Cardiac Failure Flashcards
Acute left ventricular failure
- Life-threatening emergency
- Sudden onset/worsening of HF symptoms
- Left ventricle no longer efficiently moving blood into circulation
Pathophysiology of acute left ventricular failure
- Functional/structural abnormality -> reduced CO
- Backlog of blood in left atrium, pulmonary veins, & lungs
- Increased pressures, fluid leaks -> pulmonary oedema
Aetiology of acute left ventricular failure
De-novo (new):
- myocardial dysfunction
- viral myopathy
- toxins
- valvular dysfunction
Decompensated HF:
- acute coronary syndrome
- hypertensive crisis
- acute arrythmia
- valvular disease
- sepsis
- iatrogenic (e.g. aggressive fluids in elderly)
Iatrogenic cause of decompensated HF
- Aggressive IV fluids in frail, elderly patient with known HF/impaired ventricular function
Managing acute left ventricular failure
SODIUM
SODIUM
- Sit pt. up
- Oxygen
- Diuretics (IV loop)
- IV fluids stopped!
- Underlying cause treated
- Monitoring fluid balance
Drugs used in severe cases of acute left ventricular failure
- vasodilators (opioids, nitrates)
- ionotropes (dobutamine - hypotensive)
- vasopressors (hypotensive)
- non-invasive/invasive ventilation
Chronic heart failure
Complex condition of impaired heart function, specifically the left ventricle.
Aetiology of chronic heart failure
Cardiovascular & non-cardiovascular
Cardiovascular:
- coronary artery disease
- hypertension
- valvular heart disease
- cardiomyopathies
- arrhythmias
Non-cardiovascular:
- diabetes mellitus
- renal dysfunction
- lifestyle - obesity, alcohol, smoking
- normal ageing
- infections - strep viridans
Symptoms of acute left ventricular failure
- acute SOB
- oedema
- fatigue
- ‘off-legs’
- frothy white/pink sputum
Signs of acute left ventricular failure
General:
- tachycardia
- tachypnoea
- reduced O2 sats
Cardiac:
- raised JVP
- S3 heart sound
- displaced apex beat
Chest:
- bibasal crackles
- wheeze
Investigating acute left ventricular failure
- Clinical assessment (hx., exam)
- ECG (?ischaemia, ?arrhythmia)
- Bloods (?BNP - > 100 is diagnostic)
- ABG
- chest x-ray
- ECHO
CXR findings in acute left ventricular failure
Pulmonary oedema:
- bilateral effusions
- interlobar fissures
- kerley B lines (fluid in septal lines)
Classifying chronic heart failure
New York Heart Association (NYHA):
- Class I: no symptoms, no limitations
- Class II: no symptoms at rest, mild symptoms with ADLs
- Class III: no symptoms at rest, severe symptoms with ADLs
- Class IV: symptoms at rest, severe symptoms with ADLs
Symptoms of chronic heart failure
- dyspnoea
- orthopnoea
- paroxysmal nocturnal dyspnoea
- peripheral/sacral oedema
- fatigue
- cough
- white/pink frothy sputum production
Signs of chronic heart failure
General:
- tachycardia
- tachypnoea
- hypertension
- peripheral oedema
Cardioresp:
- murmurs (if valvular)
- 3rd heart sound
- raised JVP
- displaced apex beat
- bilateral basal crackles
- cardiac cachexia
Investigating chronic heart failure
- clinical assessment
- Nt-proBNP
- ECG
- ECHO
Interpreting NT-proBNP levels in chronic HF
Moderate raise (400-2000)
- specialist assessment within 6 weeks
High raise (> 2000)
- specialist assessment within 2 weeks
Medical treatment of chronic heart failure
ABAL:
- ACE-i or ARB (e.g. ramipril)
- Beta-blocker (e.g. bisoprolol)
- Aldosterone antagonist (e.g. spironolactone, epleronone)
- Loop diuretic (e.g. furosemide)
Other:
- SGLT2-i (e.g. dapagliflozin)
- Digoxin
- Ivabradine
Procedural & surgical management options for chronic heart failure
- implantable cardioverter defib
- cardiac resynchronisation therapy
- heart transplant
- valve repair/replacement
Complications of chronic heart failure
- arrhythmias
- sudden cardiac death
- ventricular remodelling
- pulmonary oedema
- hepatic congestion
- renal dysfunction
- anaemia
- thromboembolism
- cachexia and malnutrition
