Cardiac Failure Flashcards
Define cardiac failure
inability of the cardiac output to meet the body’s demands despite normal venous pressures
Explain the aetiology and risk factors of cardiac failure
- LOW OUTPUT Cardiac Failure (reduced cardiac output)
- HIGH OUTPUT Cardiac Failure (increased demand)
LOW OUTPUT Cardiac Failure (reduced cardiac output)
- Left Heart Failure
- Right Heart Failure -Biventricular Failure
LSHF
- Ischaemic heart disease -Hypertension
- Cardiomyopathy
- Aortic valve disease
- Mitral regurgitation
RSHF
- 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
Biventricular F
- Arrhythmia
- Cardiomyopathy (dilated or restrictive)
- Myocarditis
- Drug toxicity
HIGH OUTPUT Cardiac Failure (increased demand)
Anaemia
Beri beri
Pregnancy
Paget’s disease
Hyperthyroidism
Arteriovenous malformation
Summarise the epidemiology of cardiac failure
10% > 65 yrs old
Recognise the presenting symptoms of cardiac failure
- Left Heart Failure
- symptoms caused by pulmonary congestion - Acute Left Ventricular Failure
- Right Heart Failure
Left Heart Failure-presenting symptoms of cardiac failure
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
Acute Left Ventricular Failure- presenting symptoms of cardiac failure
Dyspnoea
Wheeze
Cough
Pink frothy sputum
Right Heart Failure- presenting symptoms of cardiac failure
Swollen ankles
Fatigue
Increased weight (due to oedema)
Reduced exercise tolerance
Anorexia
Nausea
Recognise the signs of cardiac failure on physical examination- Left Heart Failure
Tachycardia
Tachypnoea
Displaced apex beat
Bilateral basal crackles
S3 gallop (caused by rapid ventricular filling)
Pansystolic murmur (due to functional mitral regurgitation
Recognise the signs of cardiac failure on physical examination- Acute Left Ventricular Failure
Tachypnoea
Cyanosis
Tachycardia
Peripheral shutdown
Pulsus alternans
Gallop rhythm
Wheeze (cardiac asthma)
Fine crackles throughout lung
Pulsus Alterans
- 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
Recognise the signs of cardiac failure on physical examination- Right Heart Failure
Raised JVP
Hepatomegaly
Ascites
Ankle/sacral pitting oedema
Signs of functional tricuspid regurgitation
Identify appropriate investigations for cardiac failure
Bloods
FBC
U&E
LFTs
CRP
Glucose
Lipids
TFTs
Identify appropriate investigations for cardiac failure- In ACUTE Left Ventricular Failure
ABG
Troponin
BNP
Raised plasma BNP suggests diagnosis of cardiac failure
Low plasma BNP rules out cardiac failure (90% sensitivity)
Identify appropriate investigations for cardiac failure- CXR
Alveolar shadowing
Kerley B lines
Cardiomegaly
Upper Lobe Diversion
Pleural Effusion
Identify appropriate investigations for cardiac failure- ECG
May be normal
May show ischaemic changes (pathological q waves, t wave inversion)
May show arrhythmia or left ventricular hypertrophy
Identify appropriate investigations for cardiac failure- Echocardiogram
Assess ventricular contraction
Systolic dysfunction = LV ejection fraction < 40%
Diastolic dysfunction = decreased compliance of the myocardium leads to restrictive filling defect
Identify appropriate investigations for cardiac failure- Swan-Ganz Catheter
Allows measurement of right atrial, right ventricular, pulmonary artery, pulmonary wedge and left ventricular end-diastolic pressures
Generate a management plan for cardiac failure
- Acute Left Ventricular Failure
- Chronic Left Ventricular Failure
Acute Left Ventricular Failure
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)
