Congestive heart failure Flashcards
1
Q
What is the definition of congestive heart failure?
A
Chronic progressive condition affecting the pumping power of the heart. CHF is specifically the stage when fluid builds up around the heart
2
Q
What is the epidemiology of congestive heart failure?
A
1-2% prevalence in the western world
3
Q
What is the pathology of congestive heart failure?
A
- Can result from any structural/functional cardiac disorder that impairs the hearts ability to contract
- Changes include:
- Ventricular dilatation
- Myocyte hypertrophy
- ↑ collagen synthesis
- Altered myosin gene expression
- Salt and water retention
- Sympathetic stimulation
- Peripheral vasoconstriction
- 2 types: left and right sided
- Framingham criteria: Either 2 major criteria/1 major criterion in conjunction with 2 minor criteria
4
Q
What are the risk factors/aetiololgy of congestive heart failure?
A
- Hypertension
- Coronary artery disease
- Valve disease
5
Q
What are the signs/symptoms of congestive heart failure?
A
- Paroxysmal nocturnal dyspnoea – major
- Crepitations – major
- S3 gallop – major
- Cardiomegaly – major
- ↑ central venous pressure - major
- Weight loss – major
- Neck vein distention – major
- Acute pulmonary oedema – major
- Hepatojugular reflex = major
- Bilateral ankle oedema – minor
- Dyspnoea on ordinary exertion – minor
- Tachycardia – minor
- Nocturnal cough – minor
- Hepatomegaly – minor
- Pleural effusion - minor
- ↓ vital capacity by a 1/3
6
Q
What investigations should be carried out for suspected congestive heart failure?
A
- Bloods
- CXR
- Electrocardiogram
- (Stress) ECG/Ambulatory 24 hour ECG monitoring
- Nuclear cardiography
- Cardiac MRI
- Cardiac catheterisation
- Cardiac biopsy
- Cardiopulmonary exercise testing
7
Q
What are the surgical treatments for congestive heart failure?
A
- Revasculisation – if coronary artery disease is the cause
- Bi-ventricular pacemaker/implantable cardioverter
- Heart transplant
8
Q
What are the pharmacological treatments for congestive heart failure?
A
- Diuretics
- ACE, angiotensin II receptor antagonists, Ca channel blockers
- Beta blockers
- Aldosterone antagonists, digoxin, nitrates, vasopressor agents
- Prophylactic anticoagulant
9
Q
What are the non pharmacological treatments for congestive heart failure?
A
- Lose weight
- Smaller meals/less salt
- Smoking cessation
- ↑ exercise
- Vaccination against pneumococcal disease/influenza
