heart Flashcards
definition of heart failure
failure of the heart to function as a pump in maintaining effective systemic circulation
3 main causes of heart failure
MI
cardiomyopathy
hypertension
3 other less common causes of heart failure
valvular problems
congenital heart defects
arrhythmias
5 factors in the pathophysiology of heart failure
increased venous return/pressure (preload) increased outflow resistance (afterload) myocardial contractility neurohormonal sympathetic activation myocardial remodelling
what is the renin-angiotensin-aldosterone-system (RAAS) and how does it relate to heart failure
heart failure causes reduced perfusion of the kidneys leading to synthesis of Renin, this activates angiotensin I which is converted to angiotensin II. angiotensin II is a vasoconstrictor and also stimulates aldosterone production. aldosterone inreases sodium retension in the kidneys while increasing potassium excretion.
this leads to a rise in plasma sodium, increased fluid retension and rise in blood pressure
what are the actions of angiotensin II
vasoconstriction aldosterone production ADH production sympathetic stimulation renal Na and water retension, and K excretion
what are the cardiac enzymes associated with heart failure
ANP
BNP
endothelin
ADH
what are the cardiac enzymes associated with myocardium damage
troponin T and I
myoglobin
creatine kinase MB
BNP
clinical symptoms of heart failure
dyspnea
tiredness
orthopnea
PND
clinical signs of heart failure
raise JVP peripheral edema dyspnea tachycardia hypotension enlarged heart/displaced apex beat heart sounds 3 + 4 bi-basal crackles pleural effusion
what type of effusion is found in heart failure
transudative pleural effusion
what is the classification used for heart failure severity
new york heart association classification
what is class IV NYHAC heart failure like
HF symptoms at rest and exacerbated by any physical activity
investigations done in HF
ECG
echo
bloods
what bloods to do in HF
FBC LFT TFT U&Es cardiac enzymes BNP
how to monitor heart failure
functional capacity
fluid status
ECG
6 types of drugs used in heart failure
ACEI beta blockerse diuretics aldosterone antagonist vasodilators cardiac glycosides
non-drug options for heart failure
pacemaker
implanted defib
revascularisation
cardiac transplants
causes of acute heart failure
MI hypertension renal failure valvular conditions atrial fibrilation
features of hypertensive HF
high BP
pulmonary edema
preserved LV function
treatment of acute HF
IV diuretics e.g. furosemide
oxygen
monitor renal fx, daily weights and fluid balance
investigations to do in suspected MI
ECG - ST changes
bloods - troponin, myglobin
associated features of MI
radiating chest pain N&V restlessness sweating pallor breathlessness
acute treatment of ACS and NSTEMI
GTN sublingual analgesia oxygen aspirin clopidogrel
acute treatment for STEMI
PCI/revascularisation
fibrinolytics/thrombolytics e.g. alteplase
metoprolol
drug chronic management after an MI
ACEI statin aspirin clopidogrel beta blocker
possible complications after MI
arrthymias
heart failure
embolism
medication commonly used in arrythmias
amiodarone
how to tell the difference between a MR murmur and a VSD murmur
VSD murmur heard loudest over LLSB while MR heard loudest over apex beat and radiates into the axilla
how does a tricuspid regurgitation murmur change with inspiration?
it gets louder on inspiration
what criteria is used in diagnosing infective endocarditis?
dukes criteria
what does the murmur of Barlow syndrome sound like?
click in mid systole followed by late-systolic murmur -> mitral valve prolapse
