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103: Theme 3 - 304 - Cardiovascular > Chronic heart failure > Flashcards

Chronic heart failure Flashcards

1
Q

What is Class I according to the NYHA classification?

A

No limitation to physical activity

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2
Q

What is Class II according to the NYHA classification?

A

Slight limitation of ordinary activity

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3
Q

What is Class III according to the NYHA classification?

A

Marked limitation, even during less-than-ordinary activity

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4
Q

What is Class IV according to the NYHA classification?

A

Severe limitation with symptoms at rest

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5
Q

What are some clinical sign of cardiac failure?

A

-cool, pale, cyanotic extremities
- tachycardia
- elevated JVP
third heart sound S3
- displaced apex: LV enlargement
- crackles or decreased breath sounds
- peripheral oedema
- Ascites
- Hepatomegaly

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6
Q

Give 5 clinical tests are used to diagnose heart failure

A
  • CXR
  • ECG
    Blood investigations
  • Echo/Cardiac MRI or CT
  • Coronary angiography/ CTCA
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7
Q

What are some medical treatments for LVSD?

LVSD: Left Ventricular Systolic Dysfunction

A
  • Using Loop Diuretics
  • Mineralocorticoid Receptor Antagonists ( Aldosterone antagonist, potassium-sparing)
  • ACE inhibitors
  • Beta-Blockers
  • SA Node Blockade
  • Digoxin
  • ARNI
  • surgical interventions
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8
Q

Give example of loop diuretics and their action

A
  • Frusemide - Bumetanide
    given iv or orally
  • Inhibit Na+ reabsorption from the proximal tubule
  • K+ loss from distal tubule
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9
Q

What are some side effects of loop diuretics?

A
  • electrolyte abnormalities
  • hypovolaemia and diminished renal function
  • hypokalaemia
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10
Q

Give example of mineralocorticoid receptor antagonists. What is their action?

A
  • Eplerenone, Spironolactone
  • acts on distal tubule as an aldosterone agonist, and is potassium-sparing
  • promotes Na+ secretion and K+ re-absorption
  • reduces hypertrophy and fibrosis
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11
Q

What are some side effects of mineralocorticoid receptor antagonists ?

A
  • Gynecomastia (enlargement of men’s breast): especially spironolactone
  • Hyperkalaemia, renal function abnormalities
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12
Q

Give an example of ACE inhibitors and their action

A
  • Ramipril, Perindopril, Enalapril, Captopril, Lisinopril
  • act on the activated RAAS, given in small slowly titrated doses
  • block production of angiotensin:–> vasodilation, lower BP, reduced cardiac output
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13
Q

What are some side effects of ACE inhibitors?

A
  • cough
  • hypotension
  • renal impairment
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14
Q

How does heart rate contribute to chronic heart failure?

A
  • excessively high heart rate –> decreased time for ventricular filling – decreased SV and CO
  • ventricles contract harder, due to reduced volume
  • increased atrial preload is too much
  • atrial/ ventricular hypertrophy
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15
Q

What is Frank-Starling’s Law?

A
  • this describes the relationship between Preload and Cardiac output
  • an increase in volume of blood filling the hear stretches the fibres causing greater contractile force, increasing the stroke volume
  • only to a point after which the fibres are overstretched, and contrile force is decreased
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16
Q

Give two examples of low output heart failure

A
  • systolic heart failure

- diastolic heart failure

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17
Q

What is High output heart failure?

A
  • when other medical conditions cause an increased demand on cardiac output
  • the heart itself is functioning normally but cannot keep up with unusually high demand for blood to one or more organs
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18
Q

What are causes of high output heart failure?

A
  • thyrotoxicosis
  • profound anaemia
  • pregnancy
  • pagets disease:abnormal
  • acromegaly
  • sepsis
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19
Q

What is pagets disease?

A

formation of new bone when - replacing old bone is abnormal

- gradually bone becomes weak and brittle

20
Q

What is systolic heart failure?

A
  • the progressive deterioration of myocardial contractile function
21
Q

What causes systolic heart failure?

A
  • Ischaemic injury
  • Volume overload
  • Pressure overload
22
Q

What is diastolic Heart Failure?

A
  • inability of the heart chamber to relax, expand and fill sufficiently during diastole to accommodate an adequate blood volume
23
Q

What causes diastolic heart failure?

A
  • significant left ventricular hypertrophy
  • infiltrative disorders
  • constrictive pericarditis
  • restrictive cardiomyopathy
24
Q

Define Cardiomyopathies

A

Disease of the heart muscle leading to functional impairment

25
Q

What is dilated cardiomyopathy and its causes?

A
  • the hearts ability to pump blood is decreased due to lower function of the left ventricle
  • 50% familial aetiology
  • ETOH, pregnancy, systemic disease, muscular dystrophies
  • Myocarditis
26
Q

What is hypertrophic cardiomyopathy?

A
  • hereditary disease

- where the myocardium becomes abnormally thick

27
Q

What is restrictive cardiomyopathy?

A
  • least common
  • where the myocardium is rigid, but not thickened, therefore heart is unable to pump blood
  • main cause in the uk in the amyloid, protein produced in the bone marrow
28
Q

Describe the neurohormonal compensatory mechanism for heart failure

A
  • release of noradrenaline, increases heart rate and myocardial contractility
  • release of ANP/ BNP
  • activation of renin-angiotensin - aldosterone system
29
Q

What is ANP/BNP?

A
  • (B-type) Atrial natriuretic peptide
  • secreted by the cardiac atria
  • promotes excretion of water and sodium
  • lowering blood pressure
30
Q

Describe the Renin- Angiotensin-Aldosterone System

A
  • Renin, ACE
  • Angiotensinogen –> Angiotensin I –> Angiotensin II
  • vasoconstriction, ADH secreted, Aldosterone secretion
  • more water and sodium moves out of the collecting duct, retained in the blood
31
Q

Describe the NP (naturistic peptide) System

A
  • proBNP released

- BNP(active), NT-proBNP (non-active)

32
Q

What is the action of active BNP?

A
  • stimulates diuresis
  • vasodilation
  • inhibits RAAS
  • inhibits the SNS
33
Q

What does RAAS stand for

A

the Renin-Angiotensin-Aldosterone System

34
Q

What are the 7 clinical types of heart failure?

A
  • Left-sided HF
  • Right-sided HF
  • Biventricular HF: left HF causing right HF due to overload of pulmonary circulation
  • Chronic HF
  • Acute HF
  • Compensated HF
  • Decompensated HF
35
Q

What is Left-sided Heart failure and what are the causes?

A
  • when there is insufficient afterload on the left heart, resulting in overload in the left atrium - leading to increased pressure in the pulmonary circulation (oedema and congestion)

Causes

  • Ischaemic heart disease
  • Hypertension
  • Valvular heart disease
  • Myocardial disease
36
Q

What is the effect of left ventricular failure on the kidneys?

A
  • Decreased renal failure due to reduced cardiac output
  • activation of RAAS
  • retention of salt and water with consequent expansion of interstitial fluid and blood volume
37
Q

What is the effect of left ventricular failure on the Brain?

A
  • causes Hypoxic encephalopathy ( lack of oxygen brain disorder)
  • Irritability
  • Loss of attention
  • Restlessness
  • Stupor and coma
38
Q

What is right-sided heart failure and what is its cause?

A
  • the inability of the heart to properly expel the contents of the right ventricle

Causes

  • Cor-pulmonale: Right-sided HF due to significant pulmonary hypertension, due to increased resistance in the pulmonary circulation
    - usually the result of a respiratory disease: COPD,
    pulmonary emboli
  • Valvular heart disease
  • Congenital heart disease
39
Q

What are the systemic effects of Right Heart failure?

  • Liver and portal system
  • Spleen
  • Abdomen
  • Subcutaneous tissue
A
  • Liver and portal system: congestive hepatomegaly, centrilobular necrosis if severe, cardiac cirrhosis
  • Spleen: congestive splenomegaly
  • Abdomen: Ascites- accumulation of transudate in the peritoneal cavity
  • Subcutaneous tissue: peripheral oedema (ankles), sacral oedema if bedridden
  • pleural and pericardial effusion
40
Q

Give examples of Beta-blockers and explain their action.

- What apart from CHF can it be used to treat?

A
  • Bisoprolol, Carvedilol, Metoprolol
  • block the action of adrenaline and noradrenaline on adrenergic beta receptors
  • slows HR + reduces BP
  • given orally in small doses in slow titrations
  • Can be used to treat arrhythmias
41
Q

What are the side effects of Beta-blockers?

A
  • Bronchospasm

- Claudication: pain caused by too little blood flow to the arms and legs

42
Q

Give an example of a SA Node Blockade and explain their action.

A
  • Ivabradine
  • blocks the If channel (funny current) within the SA node
  • Slow HR, no effect on BP
  • Given orally with dose titration
43
Q

What are the side effects of SA Node Blockades?

A
  • Visual aura (hallucinations)

- Bradycardia ( too slow heart rate)

44
Q

What is the action of Digoxin and when is it indicated?

A
  • Increase myocardial contractility
  • Slows conduction at the AV node (used in AF)
  • Excreted by kidney

Indication

  • Acute HF especially in AF
  • Chronic HF in selected cases
45
Q

Give an example of Angiotensin Receptor Neprilysin Inhibitor (ARNI). What is its action?

A
  • Sacubitril, Valsartan
  • acts on the activate RAAS
  • blocks the break down of natriuretic peptides (A and B)
  • blocks production of angiotensin: vasodilation, BP lowered, reduced cardiac work
  • promote natriuresis: increased Na extraction, vasodilation, reduce hypertrophy and fibrosis
46
Q

What are the side-effects of Angiotensin Receptor Neprilysin Inhibitor (ARNI)

A
  • Hypotension

- renal impairment

47
Q

What are other non-pharmcological treatments for LVSD?

A
  • Cardiac Resynchronisation therapy
  • Implantable Cardioverter Defibrillator (ICD)
  • Dialysis and Ultrafiltration
  • Ventricular Assist Device (LVAD/RVAD)
  • Intra-aortic balloon pump
  • Cardiac transplantation
  • Stem cell therapy**

103: Theme 3 - 304 - Cardiovascular (12 decks)

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