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Cardiovascular System > Cardiac Failure (Acute and Chronic) > Flashcards

Cardiac Failure (Acute and Chronic) Flashcards

1
Q

When does cardiac failure occur.

A

Occurs when the heart is unable to pump blood at a rate required by metabolizing tissues.
Cardiac output is inadequate for the body’s requirements.

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2
Q

What are some causes of cardiac failure. (8)

A 
Ischaemic heart disease. 
Valvular heart disease. 
Hypertensive heart disease. 
Congenital heart disease. 
Cardiomyopathy. 
Myocarditis. 
Endocarditis. 
Pulmonary embolism (PE).
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3
Q

What are some precipitating factors of cardiac failure. (9)

A 
Myocardial infarction. 
Infection. 
Arrhythmia. 
Anaemia. 
Thyrotoxicosis. 
Electrolyte imbalances. 
PE. 
Pregnancy. 
Vitamin deficiencies such as BeriBeri.
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4
Q

What are the clinical signs of left sided heart failure. (14)

A 
Dyspnoea. 
Orthopnoea. 
Poor exercise tolerance. 
Nocturnal cough (with pink frothy sputum). 
Wheeze ('cardiac asthma'). 
Nocturia. 
Cold peripheries. 
Weight loss. 
Muscle wasting. 
Paroxysmal nocturnal dyspnoea. 
Fatigue. 
Lung crepitations.
Pleural effusions.
Cyanosis.
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5
Q

What are the clinical signs of right sided heart failure. (9)

A 
Peripheral oedema. 
Nausea. 
Anorexia. 
Facial engorgement. 
Epistaxis. 
Abdominal distention/ascites. 
Tender pulsatile hepatomegaly. 
Increased jugular venous pressure (JVP). 
Hepatojugular reflex.
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6
Q

What are the clinical signs of severe heart failure. (5)

A 
Reduced pulse pressure. 
Hypotension. 
Cool peripheries. 
3rd and 4th heart sounds. 
Gallop rhythm.
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7
Q

What investigations should be carried out in a patient with suspected heart failure. (11)

A 
FBC. 
UandE. 
LFTs. 
Lipid profile. 
TFTs.
Glucose. 
Cardiac enzymes (BNP). 
ECG. 
CXR. 
Echo with colour Doppler studies (may indicate cause of heart failure).
Endomyocardial biopsy is rarely needed.
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8
Q

How is heart failure treated. (5)

A

Treat any risk factors.
Treat any exacerbating factors (anaemia, thyroid disease, infection, raised BP).
Treat the cause (eg if dysrhythmias, valvular disease).
Avoid exacerbating factors (NSAIDs, verapamil).
Drugs treatment: diuretics, ACEi, ARBs, Beta blockers, spironolactone, dogoxin, vasodilators.

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9
Q

What are the risk factors for heart failure. (4)

A

High cholesterol.
High sugar.
Increased weight.
Smoking.

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10
Q

What drugs are used to treat heart failure. (6)

A 
Diuretics. 
ACE inhibitors/angiotensin receptor blockers. 
Beta-blockers. 
Digoxin. 
GTN infusion.
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11
Q

What is the prognosis for patient’s with heart failure.

A

Poor. 20-25% of patients die within 5 years of initial diagnosis.

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12
Q

What is the prevalence of heart failure. (2)

A

1-3% of the general population.

10% amongst the elderly population.

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13
Q

What is systolic heart failure.

A

Inability of the ventricle to contract normally, resulting in a decreased CO.

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14
Q

What is the ejection fraction in a patient with systolic heart failure.

A

EF

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15
Q

What are the causes of systolic heart failure. (3)

A

Ischaemic heart disease.
Myocardial infarction.
Cardiomyopathy.

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16
Q

What is diastolic heart failure.

A

Inability of the ventricle to relax and fill normally, causing increased filling pressure.

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17
Q

What is the ejection fraction in a patient with diastolic heart failure.

A

EF>50%.

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18
Q

What are some causes of diastolic heart failure. (4)

A

Constrictive pericarditis.
Cardiac tamponade.
Restrictive cardiomyopathy.
Hypertension.

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19
Q

What is important to note about diastolic and systolic heart failure.

A

They usually coexist.

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20
Q

What is congestive heart failure.

A

Failure of both the left ventricle and right ventricle.

21
Q

What are some causes of right heart failure. (3)

A

Left ventricular failure.
Pulmonary stenosis.
Lung disease.

22
Q

What is meant by acute heart failure. (2)

A

Often used exclusively to mean new onset acute or decompensation of chronic heart failure characterised by pulmonary and/or peripheral oedema.
With or without signs of peripheral hypoperfusion.

23
Q

What is meant by chronic heart failure. (2)

A

It develops slowly.

Venous congestion is common but arterial pressure is well maintained until very late.

24
Q

What is meant by low output cardiac failure.

A

CO is decreased and fails to increase normally with exertion.

25
Q

What are some causes of low output cardiac failure. (3)

A

Pump failure.
Excessive preload.
Chronic excessive afterload.

26
Q

What are some causes of pump failure. (3)

A

Systolic and/or diastolic heart failure.
Decreased HR (eg beta blockers, heart block, post MI).
Negatively inotrophic drugs (antiarrhythmic agents).

27
Q

What are some causes of excessive preload. (2)

A 
Mitral regurgitation. 
Fluid overload (NSAID causing fluid retention).
28
Q

What may fluid overload cause if renal excretion is impaired (or if large volumes are involved).

A

Left ventricular failure.

29
Q

Who is most at risk of developing low output heart failure due to excessive preload. (2)

A

In those with simultaneous compromise of cardiac function.

In the elderly.

30
Q

What are some causes of chronic excessive afterload. (2)

A

Aortic stenosis.

Hypertension.

31
Q

What is high output heart failure. (3)

A

It is rare.
The output is normal or increased in the face of increased physiological need.
Failure occurs when CO fails to meet the needs.

32
Q

When will high output heart failure occur. (2)

A

It will occur in a healthy heart.

But it will occur even earlier if there is heart disease.

33
Q

What are some causes of high output heart failure. (6)

A 
Anaemia. 
Pregnancy. 
Hyperthyroidism. 
Paget's disease. 
Arteriovenous malformation. 
BeriBeri.
34
Q

What are the consequences of high output heart failure. (2)

A

Initially features of right ventricular failure.

Later left ventricular failure becomes evident.

35
Q

What are the physical signs of heart failure. (10)

A 
Exhaustion. 
Cool peripheries. 
Cyanosis. 
Low BP. 
Narrow pulse pressure. 
Pulsus alternans. 
Displaced apex (LV dilatation). 
RV heave (pulmonary hypertension). 
Murmurs of mitral or aortic valve disease. 
Wheeze (cardiac asthma).
36
Q

What may be seen on the CXR of a patient with heart failure. (8)

A

Cardiomegaly (cardiothoracic ration >50%).
Prominent upper lobe veins (upper lobe diversion).
Peribronchial cuffing.
Diffuse interstitial or alveolar shadowing.
Classical perihilar ‘bat’s wing’ shadowing.
Fluid in the fissures.
Pleural effusions.
Septal (Kerley B) lines.

37
Q

What are septal lines attributed to. (2)

A

Interstitial oedema.

Engorged peripheral lymphatics.

38
Q

What is the 5 year mortality for heart failure.

39
Q

What is the ABCDE of left ventricular failure. (5)

A 
Alveolar oedema (Bats wings). 
Kerley B lines (interstital oedema). 
Cardiomegaly. 
Dilated prominent upper lobe vessels. 
Pleural Effusion.
40
Q

What criteria is used to diagnose congestive heart failure.

A

Framingham criteria.

41
Q

What is needed in the framingham criteria to positively diagnose congestive cardiac failure. (2)

A

At least 2 major criteria.
OR
1 major criteria and 2 minor criteria.

42
Q

What are the major criteria in the Framingham criteria. (9)

A 
PND. 
Crepitations. 
S3 gallop. 
Cardiomegaly. 
Increased central venous pressure. 
Weight loss >4.5kg in 5 days in response to treatment. 
Neck vein dilatation. 
Acute pulmonary oedema. 
Hepatojugular reflex.
43
Q

What are the minor criteria in the Framingham criteria. (7)

A 
Bilateral ankle oedema. 
Dyspnoea on ordinary exertion. 
Tachycardia (HR>120BPM). 
Decrease in vital capacity by 1/3 of maximum recorded. 
Nocturnal cough. 
Hepatomegaly. 
Pleural effusion.
44
Q

What is the benefit of using diuretics to treat heart failure.

A

They can reduce the risk of death and worsening heart failure.

45
Q

What loop diuretics might you give a patient with chronic heart failure. (3)

A

Furosemide (loop diuretic).
Spironolactone (Potassium sparing).
Metolazone (Thiazide).

46
Q

When might you give a patient with heart failure ARBs instead of ACEi.

A

ACEi may cause an irritating cough, give ARBs if this is the case.

47
Q

Who should you consider giving an ACEi to.

A

All patients with left ventricular heart failure.

48
Q

How do you treat acute heart failure. (6)

A 
Oxygen. 
ECG. 
Diamorphine IV slowly. 
Furosemide IV. 
GTN spray. 
If systolic BP>100 start nitrate infusion. 
Consider CPAP.

Cardiovascular System (31 decks)

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