Cardiac Failure Flashcards
What is the definition of cardiac failure?
Cardiac failure is when the heart due to an abnormality in cardiac function fails to pump blood at a rate sufficient to meet the body’s metabolic demands or does so only with elevated diastolic filling pressure.
What percentage of the elderly population is affected by cardiac failure?
10% of elderly.
What are the types of cardiac failure?
Systolic Failure: Inability of the ventricles to contract normally (EF < 40%). Diastolic Failure: Inability of the ventricles to relax and fill normally causing increased filling pressures. High Output Failure: Cardiac output is normal or increased with increased metabolic needs of the body. Low Output Failure: Decreased cardiac output resulting in hypoperfusion.
What is the NYHA Classification of cardiac failure?
Class I: No limitation of physical activity.
Class II: Slight limitation of physical activity.
Class III: Marked limitation of physical activity.
Class IV: Symptoms occur at rest and discomfort with any physical activity.
What is the definition of left heart failure?
Left heart failure is when the cardiac output is inadequate to meet the body’s requirements due to a failure of the left ventricle (LV).
What is the epidemiology of left heart failure?
10% geriatric patients.
What are the symptoms of left heart failure (8)?
- Dyspnoea
- Exertional dyspnoea
- Orthopnoea
- Paroxysmal Nocturnal Dyspnoea (PND)
- Chest pain
- Palpitations
- Fatigue/weakness
- Nocturia/Oliguria
What are the clinical features of left heart failure (6)?
- Rales & crackles
- Cardiogenic wheeze
- Weak pulse
- Tachycardia
- AF
- Cardiomegaly (displaced lateral apex beat) S3 gallop
What are common causes of left heart failure (7)?
- AMI
- IHD (Ischemic Heart Disease)
- Cardiomyopathy
- Valvular disease (AR, MR)
- HTN (Hypertension)
- Myocarditis
- Infiltrative diseases (amyloidosis, hemochromatosis, sarcoidosis)
What are the differential diagnoses (D/dx) for left heart failure (3)?
- AMI or arrhythmias
- Non-cardiogenic Acute Pulm Oedema
- High output heart failure
How is left heart failure diagnosed?
Echocardiogram
ECG
Chest X-ray (CXR)
Coronary angiography
Beta Natriuretic Peptide (BNP)
Full blood count (FBC), Serum electrolytes, Serum creatinine, UEC, Lipids, Thyroid hormones, Liver function tests (LFTs)
Exercise stress tests
What is the treatment for left heart failure?
- Management of comorbidities
- Lifestyle changes (exercise, diet; fluid & salt restriction, smoking cessation)
- Pharmalogical: ACEIs + ARBs, B-blockers, Aldosterone antagonists, Nitrates, Entresto (EF <35%) Inotropes (acute), Positive pressure (CPAP)
What is the prognosis for left heart failure?
50% 5-year survival rate.
What is the definition of right heart failure?
Right heart failure is when the cardiac output is inadequate to meet the body’s requirements due to a failure of the right ventricle (RV).
What are the symptoms of right heart failure (3)?
Peripheral oedema
Hepatomegaly
Ascites
