Heart 6a Heart Failure Flashcards
Heart failure
A complex clinical syndrome with typical signs that generally occur at exertion but can also occur at rest.
It is secondary to an abnormal of cardiac function that impairs the ability of the heart to fill with blood at normal pressure or eject blood sufficiently
Heart failure prevalance
1-2%
3 or mkee times higher in elderly population
Higher in indigenous and in rural population
Aboriginal and ts hf
Higher incidence of hf at an early age
Hospitalization are higher in indigenous population
Heart failure diagnostic criteria
Herat failure with reduced ejection fractions
Heart failure with preserved ejection fraction
Heart failure with reduced ejection traction
Singa of hf
Lvef<50%
Systolic heart failure
Heart failure with preserved ejection fractional
Signs of hf
Lvef >50 %
And objective evidence of:
Relevant structural heart disease
And
Diastolic dysfunction with high filling pressure demonstrated by any of the following
- diastolic dysfunction, eith high filling pressure demonstrated by any of the ff
Invasive means
Echocardiography
Biomarker
Exercise
Systolic heart failure
Pathophysiology
Inability of the heart ti pump blood effectively causee by impaired contractile function , increased afterload, cardiomyopathy and mechanical abnormalities
The lv loses its ability to generate enough pressure to eject blood forward through the aorta abd eventually becomes dilated
The hallmark is reduced lvf
Diastolic failure
Inability of the ventricles to relax and fill during diastole
Decreased filling of the ventricles results in decreased sv and co
Characterised by high filling pressure because of stiff ventricles that result in venous engorgement both in the pulmonary and systemic vascular system
Usually result of left ventricular hypertrophy from htn, ml, valve disease
Causes of Chronic heart failure
Mycocyte damage
Abnormal loading conditions
Arrhythmia
Myocyte damage
Ischaemia Inflammation Endomyocardial pathology Metabolic abnormalities Nutritional abnormalities Genetic abnormalities Pregnancy and peripartum causes
Abnormal loading conditions
Hypertension Valve and myocardium Pericardial pathology High output states Volume overload
Arrhythmia
Tacharrhythmia
Bradyarrhtthmias
Causes of heart failure
Primary causes
Precipitating causes
Primary causes of chronic heart failure
Coronary heart disease Hypertension Idiopathic dilated cardiomyopathy Rheumatic heart disease Pulmonary hypertension Hyperthyroidism Myocarditis Valvular disorders
Precipitating factors chirnic heart failure
Anaemia Infection Thyrotoxicosis Hypothyroidism Arrythmia Bcterial endocarditis Pulmonary embolism Pagets disease Nutritional deficiencies Hypervolaemia
Modifiable risk factors if chf
Htn Cad Tobacco use Physical inactivity Obesity Diabetes
Non-modifiable risk factors of chf
Age> 60 years Gender Diabetes Family history Valvylar heart disease
Cardiac output
Multiplying stroke volume （sv) (amount of blood ejected per heartbeat) x heart rate
Co= sv x hr
Ejection fraction
The percentage of the volume of blood that is ejected with each stroke of the left ventricle.
The normal adult is 54-75%. EF is often reduced in patients with chf
Symptoms and signs of heart failure
Typical symptoms
More specific signs
Dyspnoea
Ortgonoea
Paroxysmal nocturnal dyspnoea
Fatigue
Elevated jugular venous pressure
Hepatojugular reflux
Third heart sound
Laterally displaced apex beat
Less typical symptoms
Less specific signs
Nocturnal cough Wheese Abdominal bloating Anorexia Confuaion Depression Palpitations Dizziness Sycope Bandipnoea
Weight gain( more than 2kg oer week) Weight loss Cardiac murmur Tachycardia Tachypnoea Ascites Pulmonary crackles
Nyha functional classification of heart disease class 1
No limitation of physical activity. Ordinary physical activity does not cause fatigue, dyspnoea, palpitation or anginal pain
Nyha functional classification of heart disease class 2
Slight limitation of physical activity. No symptoms at rest. Ordinary physical activity result in fatigue, dyspnoea, palpitations or anginal pain
Nyha functional classification of heart disease class 3
Marked limitation of physical activity but usually comfortable at rest. Less than ordinary physical activity causes fatigue, dyspnoea, palpitation or anginal pain
Nyha functional classification of heart disease class 4
Inability to carry one any physical activity without discomfort. Symptoms of cardiac insufficiency or of angina may be present even at rest. If any physical activity is undertaken, discomfort is in increased
