ELM14: Heart failure Flashcards
What are the two main problems resulting in a heart attack?
Heart doesn’t contract well
Heart doesn’t fill well
What is the ejection fraction?
Percent of blood in ventricle ejected from heart each cycle
What is the equation for ejection fraction?
100(stroke vol)/ventricle vol
What is considered reduced ejection fraction?
Under 40%
What are some risk factors causing reduced ejection fraction?
Previous heart attack
Diabetes
Hypertension
CAD
Male
What is preserved ejection fraction?
Over 50% with low stroke volume
What are some risk factors of preserved ejection fraction?
Hypertension
Hypertrophic cardiomyopathy
Female
Diabetes
What are some characteristics of reduced ejection fraction?
Enlarged left ventricle
Weakened heart muscle
What are some characteristics of preserved ejection fraction?
Thickened left ventricle wall
Small left ventricle
Thickened ventricular septum
What are some genetic forms of heart failure?
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
What is dilated cardiomyopathy?
Enlarged baggy ventricle
Gives HFrEF 50% familial
What is hypertrophic cardiomyopathy?
Ventricle has thick muscle wall causing filling problems
Autosomal dominant
Where do cardiomyopathy mutations usually form?
Actin
Myosin
MLCK
Titin
What are some symptoms of left forward heart failure?
Easily tired
Cyanosis
Underperfused kidney
What are some symptoms of left backwards heart failure?
Pulmonary oedema
What are some symptoms of right forward heart failure?
Easily tired
What are some symptoms of right backward heart failure?
Engorged liver and spleen
Peripheral oedema
Pulmonary effusion
What is the process of decompensation?
- Body interprets low cardiac output as haemorrhage and compensates
- Compensation is maladaptive
- Decompensation occurs
What was the CONSENSUS study?
Cooperative north scandinavian enalapril survival study
Studies of left ventricular dysfunction ACE inhibitors help survival
What was the COMET CIBIS II trial?
Cardiac insufficiency bisoprolol trial II
Carvedilol or metoprolol european trial
Bisoprolol improves survival Carvedilol better than metoprolol
What was the RALES trial?
Randomised aldactone evaluation study
Spironolactone improves survival
What was the CHARM trial?
Candesartan in heart failure assessment of reduction in mortality and morbidity
ARBS are good
What was the PARADIGM-HF study
Prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure
ANRI superior to ACEI
What was the SHIFT trial?
Systolic heart failure treatment with the IF inhibitor ivabradine trial
Ivabradine reduced deaths
What was the A-HEFT trial?
African american heart failure trials
Isosorbide dinitrate and hydralazine superior
What is sacubitril?
Cardiac natriuretic peptide
Oppose effects of RAAS
Increase salt and water excretion Inhibits neprilysin
What is ivabradine?
Inhibits SA node pacemaker current
Slows heart
What is hydralazine?
Interferes with IP3 stimulated Ca2+ release from smooth muscle SR
