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Cardio > Heart Fail > Flashcards

Heart Fail Flashcards

1
Q

What is heart fail

A

Inability of the heart to pump sufficient blood to meet body demand

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2
Q

What are some risk factors of Heart fail

A 
Age >65
CAD/HTN/Valvular disease
Smoking
Obesity
Male
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3
Q

What is Systolic heart fail (REDUCED EJECTION FRACTION)

A

Impaired myocardial contraction during systole = Low CO

-IHD

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4
Q

What is Diastolic heart fail (PRESERVED EJECTION FRACTION)

A

Impaired ventricular filling during diastole

  • Cardiomyopathy
  • LVH/ aortic stenosis
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5
Q

What is high output cardiac fail

A

The CO is normal but the demand is raised

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6
Q

What causes High ouput cardiac fail

A 
Anaemia
Paget's
Pregnancy
Thyrotoxicosis
Wet Beri-Beri (Thiamine deficiency)
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7
Q

What is the New York Heart classification for heart fail

A

1 - no physical activity limitation
2 - Slight discomfort with activity, normal at rest
3 - limitation with exercise but comfort with rest
4 - exercise limited and discomfort at rest

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8
Q

What are the general symptoms of heart fail

A

Fatigue
Palpitation
Dyspnoea

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9
Q

What are the investigations for heart fail

A 
ECG - might reveal cause
NT-prBNP - Released with myocardial stretch
Echo - ventricular dysfunction
Bloods - U/E, LFT, TFT, Glucose and BNP
CXR (ABCDEF)
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10
Q

Why is BNP investigated in heart fail

A

myocardial stretch of ventricles
It has high negative predictive value (if not raised = not heart fail)
If raised = Transthoracic echo needed

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11
Q

What does a chest X ray show for heart fail

A 
A = Alveolar oedema (Bat wing shadow)
B = kerly B lines (Interstial oedema)
C = Cardiomegaly
D = Diverted upper lobe
E = pleural Effusion (Bilateral transudates)
F = Fluid in horizontal fissure
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12
Q

What is the pharmacological treatment for Heart fail

A

1st = ACEI w/BB
Add = Spiranolatone/Loop
Consider = CRT (Improve av conduction)
Digoxin (AF) but poor mortality

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13
Q

What is the Surgical management of Heart Fail

A

Cardiac Revascularisation
Valve surgery
Heart transplant

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14
Q

What are the features of Left heart fail

A 
Pulmonary congestion(pressure behind left heart/lungs) 
Systemic hypoperfusion (Reduced Left output)
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15
Q

What are the symptoms of pulmonary hypoperfusion (Decreased left output)

A

SOB on exertion
Orthopnoea
Paroxysmal nocturnal dyspnoea
Nocturnal cough with pink frothy sputum

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16
Q

What are the signs of Pulmonary congestion

A

Tachypnoea

Bibasal crackles during lung auscultation

17
Q

What are the signs of systemic hypoperfusion

A

Cyanosis
Long CRT
Hypotension
Can show mitral regurgitation

18
Q

What are the features of Right heart fail

A

Presence of venous congestion (pressure behind right heart) and pulmonary hypoperfusion (reduced right output)

19
Q

What symptoms does venous congestion cause

A 
Ankle swelling
Weight gain
Abdo discomfort
Anorexia
Nauseau
20
Q

What signs presents with venous congestion

A 
Raised JVP
Ankle oedema
Tender hepatomegaly
Ascites
Transudative pleural effusion
21
Q

What is the pathology behind heart fail

A
  1. Myocardium fails so less CO
  2. Preload increases so ventricular load increases causing Myocardial Hypertrophy
  3. Myocardium gets thicker with hypertrophy so the muscle wall can’t get enough O2 and becomes ischemic (fibrous and stiff)
22
Q

What is Cor. Pulmonale

A

Right heart fail caused by chronic pulmonary arterial HTN

23
Q

What causes Co. Pulmonale

A

Chronic Lung disease
Vascular disorders
Rheumatological disease

24
Q

What are the symptoms of Cor. Pulmonale

A

Dyspnoea
Fatigue
Syncope

25
Q

What are the signs of Cor. Pulmonale

A 
Cyanosis
Tachycardia
Raised JVP
Ankle oedema
Pan-systolic murmur as Tricuspid Regurgitation
Hepatomegaly
26
Q

What investigation is used in Cor. Pulmonale

A

THINK HEART FAIL

w/ ABG - Hypoxia and Hypercapnia

27
Q

How do you manage Cor.Pulmonale

A

Treat cause
OXYGEN - Resp fail
Venesection - if haematocrit over 55
Heart/Lung transplant

28
Q

What are the causes of Heart fail

A 
IHD
Cardiomyopathy
Valvular Disease
Cor Pulmonale (RHF)
Increased CO causes
29
Q

What is the pathology of Heart fail

A 
Low CO (Dysfunctional Frank Starling)
Compensation -RAAS and SNS Increase BP
Compensation fails and Cardiac remodelling = RAAS and SNS cause fluid overload
30
Q

What are the 3 cardinal signs of Heart fail (SOBAsFat)

A

SOB
Ankle swelling
Fatigue

31
Q

What are the general signs of heart fail

A 
Orthopneao
Oedema
S3 nd S4
Raised JVP
Bibasal crackle
32
Q

What is the NYHA classification for heart fail

A 
1 = no limit w/exercise
2 = sight limit w/moderate exercise
3 = limitation w/mild exercise
4 = symptomatic at rest

Cardio (26 decks)

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