CARDIO- Heart failure Flashcards
what is the classification of chronic heart failure
HF with reduced ejection fraction or systolic HF
HF with preserved ejection fraction or diastolic HF
how many classes of heart failure are there
4
what are the symptoms of heart failure
serious, significant effect on quality of life nocturnal dyspnoea dyspnoea on exertion orthopnoea rales / ling crackles acute pulmonary oedema neck vein distension increased venous pressure cardiomegaly cough ankle oedema renal dysfunction
what is heart failure
structural / functional cardiac disorder which impairs the ability of the heart to fill / eject blood to meant the bodies needs
outline similarities and differences between HFrEF and HFpEF
HFrEF
inability of heart to maintain contractility producing reduction on ejection fraction and stroke volume
volume - overload in ventricles = MI, IHD
HFpEF
ventricles are unable to adequately relax and fill and a normal diastolic pressure / volumes to maintain stroke volume
pressure - overload in ventricles (hypertension, aortic stenosis)
what are the causes of heart failure
impaired ventricular function - myocardial infarction
pressure overload of ventricle - increased systemic / pulmonary hypertension
inflow obstruction of ventricle- mitral stenosis / diastolic HF
valvular disease - mitral stenosis
volume overload of ventricle - ventricular and atrial septal defect
what does it mean when HF is described as a progressive syndrome
continues to get worse and is difficult to reverse
outline stage 1 of HF
insult / stimulus
myocardium injury / increase chronic pressure load
decrease in contractility
outline stage 2 of HF
compensated function
initial preserved function
myocardia; hypertrophy and chamber dilation
moderate symptoms and treatment
outline stage 3 of heart failure
decompensation overt failure
gross change in heart shape- wall thinning, spherical, dilation
significant morbidity and mortality
hospitalisations
outline the compensatory mechanisms in HF
drop in stroke volume through ventricular failure leads to compensatory mechanisms to maintain CO
increase in sympathetic + RAAS + vasopressin activities
opposed via activation of ANP/BNP system
what is an issue associated with the compensatory mechanisms in HF
excessive increase in neurohormonal compensation leads to changes in oxygen demand and long term changes to the heart
outline effects of prolonged compensatory mechanisms
continuous sympathetic activation - beta adrenergic down regulation and desensitisation
increased heart rate
increased pre-load
increased total peripheral resistance
continuous neurohormonal activation - chronically elevated RAAS, ang II and aldosterone trigger inflammatory responses
how does remodelling in HF happen
genome expression, molecular, cellular and interstitial changes manifest clinically as a change in size, shape and function of the heart
outline the diagnostic algorithm for HF
heart failure suspected
request NT-proBNP test (sensitive test for HF - will not miss any cases- non specific- may also present with AF, hypertension)
if BNP normal - look for other reasons
if BNP elevated - echo to confirm/refute - will also confirm the cause
