Cardiac Failure

Question 1

Definition of cardiac failure

Answer 1

Heart is unable to pump sufficient blood to meet body or metabolic requirements of tissue
Due to structural or function disorder & impair ventricles to fill/eject blood

Question 2

3 disorders of preload

Answer 2

1. Valvular abnormalities
2. Increased heart rate (decrease filling time)
3. Constrictive pericarditis

Question 3

2 disorders of afterload

Answer 3

1. Valvular abnormalities
2. Increase arterial resistance

Question 4

4 disorders of contractility

Answer 4

1. Myocarditis
2. Ischaemia/infarction
3. Arrhythmia
4. Amyloidosis

Question 5

2 others factors contributing to cardiac failure

Answer 5

1. High output states (pregnancy, anaemia, sepsis, Beri-beri)
2. Cardiac tumour

Question 6

4 common cardiac failure causes (think of blood flow into RA)

Answer 6

1. Ischaemic heart disease
2. Systemic HPT
3. Valvular abnormalities
4. Chronic lung disease

Question 7

4 classifications of cardiac failure

Answer 7

1. Location (R, L or bi)
2. Course of disease (acute or chronic)
3. Output (high output high O2 needs or low output decreased ejection fraction)
4. Impaired function (diastolic- thick & stiff & systolic- weak & thin)

Question 8

Left sided heart failure signs & symptoms

Answer 8

Above diaphragm
Pulmonary congestion & oedema: increase filtration at loose junctions of pulmonary capillaries due to increase pressure & further increase in pressure result in impermeable tight junctions becomes permeable resulting in alveolar floodin
Blood in sputum
Crackles
Cardiomegaly (displaced apex beat)
Cyanosis
Orthopnoea (SOB when lying flat)

Question 9

Right sided cardiac failure signs & symptoms

Answer 9

Below diaphragm
Hepatomegaly: IVC through liver & congestion of hepatic & portal vein, increase in liver size & weight causing red/brown congestion & steatosis- yellow congestion
Oedema: increase hydrostatic pressure of capillaries & forces transudate into interstitium
Cor pulmonary: RV hypertrophy/-dilation secondary heart failure due to primary lung/pulmonary disease
Ascites & anasarca
Raised JVP
Pitting oedema
Parasternal heaves
Weight gain

Question 10

4 modes of death of cardiac failure

Answer 10

Thromboembolism
Arrhythmia
Metabolic disturbance
MI

Question 11

What is the 2 biomarkers of cardiac failure

Answer 11

1. Brain Natriuretic Peptide (BNP)
2. N terminal proBNP

Question 12

What is BNP & its effect

Answer 12

Released by V myocytes when overstretched to decrease fluid & heart rate (antihypertensive & diuretic) to prevent/decrease hypertrophy by decreasing water, salt, vasodilation & increase epithelial permeability

Question 13

What is NT-proBNP used for

Answer 13

Longer half life
Sensitive & not specific
Used to differentiate cardiac dyspnoea from other causes

Question 14

What degrades BNP

Answer 14

Neprilysin is released by lungs & kidneys that degrades ANP/BNP - short half live