Cardiac Failure Flashcards
Define chronic HF?
Long term conditionin which the heart fails to maintain an adequate circulation for the needs of the body
Define acute heart failure?
Rapid onset symptoms and signs of heart failure, requiring urgent management
Caused by acute coronary syndrome OR decompensation of chronic HF
outline the classification of HF anatomically?
Left Heart Failure (LHF)
Right Heart Failure (RHF)
LHF + RHF = Congestive Heart Failure(CHF)
outline the classification of heart failure by cardiac output?
Low Output State: Heart fails to pump in response to normal exertion -> low CO
High Output State: CO is normal but higher metabolic needs e.g. pregnancy, anaemia, hyperthyroidism
what are the causes of chronic left HF?
Valvular
- Aortic stenosis
- Aortic regurgitation
- Mitral regurgitation
Muscular
- Ischaemia (IHD)
- Cardiomyopathy
- Myocarditis
- Arrhythmias (AF)
Systemic
- Hypertension
- Amyloidosis
- Drugs (e.g. cocaine, chemo)
what are the causes of chronic right HF?
Lungs
- Pulmonary hypertension (corpulmonale)
- Pulmonary embolism
- Chronic lung disease e.g. interstitial lung disease, cystic fibrosis
Valvular
- Tricuspid regurgitation
- Pulmonary valve disease
LHF -> CHF
which conditions require a higher cardiac ouput and therefore put strain on the heart?
NAP MEALS
- Nutritional (B1/thiamine deficiency)
- Anaemia
- Pregnancy
- Malignancy
- Endocrine
- AV malformations
- Liver cirrhosis
- Sepsis
what happens if fluid is congested backwards in LHF and RHF?
LHF: fluid accumulates in lungs -> respiratory symptoms
RHF: fluid accumulates in the peripheries -> swelling signs
what are the symptoms of LHF?
Respiratory Problems
Dyspnoea:
- Paroxysmal nocturnal dyspnoea (PND)
- Exertional dyspnoea
- Orthopnoea
Nocturnal cough (+/- pink frothy sputum)
Fatigue
What are the signs of left heart failure?
what are the symptoms of RHF?
- Fatigue
- Reduced exercise tolerance
- Anorexia
- Nausea
- Nocturia
what are the signs of RHF?
- Face: face swelling
- Neck: ↑ JVP
- Heart/Chest: TR murmur, ↑ HR, ↑ RR
- Abdomen: ascites, hepatomegaly
- Other: ankle and sacral pitting oedema
JB is a 34-year-old male, with a history of infective endocarditis, complaining that he’s tiredall the time and struggles to run as far as he used to. He also says that his anklesand facefeel more swollenthan before.
On examination, he has a raised JVP, breathing rate and heart rate. You also hear a pansystolic murmuron auscultation.
What is the most likely diagnosis?
A. Left heart failure secondary to mitral regurgitation
B. Left heart failure secondary to cocaine abuse
C. Right heart failure secondary to tricuspid regurgitation
D. Myocardial infarction
E. High output heart failure
C. Right heart failure secondary to tricuspid regurgitation
what are the investigations for cardiac failure?
Bedside: ECG
Bloods: FBC, U&Es, LFTs, TFTs, BNP
Imaging: CXR, TTE
which investigation is diagnostic for HF?
Transthoracic echocardiogram (TTE) coupled with doppler = DIAGNOSTIC
- Visualise the structure and function of the heart -> may show the cause of HF
- Can calculate ejection fraction (EF): % of the blood present in the LV that gets pumped during systole – normal = 50-70%
outline the classification of heart failure in terms of ejection fraction?
EF < 40%: HF with reduced ejection fraction (HFrEF) – previously called systolicHF
- Indicates inability of the ventricle to contract normally
EF >50%: HF with preserved ejection fraction (HFpEF) – previously called diastolicHF
- Indicates inability of the ventricle to relax and fill normally
what is seen on the x ray for heart failure?
Alveolar oedema
B-lines (Kerley)
Cardiomegaly
Dilated upper lobe vessels + Diverted upper lobe
Effusion (Transudative pleural effusion)
which criteria is used to diagnose heart failure?
Framingham Criteria
2+ majors OR 1 major and 2 minors
outline the management of cardiac failure?
ACE inhibitors: give to all patients with LV dysfunction
- Enalapril, perindopril, ramipril (all end in –pril)
- Can switch to ARB if not tolerable (cough)
Beta-blockers: reduce O2demand on the heart
- Bisoprolol, carvedilol
Diuretics: use if evidence of fluid retention
- Loop diuretics e.g. furosemide
- Aldosterone antagonists e.g. spironolactone
Hydralazine + nitrates – considered in Afro-Caribbean patients
Digoxin– positive inotrope, improves symptoms but not mortality
Cardiac resynchronization therapy – aims to improve timings of contraction of atria and ventricles
outline the management for acute heart failure?
what are the complications of heart failure?
- Respiratory failure
- Renal failure - due to hypoperfusion
- Acute exacerbations
- Death
outline the prognosis of heart failure?
- Very poor, worse than most malignancies
- 50% of severe HF patients die within 2 years
- Acute HF in-hospital mortality = 2-20%
what drugs should be avoided in cardiac failure?
srugs that adversel affect the heart due to systlic dysfunciton- NSAIDs, non- dihydropyridine CCBs
