Cardiac Failure Flashcards

1
Q

Types of heart failure

A

Chronic heart failure
Congestive heart failure
Congestive cardiac failure (CCF)

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2
Q

Causes of heart failure

A

Failure of the heart muscle or failure of heart valves

Often secondary

  • IHD (most common)
  • Hypertension
  • Cardiomyopathies
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3
Q

Risk factors of cardiac failure

A
Pregnancy
Anaemia 
Hyper & hypothyroidism 
Fluid retaining drugs:
 - Glucocorticoids
 - NSAIDs
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4
Q

What factors make up cardiac output

A

Preload
Afterload
Muscle contractility

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5
Q

Effect of hypertension on heart function

A

Increase in afterload causes hypertrophy; an increase in heart size makes it less efficient and lessens the ejection fraction

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6
Q

Ejection Fraction

A

Fraction of blood ejected per cardiac cycle

Used in diagnosis of heart failure

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7
Q

What happens as cardiac circumference increases

A

The heart has to work harder to get blood pumping around the body

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8
Q

Neurohormonal adaptation to compensate for circulatory failure

A

Sympathetic nervous system compensates, making things worse

Renin-angiotensin-aldosterone system

ADH

Atrial Natriutetic peptide (ANP)

Only mechanism that doesn’t make anything worse

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9
Q

ACE-I vs ACE-II

A

ACE-I converts Angiotensin I to A II

ACE-II converts A II to angiotensin 1-7

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10
Q

ACE 2 and Covid-19

A

ACE-2 is the spike protein receptor for the Sars-CoV-2 virus

It is present in lungs, heart, arteries, intestines, kidneys

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11
Q

Dangers of neurohormonal adaptations against cardiac failure

A

Increased afterload
Increased circulating volume (> pre and afterload)
Increased resistance will lead to impaired renal function; further activation of RAAS

Vicious cycle develops which further impairs the pump activity of hear and leads to myocyte dysfunction

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12
Q

Left sided heart failure

A

Often secondary to hypertension

LV gets impaired, building up pressure in LV and cardiac circulation

Leads to pulmonary oedema as pulmonary venous pressure increases which opposes reabsorption of fluid in lungs; fluid accumulates in lung tissue - Oedema

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13
Q

Right sided heart failure

A

RV output fails

Often due to

  • lung disease (Cor Pulmonale)
  • Pulmonary vavular stenosis
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14
Q

Biventricular failure

A

Both chambers

Disease (e.g. IHD gas affected both ventricles)

Or, LVF leads to pulmonary congestion, increasing load on right side, leading to right failure

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15
Q

Signs and Symptoms of Left Ventricle Failure

A

Pulmonary Oedema
Dyspnoea (breathlessness) - Sensation of drowning
Cough
Orthopnoea Breathless on lying which is relieved by sitting up
- Nocturnal problem?
Inspiratory Crepitations

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16
Q

Signs and Symptoms of Right Ventricle Failure

A

Raised venous pressure
Increased Jugular Venous Pressure
Enlarged liver
Oedema - ankles (if lying down, rises to thighs/abdomen)

17
Q

Diagnosis of Heart Failure

A

B-type natriuretic peptide (BNP) levels
Echocardiogram: Ejection fraction <45%
Symptoms and examination
Chest X-ray showing a much larger cardiac silhouette

18
Q

How does heart failure lead to Atrial fibrillation

A

LV/valve failure leading to increased pressure in left atria, leading to distension which leads to atrial fibrillation

19
Q

Goals of cardiac failure treatment

A

Identify/treat any cause

Reduce cardiac workload

Increase cardiac output

Counteract maladaptation

Relieve symptoms

Prolong quality life - reduce hospitalisation