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CVS > CVS 10 Heart Failure > Flashcards

CVS 10 Heart Failure Flashcards

1
Q

What is ejection fraction?

A

Stroke volume / end diastolic volume (EDV)

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2
Q

What % is ejection fraction typically?

A

60-70%

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3
Q

If stroke volume increases what happens to ejection fraction?

A

If SV increases, EF increases too

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4
Q

Increasing demand of heart is met by what two factors?

A

CO needs to increase so increasing: - heart rate
- stoke volume

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5
Q

What determines the ability to increase stroke volume?

A

Pre load
Myocardial contractility
After load

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6
Q

Define heart failure

A

Inability of heart to meet demand of body

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7
Q

Describe heart failure - what are the components?

A

Clinical syndrome of reduced cardiac output, tissue hypoperfusion, increased pulmonary pressures + tissue congestion

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8
Q

What does reduced cardiac output in heart failure arise from?

A
  • Impaired ventricular filling and/or emptying
  • Due to remodelling (e.g. Loss of myocytes, fibrosis) of cardiac muscle, changes in ventricular shape or function
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9
Q

What is the most common cause heart failure?

A

Coronary artery disease - ischaemic heart disease

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10
Q

Causes of heart failure

A
  • ischaemic heart disease (most common)
  • Hypertension
  • Valvular disease e.g. aortic stenosis
  • Cardiomyopathies
  • AF
  • HIV
  • chronic lung disease
  • previous cancer chemo drugs
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11
Q

Explain heart failure caused by ejection problem

A
  • a contractility (systolic) problem
  • can’t pump with enough force for given EDV - ventricles don’t empty well
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12
Q

Reasons for heart failure caused by ejection problem

A

Thin + fibrosed muscle walls
Enlarged chamber space
Abnormal or uncoordinated myocardial contraction

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13
Q

Explain heart failure caused by filling problem

A
  • filling (diastolic) problem
  • ventricular volume for blood is reduced so EDV/preload is reduced
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14
Q

Causes of heart failure caused by filling problem

A

Ventricular chambers too stiff - not relaxing enough
Thickened ventricular walls

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15
Q

What is a rare cause of heart failure?
Examples that cause this

A

Due to increased demand on cardiac output
e.g sepsis, thyrotoxicosis

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16
Q

What is a systolic problem of the heart also called?

A

Ejection problem
Contractility problem

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17
Q

What is a diastolic problem of the heart also called?

A

Filling problem

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18
Q

How do we determine if heart failure is due to an ejection or filling problem?

A

Measuring ejection fraction
EF < 40% ejection problem HFrEF
EF >50% filling problem HFpEF

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19
Q

Key symptoms of heart failure

A
  • Dyspnoea
  • Fatigue
  • peripheral oedema
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • cough
20
Q

Why is an echocardiogram performed for suspected heart failure patients?

A

Confirms diagnosis
Can identify LV damage
Identifies potential causes
Implications of treatment options + prognosis

21
Q

What is used to measure ejection fraction?

A

Echocardiogram

22
Q

What is ejection problem involving the left ventricle called?

A

Left ventricular systolic dysfunction

23
Q

How does reduced cardiac output trigger neuro-hormonal activation?

A

Decreased CO > decreased BP
- detected by baroreceptors
- RAAS

24
Q

Explain the neuronal activation with low CO

A
  • Decreased CO > decreased BP
  • Detected by baroreceptors
  • Increased sympathetic activity > ^ HR + peripheral resistance (afterload) > increased cardiac work > heart failure
25
Q

What would the ejection fraction be in left ventricular systolic dysfunction?

A

Ejection problem - HFrEF
<40%

26
Q

Explain the hormonal activation due to low CO

A
  • Decreased CO > decreased BP > less renal perfusion
  • RAAS activated - AngII made > aldosterone release
  • aldosterone (+ ADH) causes Na+ and fluid retention = increase in preload
  • AngII increases sympathetic activity > vasoconstriction = increased afterload
  • increased cardiac work > heart failure
27
Q

Damaging effects of neuro-hormonal corrective mechanisms of heart failure

A
  • Increased afterload + circulating volumes cause increased cardiac work > further deterioration of CO
  • Increased pressure within ventricles due to failure of sufficient ejection
  • Increased tissue fluid in lungs and peripheries
  • Cardiotoxic effects from long term activation of SNS + AngII
28
Q

How does LV heart failure cause pulmonary + peripheral oedema?

A
  • increased pressure within LV due to failure to eject volume sufficiently
  • increased pressure in pulmonary circulation
  • increased hydrostatic pressure at venule end of pulmonary capillary beds
  • gradient between hydrostatic + oncotic pressure causes fluid to move out
  • increased volume of tissue fluid accumulates within interstitium
  • oedema
29
Q

How does RAAS cause peripheral oedema?

A

Causes Na+ reabsorption
Water follows
Water retention

30
Q

Presentation of pulmonary oedema

A

due to LV heart failure
Dyspnoea
Basal pulmonary crackles on auscultation
Orthopnoea
Paroxysmal nocturnal dyspnoea

31
Q

Orthopnoea meaning

A

Dyspnoea worsens on lying flat

32
Q

What is paroxysmal nocturnal dyspnoea?

A

Waking up in middle of night gasping for breath

33
Q

How does RV heart failure cause peripheral oedema?

A
  • increased pressure in RV due to failure to eject volume sufficiently
  • increased pressure in systemic circulation
  • increased central venous pressure = increased jugular venous pressure
  • increased hydrostatic pressure at venule end of systemic capillary bed
  • gradient between hydrostatic + oncotic pressure causes fluid to move out
  • increased volume of tissue fluid accumulates within interstitium
  • oedema in gravity dependent areas - peripheral oedema in legs
34
Q

Signs and symptoms of LV heart failure

A

Fatigue
Dyspnoea
Paroxysmal nocturnal dyspnoea
Orthopnoea
Peripheral (RAAS) + pulmonary oedema
Basal pulmonary crackles
Cariomegaly

35
Q

What indicates cardiomegaly?

A

Displaced apex beat

36
Q

Signs + symptoms of RV heart failure

A

Fatigue
Dyspnoea
Peripheral oedema
Raised jugular venous pressure
Tender, smooth liver
Hepatomegaly

37
Q

What drugs can be used to reduce effects of heart failure?

A

ACE inhibitors
Beta blockers
AngII blockers
Diueretics - decrease circulating volume > preload
Calcium channel blocker - vasodilation

38
Q

Drugs for atrial fibrillation

A

Rate or rhythm control
Rate control - B blockers + Ca2+ channel blockers

Worried about strokes - anticoagulants needed - warfarin or DOACs

39
Q

Displaced apex beat to left indicates what?

A

LV heart failure
Cardiomegaly

40
Q

How does activation of the sympathetic nervous system effect preload + afterload of heart in heart failure?

A

Increases afterload only

41
Q

How are ACE inhibitor and Ang receptor inhibitors effective at decreasing heart failure?

A

Reduce the effect of RAAS system
- vasodilation&raquo_space; reduces preload
- reduced ADH + aldosterone release&raquo_space; reduces blood volume&raquo_space; reduces afterload

Reduced preload + afterload&raquo_space; reduced work load on heart

42
Q

Compare and contrast the signs and symptoms of left and right sided heart failure

A

Both:
- fatigue
- dyspnoea
- peripheral oedema

Left:
- paroxysmal nocturnal dyspnoea
- Orthopnoea
- basal pulmonary crackles
- cardiomegaly

Right:
- raised jugular venous pressure
- tender, smooth enlarged liver

43
Q

Adverse effects of ACEi

A
  • dry cough
  • angioedema
  • hypotension
  • tinnitus or vertigo
  • hyperkalaemia
44
Q

Adverse effects of ARBs

A

Hyperkalaemia
Hypotension

45
Q

How do you classify heart failure?

A

Ejection fraction

46
Q

How does sacubitril work?
What is it often given with?

A
  • neprilysin inhibitor
  • inhibtis natriuteric inactivating enzyme > ^ effect of ANP/BNP > natriuresis
  • stops breakdown of bradykinin > vasodilatation
    .
  • ARBs e.g. valsartan
47
Q

How can left sided heart failure cause right sided heart failure?

A
  • decrease in blood pumped out by LV
  • back up of blood
  • increases pulmonary pressure
  • pulmonary congestion
  • increases work of RV > weakens + fails

CVS (22 decks)

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