FN: Heart Failure

Question 1

Definition

Answer 1

CO is inadequate for the body’s requirements despite adequate filling pressures

Question 2

Epi

Answer 2

2% @ 50 yrs

10% @ 80 yrs

Question 3

Pathophysiology

Answer 3

1. Reduced CO initially –> compensation

2. Progressive decline in CO –> decompensationcompensation

Question 4

Compensation process

Answer 4

1. Starling effect dilates heart to enhance contractility
2. Remodelling - hypertrophy
3. RAS and ANP/BNP release
4. Sympathetic activation

Question 5

Decompensation process

Answer 5

1. Progressive dilation - Impaired contractility and functional valve regurgitation
2. Hypertrophy - relative myocardial ischaemia
3. RAS activation - Sodium and fluid retention - increase venous pressure - oedema occurs
4. Sympathetic excess - increase afterload - reduced CO

Question 6

Low output:

Answer 6

Co reduced and fails to increase with exertion

Question 7

Low output due to (3)

Answer 7

1. Pump failure
2. Excessive preload
3. Excessive afterload

Question 8

Pump failure description

Answer 8

1. Systolic failure - impaired contraction
2. Diastolic failure - impaired filling
3. Arrhythmias

Question 9

Systolic failure causes

Answer 9

Iscaemia/MI (commonest cause)Dilated cardiomyopathy
Hypertension
Myocarditis

Question 10

Diastolic failure causes

Answer 10

pericardial effusion/tamponade/constriction

Cardiomyopathy: restrictive, hypertrophic

Question 11

Arrhythmias examples causing low output

Answer 11

Bradycardia, heart block
Tachycardia
Anti-arrhythmics (e.g. beta-blocker, verapamil)

Question 12

Excessive preload causes

Answer 12

AR, MR

Fluid overload

Question 13

Excessive afterload

Answer 13

AS
HTN
HOCM

Question 14

High Output

Answer 14

increase needs - RVF initially, then LVF
1. Anaemia, AVM
Thyrotoxicosis, Thiamine deficiency (beri beri)
Pregnancy, Pagets

Question 15

RVF causes

Answer 15

LVF
Cor pulmonale
Tricuspid and pulmonary valve disease

Question 16

RVF symptoms

Answer 16

Anorexia and nausea

Question 17

RVF signs

Answer 17

Increased JVP and jugular venous distension
Tender smooth hepatomegaly (may be pulsatile)
Pitting oedema
Ascites

Question 18

LVF causes

Answer 18

1st: HD
2nd: idiopathic dilated cardiomyopathy
3rd: Systemic HTN
4th: Mitral and aortic valve disease
Specific cardiomyopathies

Question 19

LVF symptoms

Answer 19

Fatigue
Exertional dyspnoea
Orthopneoa + PND
Nocturnal cough (± pink, frothy sputum)
Wt. loss and muscle wasting

Question 20

LVF signs

Answer 20

Cold peripheries ± cyanosis
Often in AF
Cardiomegaly with displaced apex
S3 + yachycardia = gallop rhythm
Wheeze (cardiac asthma)
Bibasal creps

Question 21

Acute description

Answer 21

New onset or decompensation fo chronic
Peripheral/pulmonary oedema
± evidence of peripheral hypoperfusion

Question 22

Chronic description

Answer 22

Develops/progresses slowly
Venous congestion common
Arterial pressure maintained until v. late