Chronic heart failure Flashcards
What is chronic heart failure?
It is clinical syndrome with dyspnoea, fatigue and fluid retention due to cardiac dysfunction both either at rest or on exertion with accompanied neurohormonal activation, inadequate cardiac output
What are some possible causes of chronic heart failure?
LV systolic dysfunction, ischaemic heart disease, MI, severe aortic stenosis, cardiomyopathy, cardiac tamponade, hypertension, restrictive pericarditis etc
What are the risk factors for chronic heart failure?
Obesity, diabetes, hypertension, coronary artery disease, valvular heart disease, alcoholism, infection viral mainly, congenital heart defect, obstructive sleep apnoea, age, smoking, high or low hematocrits levels
What is the prognosis for heart failure?
very bad prognosis, similar to cancer
What are to different types of heart failure based on their function?
Systolic and diastolic heart failures, they very often co-exist
What are the types of heart failure based on the location?
Right side, left sided, combined in congestive heart failure
What are the symptoms of left sided heart failure ?
Dyspnoea, lower exercise tolerance, fatigue, cough, pinky frothy sputum, orthopnoea, paroxysmal nocturnal dyspnoea, cold peripheries, muscle waisting, weight loss, wheeze
What are the symptoms of right sided heart failure?
peripheral oedema, ascites, pulsation in neck and facial nausea, anorexia, facial engorgement,
What are the signs of heart failure?
Raised JVP, S3, peripheral, sacral oedema, crackles from pulmonary effusion, cardiac wheeze, displaced apex beat, RV heave, cold peripheries, peripheral cyanosis, tachycardia, narrow pulse pressure
What are the investigations performed for cardiac failure ?
Bloods (FBC, U+E, BNP), ECG, echo, chest X ray, radionuclide ventriculography, left ventriculography
What are the three echo views?
Parasternal long axis, parasternal short axis and parasternal base
What is required for diagnosis?
signs and symptoms, evidence of cardiac dysfunction and responsiveness to diuretics
What is the screening for heart failure?
Measurement of brain natriuretic peptide, it is low in healthy patients, elevated in heart failure
Name some important causes of LV dysfunction
ischaemic heart disease, dilated cardiomyopathy, severe aortic stenosis, mitral regurgitation, MI, toxins such as alcohol, catecholamines, muscular dystrophies, viral infections
What are the different types of ejection fraction?
normal 50-80%, mild 40-50%, moderate 30-40%, severe less than 3-%
What is the name of the method that is commonly used to measure ejection fraction?
Biplane modified Simpsons’s rule
What is the grading system used for cardiac failure?
NYHA class I to IV, it is based on symptoms
Define the 4 stages of heart failure
class I no limitations to exercise, no symptoms during usual activity, class II mild militating, comfortable at rest and mild exertion, class III moderate limitations to exercise, comfortable only at rest, class IV severe exercise limitations, any physical activity brings discomfort
What is the pathology of heart failure?
It is very complex, it is systemic disorder not just about CO, there is cardiac dysfunction, renal blood flow dysfunction, systemic inflammation, neurohormonal activation that is maladaptive, skeletal dysfunction, activation of sympathetic system and RAAS
What is HFrEF?
Heart failure with reduced ejection fraction, it is systolic heart failure
What is HFPEF?
Heart failure with preserved ejection fraction
What happens to Frank-Starlings law in heart failure?
The Frank-Starling law is lost in heart failure, more preload causes more dilation in the heart, as the heart dilates more the contraction is weaker and therefore less blood is pumped out, this causes activation of sympathetic system and kidneys which cause blood retention, again preload is increased and the same cycle repeats
What pathological changes occur as a result of activation of RAAS and sympathetic system?
hypertrophy of heart muscle, vasoconstriction and fibrosis of myocytes
Which factors are vasodilating?
EDFR and ANP, BNP, atrial and brain natriuretic peptides
