Cardiac failure (CV) Flashcards
Define cardiac failure.
Inability of the cardiac output to meet the body’s demands, despite normal venous pressures
Which age group is cardiac failure most common in?
> 65 years old
What are the three types of cardiac failure?
- left heart failure (systolic + diastolic)
- right heart failure
- congestive heart failure (left HF + right HF) where LHF causes RHF
What are the two types of left heart failure?
- systolic heart failure
- diastolic heart failure
Define systolic heart failure.
HFrEF <40%, unable to pump blood
What are some causes of systolic heart failure? (4)
DAMI:
- dilated cardiomyopathy
- arrhythmias
- myocarditis
- ischaemic heart disease
What heart sound is heard in systolic heart failure?
- S3
- rapid filling of ventricles at start of diastole - normal variant in young and athletes due to strong atrial contraction
- abnormal in left-sided HF usually due to mitral regurgitation –> over-filled LA = when mitral valve opens in diastole a lot of blood rapidly empties into ventricle - sign of systolic HF, usually with MR
Define diastolic heart failure.
HFpEF >50%, heart cannot relax and properly fill with blood
What are some causes of diastolic heart failure? (4)
- hypertrophic obstructive cardiomyopathy
- restrictive cardiomyopathy
- constrictive pericarditis
- cardiac tamponade
What heart sound is heard in diastolic heart failure?
- S4
- atrial-kick near the end of diastole as the atria contract hard trying to force blood into a ‘stiff non-compliant ventricle’ - classically associated with diastolic HF
- pure diastolic HF is rare, whereas pure systolic and mixed HF are more common = S3 much more common in HF
What are some causes of right heart failure? (4)
LIPT(on iced tea will give you heart failure):
- secondary to Left HF (congestive HF)
- Infarction
- Pulmonary hypertension
- Tricuspid regurgitation
How can you categorise cardiac failure? (4)
- acute
- chronic
- low output state - low cardiac output
- high output state - NORMAL heart unable to pump enough blood to meet metabolic needs of the body
What conditions can cause a high output state - cardiac failure? (4)
- anaemia
- Beri-Beri –> thiamine deficiency
- pregnancy
- hyperthyroidism
What are the clinical features of high output state cardiac failure? (3)
Heart failure with fluid overload:
- acute breathlessness with no associated pain
- bilateral pitting oedema
- elevated JVP
What are the clinical features of left heart failure? (6)
- dyspnoea
- orthopnoea
- paroxysmal nocturnal dyspnoea
- bibasal crackles on inspiration
- pink frothy sputum - due to pulmonary oedema
- wheeze
When are inspiratory vs expiratory bibasal crackles heard?
- inspiratory - left HF
- expiratory - lung fibrosis
What is an early sign of LV failure?
S3 gallop rhythm
Why do patients get pulmonary symptoms in left heart failure?
Fluid accumulation in lungs –> pulmonary oedema
What are the clinical features of right heart failure? (4)
- swollen ankles - peripheral oedema
- raised JVP
- hepatomegaly - pulsatile liver edge on palpation
- ascites
Why do patients get swollen signs in right heart failure?
Fluid accumulates in peripheries as it is congested backwards (into systemics)
Why do you get different types of symptoms in left vs right heart failure?
- left HF - fluid build up in lungs as left heart not functioning properly
- right HF - fluid build up in peripheries as right heart not working properly
What is the first-line investigation for heart failure?
BNP - raised in heart failure - sensitive but not specific
What drug types can cause a falsely low BNP? (5)
- ACEi
- ARBs
- beta blockers
- diuretics
- aldosterone antagonists
What investigation is diagnostic for heart failure?
Transthoracic echocardiogram - done if BNP is raised for confirmation of heart failure