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CVS > Cardiac Failure > Flashcards

Cardiac Failure Flashcards

1
Q

Define cardiac failure

A

inability of the cardiac output to meet the body’s demands despite normal venous pressures

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2
Q

Explain the aetiology and risk factors of cardiac failure

A
  • LOW OUTPUT Cardiac Failure (reduced cardiac output)

- HIGH OUTPUT Cardiac Failure (increased demand)

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3
Q

LOW OUTPUT Cardiac Failure (reduced cardiac output)

A
  • Left Heart Failure

- Right Heart Failure -Biventricular Failure

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4
Q

LSHF

A
  • Ischaemic heart disease -Hypertension
  • Cardiomyopathy
  • Aortic valve disease
  • Mitral regurgitation
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5
Q

RSHF

A
  • Secondary to left heart failure (in which case it is called congestive cardiac failure)
  • Infarction
  • cardiomyopathy
  • Pulmonary hypertension/embolus/valve disease
  • Chronic lung disease
  • Tricuspid regurgitation
  • Constrictive pericarditis/pericardial tamponade
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6
Q

Biventricular F

A
  • Arrhythmia
  • Cardiomyopathy (dilated or restrictive)
  • Myocarditis
  • Drug toxicity
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7
Q

HIGH OUTPUT Cardiac Failure (increased demand)

A

Anaemia

Beri beri

Pregnancy

Paget’s disease

Hyperthyroidism

Arteriovenous malformation

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8
Q

Summarise the epidemiology of cardiac failure

A

10% > 65 yrs old

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9
Q

Recognise the presenting symptoms of cardiac failure

A
  • Left Heart Failure
    - symptoms caused by pulmonary congestion
  • Acute Left Ventricular Failure
  • Right Heart Failure
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10
Q

Left Heart Failure-presenting symptoms of cardiac failure

A

Dyspnoea - divided based on the New York Heart Association classification:

1 - no dyspnoea

2 - dyspnoea on ordinary activities

3 - dyspnoea on less than ordinary activities

4 - dyspnoea at rest

Orthopnoea

Paroxysmal nocturnal dyspnoea

Fatigue

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11
Q

Acute Left Ventricular Failure- presenting symptoms of cardiac failure

A

Dyspnoea

Wheeze

Cough

Pink frothy sputum

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12
Q

Right Heart Failure- presenting symptoms of cardiac failure

A

Swollen ankles

Fatigue

Increased weight (due to oedema)

Reduced exercise tolerance

Anorexia

Nausea

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13
Q

Recognise the signs of cardiac failure on physical examination- Left Heart Failure

A

Tachycardia

Tachypnoea

Displaced apex beat

Bilateral basal crackles

S3 gallop (caused by rapid ventricular filling)

Pansystolic murmur (due to functional mitral regurgitation

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14
Q

Recognise the signs of cardiac failure on physical examination- Acute Left Ventricular Failure

A

Tachypnoea

Cyanosis

Tachycardia

Peripheral shutdown

Pulsus alternans
Gallop rhythm

Wheeze (cardiac asthma)

Fine crackles throughout lung

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15
Q

Pulsus Alterans

A
  • Arterial pulse waveforms showing alternating strong and weak beats
  • Sign of left ventricular systolic impairment

Explanation:

In left ventricular dysfunction, ejection fraction significantly decreases leading to a reduction in stroke volume

This causes an increase in end-diastolic volume

This means that the left ventricle is stretched more for the next contraction

Due to Starling’s Law, the increased stretch of the left ventricle caused by the increased end-diastolic volume following the previous beat leads to an increase in the strength of the myocardial contraction

This results in a stronger systolic pulse

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16
Q

Recognise the signs of cardiac failure on physical examination- Right Heart Failure

A

Raised JVP

Hepatomegaly

Ascites

Ankle/sacral pitting oedema

Signs of functional tricuspid regurgitation

17
Q

Identify appropriate investigations for cardiac failure

Bloods

A

FBC

U&E

LFTs

CRP

Glucose

Lipids

TFTs

18
Q

Identify appropriate investigations for cardiac failure- In ACUTE Left Ventricular Failure

A

ABG

Troponin

BNP

Raised plasma BNP suggests diagnosis of cardiac failure

Low plasma BNP rules out cardiac failure (90% sensitivity)

19
Q

Identify appropriate investigations for cardiac failure- CXR

A

Alveolar shadowing

Kerley B lines

Cardiomegaly

Upper Lobe Diversion

Pleural Effusion

20
Q

Identify appropriate investigations for cardiac failure- ECG

A

May be normal

May show ischaemic changes (pathological q waves, t wave inversion)

May show arrhythmia or left ventricular hypertrophy

21
Q

Identify appropriate investigations for cardiac failure- Echocardiogram

A

Assess ventricular contraction

Systolic dysfunction = LV ejection fraction < 40%

Diastolic dysfunction = decreased compliance of the myocardium leads to restrictive filling defect

22
Q

Identify appropriate investigations for cardiac failure- Swan-Ganz Catheter

A

Allows measurement of right atrial, right ventricular, pulmonary artery, pulmonary wedge and left ventricular end-diastolic pressures

23
Q

Generate a management plan for cardiac failure

A
  • Acute Left Ventricular Failure

- Chronic Left Ventricular Failure

24
Q

Acute Left Ventricular Failure

A

Treating Cardiogenic Shock:

  • This is severe cardiac failure with low blood pressure
  • Requires the use of inotropes e.g. dobutamine)
  • Managed in ITU

Treating Pulmonary Oedema:

  • Sit the patient up
  • 60-100% Oxygen (and consider CPAP)
  • Diamorphine (venodilator + anxiolytic)
  • GTN infusion (venodilator –> reduced preload)
  • IV furosemide (venodilator and later diuretic effect)

Monitor:

-BP
-Respiratory rate
-Oxygen saturation
-Urine output
-ECG
TREAT THE CAUSE! (e.g. MI, arrhythmia)

25
Q

Chronic Left Ventricular Failure

A
  • ACE Inhibitors
  • Beta-Blockers
  • Loop Diuretics
  • Aldosterone Antagonists
  • Angiotensin Receptor Blockers
  • Hydralazine and a Nitrate
  • Digoxin
  • N-3 Polyunsaturated Fatty Acids
  • Cardiac Resynchronisation Therapy
26
Q

ACE Inhibitors

A

Inhibits renin-angiotensin system and inhibits adverse cardiac remodelling

They slow down the progression of heart failure and improve survival

27
Q

Beta-Blockers

A

Blocks the effects of a chronically activated sympathetic system

Slows progression of heart failure and improves survival

The benefits of ACE inhibitors and beta-blockers are additive

28
Q

Loop Diuretics

A

Alongside dietary salt restriction, can correct fluid overload

29
Q

Aldosterone Antagonists

A

Improves survival in patients with NYHA class III/IV symptoms on standard therapy

Monitor K+ (as these drugs may cause hyperkalaemia)

30
Q

Angiotensin Receptor Blockers

A

May be added in patients with persistent symptoms despite the use of ACE inhibitors and beta-blockers

Monitor K+ (as these drugs may cause hyperkalaemia)

31
Q

Hydralazine and a Nitrate

A

May be added in patients (particularly Afro-Caribbeans) with persistent symptoms despite the use of ACE inhibitors and beta-blockers

32
Q

Digoxin

A

Positive inotrope

Reduces hospitalisation but does NOT improve survival

33
Q

N-3 Polyunsaturated Fatty Acids

A

Provide a small beneficial advantage in terms of survival

34
Q

Cardiac Resynchronisation Therapy

A

Biventricular pacing improves symptoms and survival in patients with a left ventricular ejection fraction < 35%, cardiac dyssynchrony (QRS > 120 msec) and moderate-severe symptoms

These patients are also candidates for implantable cardioverter defibrillator (ICD)

They may receive a combined device

35
Q

Identify the possible complications of cardiac failure

A

Respiratory failure

Cardiogenic shock

Death

36
Q

Summarise the prognosis for a patient with cardiac failure

A

50% with cardiac failure die within 2 years

CVS (16 decks)

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