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MD2 Foundation > Cardiac Failure > Flashcards

Cardiac Failure Flashcards

1
Q

What is cardiac failure?

A

Cardiac output less than body needs

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2
Q

What is the normal cardiac output?

A

5-6 L/min

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3
Q

What is the normal stroke volume?

A

70 ml/beat

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4
Q

What is high output cardiac failure?

A 
Failure due to increased body needs
- Anaemia
- Severe aortic regurgitation
- Thyrotoxicosis
- Fever
- AV fistulae
Rare
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5
Q

What is usually reduced in cardiac failure: systolic or diastolic function?

A

Systolic - low ejection fraction

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6
Q

At what ejection fraction do you usually get symptoms of cardiac failure at?

A

30-40%

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7
Q

What is the ejection fraction in stiff diastolic function causing cardiac failure?

A

Normal

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8
Q

What is preload?

A

Venous return

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9
Q

What is contractility?

A

Strength of pump

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10
Q

What is afterload?

A

Resistance against which heart must pump

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11
Q

Why should you check the JVP before giving a cardiac failure patient fluid for low blood pressure?

A

Danger in giving a person with high preload more fluid

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12
Q

How can preload be clinically determined?

A

Right heart: JVP

Left heart: pulmonary venous pressure = PA wedge pressure

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13
Q

What does an increase in venous pressure mean?

A

Fluid leaks out

Oedema

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14
Q

What are some signs of right heart failure?

A

High JVP
Peripheral oedema
Hepatic congestion

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15
Q

What are the causes of oedema?

A

Increased venous pressure
Decreased osmotic pressure
Blocked lymphatics
Increased capillary permeability

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16
Q

What can cause a decreased osmotic pressure?

A

Plasma protein loss

  • Renal failure
  • Liver failure
17
Q

What can block lymphatics?

A

Cancer

18
Q

What can cause increased capillary permeability?

A

Infection

19
Q

Where is the oedema if there is increased pulmonary venous pressure, affecting the left atrium?

A

Pulmonary congestioon

Pulmonary oedema

20
Q

Where is the oedema if there is increased systemic venous pressure, affecting the right atrium?

A

Peripheral congestion

Peripheral oedema

21
Q

Why and how is preload increased in cardiac failure?

A

Decreased contractility > decreased cardiac output

To bring cardiac output to normal > Na and fluid retention

22
Q

What is the mechanism for fluid retention in cardiac failure?

A

Decreased cardiac output > decreased renal blood flow > activation of renin-angiotensin-aldosterone system (RAAS) >

  • Fluid and Na retention
  • K loss
  • Vasoconstriction
23
Q

What does the sympathetic nervous system do in cardiac failure?

A 
Increased noradrenaline
Initial increased contractility
Long-term deleterious effects
- Vasoconstriction
- Ventricular arrhythmias
- Direct toxic effect
24
Q

What does it mean if you find both swollen ankles and sacral oedema?

A

Like paroxysmal nocturnal dyspnoea (PND) is to orthopnea - need to be admitted to hospital for treatment

25
Q

Why is orthopnoea specific for cardiac failure?

A

When standing most of fluid in lower part of lungs, so able to use upper part of lungs
When lying down, more alveoli involved
For other causes of shortness of breath, there is no effect of gravity on lungs

26
Q

What are the examination findings for cardiac failure?

A

Crackles on chest examination
- Could be cardiac/respiratory cause
- If respiratory, may improve on coughing
JVP elevated
- Indicates high right atrial pressure, and thus, right ventricular end diastolic pressure
- Often correlates with high left atrial pressure
Oedema

27
Q

What are the investigations for cardiac failure?

A 
CXR
- Heart size > make sure using erect PA film
- Lung fields, looking for
   - Pleural effusion
   - Kerley B lines
   - Perihilar batwing shadowing
   - Fluffy alveoli
Echocardiogram
- Chamber size and function
- Valves
- Structure
28
Q

What are the causes of cardiac failure?

A 
Ischaemic heart disease: MI
- Vast majority of cases
Valvular heart disease
- Common
Hypertension
Congenital heart disease
Cardiomyopathy
Cor pulmonale
Pericardial disease; eg: Coxsackie virus
29
Q

Can the JVP be elevated but the pulmonary venous pressure be normal?

A

In pure right heart failure

Rare

30
Q

What are the causes of right heart failure?

A 
Pulmonary hypertension
- Cor pulmonale
- Pulmonary embolism
Right sided structural disease
- Pulmonary/tricuspid valves
- Right ventricular cardiomyopathy
Pericardial disease
31
Q

What is cor pulmonale?

A

Heart failure due to lung diseases?

32
Q

What lung diseases can cause cor pulmonale?

A

COPD
Cystic fibrosis
Pulmonary fibrosis

33
Q

What is the cardinal symptom of left heart failure?

A

Shortness of breath

34
Q

What is the cardinal sign of left heart failure?

A

Lung crepitations

35
Q

What is the classification of left heart failure based on ejection fractions?

A

Mild = 40-50%
Moderate = 30-40%
Severe <30%

36
Q

What are the possible causes of diastolic heart failure?

A

Stiff ventricle - poor compliance

  • Infarct-related scar
  • Chronic hypertension
  • Ventricular hypertrophy
37
Q

What are the principles of treatment for heart failure?

A

Reduce venous pressure
- Relieves congestion and oedema
- But without reducing cardiac output too much
Block RAAS
- Produces long-term fluid loss and vasodilatation
Block sympathetic nervous system
- Block direct cardiac toxic effects of beta stimulation
Treat underlying and precipitating causes

38
Q

What are the medications used in the treatment of cardiac failure?

A

Duiretics; eg: frusemide
Aldosterone antagonists; eg: spironolactone
ACE inhibitors and/or angiotensin receptor antagonists (ARBs)
Beta blockers
- Use cardioselective if possible

39
Q

What additional treatment is there available for cardiac failure?

A

Biventricular pacing
- Improves cardiac function
Implantable cardioverter defibrillator
- Because ventricular arrhythmias and sudden death common in heart failure
Cardiac assist devices and transplantations
- For small group who don’t respond to other treatment
- Not usually appropriate for elderly patients

MD2 Foundation (42 decks)

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