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ESA2 > CVS 11 (Heart Failure) > Flashcards

CVS 11 (Heart Failure) Flashcards

1
Q

Define Heart failure:

A

Chronic failure of heart to provide sufficient output to meet the body’s requirements, despite adequate filling pressure

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2
Q

List some causes of heart failure:

A
  • Ischaemic heart disease (>70% cases)
  • Hypertension
  • Dilated cardiomyopathy (infection/drugs/pregnancy)
  • Valvular heart disease
  • Restrictive cardiomyopathy (ie Amyloidosis)
  • Hypertrophic cardiomyopathy
  • Pericardial disease
  • Arrhythmias
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3
Q

Right sided heart failure rarely occurs without left sided heart failure, except…

A

If chronic lung disease present

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4
Q

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

A
  • Pressure build up in pulmonary veins due to back-up of blood
    = Pulmonary hypertension
  • Backs-up into right heart, overstretching the fibres causing right heart failure
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5
Q

What are the 2 types of myocyte hypertrophy?

A

1) Eccentric = Elongation in response to volume overload, causes thinning of heart wall
2) Concentric = Increase in width, in response to pressure overload, causing thickening of heart wall

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6
Q

What type of myocyte hypertrophy causes thinning of the heart wall?

A

Eccentric hypertrophy

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7
Q

What type of myocyte hypertrophy causes thickening of the heart wall?

A

Concentric hypertrophy

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8
Q

Heart failure stimulates an increased SNS innervation to the CVS. Explain how this can exacerbate symptoms:

A
  • Increased vasoconstriction increases stress on the heart, causing myocardial hypertrophy
  • Increased heart rate and contractility increases the O2 demand, resulting in decreased contractility
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9
Q

What is the result of Angiotensin II at AT2 receptors?

A

Increased NO production

= vasodilation

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10
Q

Name the most sensitive serum biomarker for heart failure:

A

BNP (Brain Natriuretic Peptide)

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11
Q

How do Natriuretic peptides help the body in heart failure?

A

Decrease blood pressure via:

  • vaso and venodilation
  • decrease RAAS stimulation = natriuresis + diuresis
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12
Q

Why is the release of ADH in heart failure ‘paradoxical’?

A
  • ADH causes increase in blood pressure, which exacerbates and worsens heart failure
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13
Q

How is NO production affected in heart failure?

A

Increased NO production, to maintain tissue perfusion (oppose vasoconstriction caused by SNS and RAAS)

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14
Q

How does bradykinin help the body in heart failure?

A
  • Natriuresis
  • Vasodilation
  • Increased prostaglandin production
    = Decreased blood pressure
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15
Q

How does GFR change during heart failure progression?

A

Early HF
= Vasodilation due to prostaglandins and NO
= GFR maintained

Late HF
= Vasoconstriction due to SNS, RAAS, ET-1
= GFR falls

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16
Q

How does serum urea and creatinine change during heart failure progression? Why?

A

Increases in severe heart failure

- GFR falls due to SNS, RAAS and ET-1

17
Q

How does concentric hypertrophy exacerbate heart failure?

A

Concentric hypertropy = thickening of wall, causing stiffness of heart, impairing contraction, decreasing cardiac output

18
Q

What is the name given to describe ‘shortness of breath when lying flat’?

A

Orthopnoea

Symptom of heart failure

19
Q

Define Orthopnoea:

A

Shortness of breath when lying flat

20
Q

List some signs/symptoms of left heart failure:

A
  • Fatigue
  • Dyspnoea on exertion
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • Tachycardia
  • Peripheral oedema
  • Basal pulmonary crackles
21
Q

What is Paroxysmal Nocturnal Dyspnoea?

A

Attacks of severe shortness of breath and coughing which usually occur at night
Symptom of left heart failure

22
Q

Why do patients with LEFT-sided heart failure often get peripheral oedema?

A

Reduced CO
- reduced kidney perfusion = RAAS activation
- Aldosterone increases Na+ and H2O retention
- Increased fluid = increased venous pressure
- Increased capillary hydrostatic pressure
- Fluid moves out of vessels into interstitial fluid
= Peripheral oedema

23
Q

How can you test for cardiomegaly during an examination?

A

Feel for apex beat - will be displaced/sustained

24
Q

What heart sounds can be usually heard in left-sided heart failure?

A
  • S3 or S4

- Mitral regurgitation murmur

25
Q

List some causes of RIGHT-sided heart failure:

A
  • Secondary to left-sided heart failure (most common)
  • Chronic lung disease
  • Pulmonary embolism
  • Pulmonary hypertension
  • Pulmonary/tricuspid valvular disease
  • Left to right shunt (ASD/VSD)
  • Isolated Right Ventricular Cardiomyopathy (idiopathic)
26
Q

List some signs/symptoms of RIGHT-sided heart failure:

A
  • Fatigue
  • Dyspnoea
  • Anorexia
  • Nausea
  • Increased JVP
  • Tender, smooth hepatic enlargement
  • Peripheral pitting oedema
  • Ascites
  • Pleural effusion
27
Q

Why do patients with RIGHT-sided heart failure often get peripheral oedema?

A

Increased RH pressure
- Increased systemic venous pressure
- Increased capillary hydrostatic pressure
- Fluid moves out of vessels into interstitium
= Peripheral oedema

28
Q

Define cor pulmonale:

A

Right-sided heart failure due to primary disorder of the respiratory system ie pulmonary hypertension

29
Q

What are the 3 main types of drugs used to treat heart failure?

A
  • Diuretics
  • ACE inhibitor
  • Beta-blocker
30
Q

Which class of diuretics are usually used in heart failure management? Give an example, and where it works:

A

Loop diuretics

  • Furosemide
  • Loop of Henle, blocks NKCC2 (Na+-K+-2Cl symporter)

May be used with Aldosterone antagonists (K+ sparing diuretics):

  • Spironalactone
  • Late DCT + Collecting duct, prevents aldosterone-mediated AQP2 insertion in apical wall of principal cells

ESA2 (27 decks)

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