Chronic heart failure Flashcards
Heart failure characterised by:
Typical symptoms - breathlessness, fatigue, ankle swelling
Typical signs - Tachycardia, tachypnoea, pulmonary creps, pleural effusion, oedema, raised JVP, hepatomegaly
Objective evidence of a structural or functional abnormality of the heart at rest - cardiomegaly, third heart sound, cardiac murmurs, abnormal echo, elevated BNP
NYHA functional classification
I - no limitation; ordinary activity does not result in symptoms
II - slight limitation; comfortable at rest, ordinary physical activity results in symptoms
III - marked limitation of physical activity; comfortable at rest, symptoms at less than ordinary activity
IV - inability to carry out any physical activity without discomfort; symptoms at rest or minimal exertion
Correlates well with prognosis
Heart murmurs - why and manoeuvres
Due to turbulent blood flow
Can be benign
Exaggerated by high-output states
Roll on left, apex with bell - mitral stenosis
Lean patient forward, LLSE with diaphragm - aortic regurg
Murmurs - types
Aortic stenosis - systolic, crescendo-decrescendo in aortic area, radiates to carotids
Aortic regurg - early diastolic murmur aortic area to LLSE
Mitral regurg - pansystolic at the apex, radiates to axilla
Mitral stenosis - late diastolic at the apex, radiates to axilla, best heard in left lateral
Naturitic peptides
ANP in atria, increased by atrial stretch
BNP in ventricular myocardium
(CNP vascular endothelium)
ANP and BNP cause natriuresis and vasodilatation
They demonstrate that the myocardium is under pressure, not that there is heart failure
They are natural diuretics
BNP levels increased when there is left ventricular stretch
Echo - clinical use
Highly sensitive and specific for left ventricular systolic dysfunction
Useful to assess valves
Can look for left ventricular hypertrophy and diastolic dysfunction but not very much standardisation
