CVS 19 - Pathophysiology of Heart Failure Flashcards
Define Heart Failure
(PJ Harris definition)
Syndrome that arises when the heart is unable to maintain appropriate BP without support
(it is a reflex response)
Define Heart Failure in man
Clinical syndrome caused by abnormality of the heart and recognised by a characteristic pattern of haemodynamic, renal, neural and hormonal responses.
Which organ is a particularly big part of heart failure?
The kidneys, as they are not perfused enough. (they receive 35-40% of CO)
What are the 5 causes of heart failure?
Arrow Vs Prometheus Coolest Matchup
- Arrhythmias
- Valve disease
- Pericardial disease
- Congenital Heart Disease
- Myocardial Disease
Within myocardial disease, which is the most common cause of it?
Coronary Heart Disease
What are the types of cardiomyopathy? (cardiomyopathies are part of myocardial disease)
(Deathstroke Has Remained Alive)
- Dilated Cardiomyopathy (DCM) - specific or idiopathic (IDCM)
- Hypertrophic Cardiomyopathy (HCM/HOCM/ASH)
- Restrictive cardiomyopathy
- Arrhythmic RV Cardiomyopathy
Which drugs can cause Heart Failure?
- OD on beta-blockers decreases the heart rate extremely
- Anti-arrhythmics can cause heart dysfunction
- Ca antagonists
What is myocardial remodelling?
When the rest of the heart tries to remodel to maintain normal pumping activity as the fibrous tissue does not contract.
Occurs over months/years
What is cardiomyopathy?
Heart disease in the absence of a known cause
What is the most common cause of young athletes dropping dead?
Hypertrophic cardiomyopathy
Give some causes of dilated cardiomyopathy
Infectious diseases, toxins and poisons (e.g. alcohol/cocaine), chemotherapeutic agents, collagen disorders, etc
What are the 4 general causes of restrictive cardiomyopathy?
- Associated with fibrosis
- Infiltrative disorders
- Storage disorders
- Endomyocardial disorders
Patients with restrictive cardiomyopathy have a normal ejection fraction. What is different?
They have diastolic dysfunction so these patients are very slow in relaxing
What are the causes of death in heart failure?
- Progression of Heart failure (increased myocardial wall stress, increases Na/H2O retention)
- Sudden death (Opportunistic arrhythmia - most common cause of death)
- Cardiac event (MI) (or others e.g. stroke, pulmonary vascular disease)
- Non-cardiovascular cause (e.g. pneumonia)
There are many hormonal mediators in heart failure. Which 3 constrictors are present?
- NA - increased sympathetic drive
- Renin/angiotensin 2
- Endothelin-1 (and more e.g. vasopressin, NPY)
Which are the most effective drugs to use for heart failure?
- Beta blockers (block sympathetic drive)
- ACE inhibitors. - block RAS
- Aldosterone receptor antagonists
What is ANP and why is it important?
Used as part of diagnostic criteria for heart failure.
Atrial Natriuretic Peptide.
What other levels are increased in heart failure?
Troponin and T levels
What are some inflammatory markers/cytokines of Heart failure?
Heart : troponin T
Vessel Wall : ICAM-1, VCAM-1, selectins
Macrophages: phospholipase A2s
Adipose tissue
All cells also express more : IL 1B, IL 6, TNF a, CRP, Fibrinogen, Serum Amyloid A
What is median survival following diagnosis?
- 7 years (M)
3. 2 years (F)
What are some signs and symptoms of Heart failure?
- Tiredness (most common)
- Orthopnoea (patients must sleep propped up as less pressure in atria so easer contraction)
- PND (Paroxysmal Nocturnal Dyspnoea) - sleep propped up, if they slip they wake up gasping for air
- Many look like cancer patients
- Increased HR to maintain CO
- Weak pulses
- Increased venous pressured (due to elevated RHS pressures)
- Peripheral oedema due to salt and water retention
- Crepitations of the bases
- Hepatomegaly and ascites
What are some features of a cardiac failure chest X-ray?
Increase in cardio-thoracic ratio (normally it should not be over 50%)
How does the NYHA classify functional capacity of the heart?
(Functional Classification 1-4)
Class 1 - no limitation in physical activity, no real symptoms
Class 2 - slight limitation in physical activity
Class 3 - Marked limitation in physical activity
Class 4 - bed bound patient
Describe quality of life progression of heart failure?
Initial plateau then suddenly drops off
What are the syndromes of heart failure?
- Acute Heart Failure - (pulmonary oedema)
- Circulatory shock (cardiogenic shock - poor peripheral perfusion, etc)
- Chronic Heart Failure (untreated/undulating/treated/compensated)
How are pulmonary oedemas treated?
Diuretics given asap
NEVER GIVE BETA BLOCKERS TO?
Someone with Acute Heart Failure
What are common drugs used for heart failure?
aside from devices
- Diuretics
- ACE inhibitors
- Beta blockers
- Aldosterone Antagonists
- Digoxin (for atrial fibrillation)
If there is severe heart failure, what are the possible treatments?
- IV drugs (nitrates, positive inotropes, diuretics)
- Fluid control
- Devices
- Surgery
