Cardiovascular System Flashcards
What is heart failure?
The state in which the heart is unable to pump at a rate commensurate with the requirements of the tissues or can do so only from high pressures
What are the two types of heart failure?
Systolic or diastolic
What is systolic heart failure?
Less blood pumped out of ventricles, weakened heart muscle can’t squeeze as well
What is diastolic heart failure?
Stiff heart can’t relax normally, less blood fills the ventricles
What causes heart failure?
Coronary artery disease
Hypertension
Valvular disease
Diabetes mellitus
What are the symptoms of heart failure?
Dyspnea (SOB) Swelling Fatigue Weight gain Paroxysmal nocturnal dyspnea (night wakening from SOB)
What are the pulmonary clinical findings of heart failure?
Respiratory distress
Crepitations
Wheeze
What are the cardiac clinical findings of heart failure?
Bradycardia/tachycardia Displaces apex beat Raised JVP (jugular venous pulse) Extra heart sounds Murmurs
What are the abdominal clinical findings of heart failure?
Ascites (fluid collection in spaces within your abdomen)
Hepato-jugular reflux
What are other extremities of heart failure?
Cool
Dependent Edelman
Cyanosis
Pallor
What are some signs that show right sided heart failure?
Oedema Ascites Pleural effusions Raised JVP Hepatomegaly
What are some signs that show left sided heart failure?
Pulmonary oedema
Low BP
Fatigue
What is pulmonary oedema?
Build up of excess fluid in the lungs
What causes pulmonary oedema?
Increased left ventricle diastolic pressure (due to decreased amount of blood ejected during systole), raised left atrium pressures and increased pulmonary venous and capillary pressures
Once the pulmonary capillary pressure exceeds oncotic pressure fluid enters the alveoli
Respiration is stimulated via the vagus (Hering Brewer reflex)
There is also bronchial mucosa constriction causing wheeze- cardiac asthma
What are the symptoms of pulmonary oedema?
Patient fighting for breath Rapid respiratory rate Distressed Frothy pick sputum Crepitations and rhonchi (bubbling sound in the lungs)
What is the NYHA classification I of heart failure?
No limitation of physical activity
Ordinary physical activity does not cause symptoms of HF
What is the NYHA classification II of heart failure?
Comfortable at rest
Slight limitation of physical activity
What is the NYHA functional classification III of heart failure?
Comfortable at rest
Marked limitation, less than ordinary activity causes discomfort
What is the NYHA classification IV of heart failure?
Discomfort at rest
What are some of the complications of HF?
Renal failure Electrolyte abnormalities Impaired liver function Thrombo-embolism Ventricular arrhythmias Sudden death
How do you diagnose HF?
ECG (check for MI, PE, arrhythmia, LVH)
CXR (pulmonary venous congestion, interstitial edema, cardiomegaly, pleural effusions)
Labs- CBC, BNP, U&E, troponin, ABG, thyroid function tests
Echocardiography- evaluate severity , causes, characterisation
MRI
What is BNP?
Brain natriuretic peptide
Helps to diagnose HF
If your BNP is <150 then it’s unlikely to be HF
BNP naturally increases with age, it also increases with renal disease, arrhythmia, sepsis, CAD, its also higher in women and African-Americans
It is decreased in obesity
BNP is increased in HF
How are patients with HF managed?
Lifestyle modification Vaccines Low sodium diet Alcohol and tobacco cessation Weight management Fluid management Treat anaemia Avoid NSAIDs, aspirin, thiazolidinedione (fluid retention), metformin (increased risk for lactic acidosis)
What drugs can be used to improve the symptoms of HF?
Diruetics
Digoxin
What drugs are used to improve the survival of HF?
Beta blockers Ivabradine ACE inhibitors Angiotensin receptor blockers Aldosterone blockers
What is cardiac resynchronisation therapy?
Abnormal ventricular conduction resulting in a mechanical delay and dyssynchronous contraction
Seen in left bundle branch block
What should be done during acute HF?
Oxygen Fluid restrictions Diuretics IV nitrates Inotropes
