachycardia
toxins and drugs
endocrine - thyrotoxicosis and phaeochromocytoma
dilated cardiomyopahty
HOCM
What is the first line treatment for heart failure?
ß-blockers
ACEi
What is ejection fraction?
Stroke volume devided end diastolic volume
SV
EDV
What is stroke volume?
EDV - ESV
End diastolic volume - end systolic volume
What is preserver ejection fraction
EF > 40%
This is diastolic dysfunction due to ventricle not being able to relax
Due to: hypertrophy, obesity, tamponade, constrictive pericarditis, restrictive cardiomyopathy.
What is systolic dysfunction?
EF < 40%
Due to ventricle not being able normally
MI, IHD and cardiomyopathy
After ß blockers and ACEi, what medication can be used for heart failure?
mineralcorticoid antagonists - spiranolactone
Digoxin
Isosorbides dinitrates and other peripheral dilators
Cardiac re-synchronisation therapy
What is the managment of atrial fibrilation?
1st line is rate limiting therapy: ß blocker or CCB, digoxin in sedentary/ paroxysmal
2nd line is rythmn control: Flecanide or amiodarone (for abdnormal structure)
When do you cardio evert someone in AF?
< 48 hours since onset
or after being fully anticoagulated.
What is cardioevertion in AF?
A form of rythmn control therapy.
sedation and then 200-360J
Drugs: flecanide and amiodarone
Patholgy of arrythmias?
Re-entrant activity
Delayed after repolarisation due to Ca overload leading to spontanoues depolariesation after repolarisation,
Early after depolaristion - spontaneouns depolarisation during plateau of cardiac cycle
