Heart Fail Flashcards
What is heart fail
Inability of the heart to pump sufficient blood to meet body demand
What are some risk factors of Heart fail
Age >65 CAD/HTN/Valvular disease Smoking Obesity Male
What is Systolic heart fail (REDUCED EJECTION FRACTION)
Impaired myocardial contraction during systole = Low CO
-IHD
What is Diastolic heart fail (PRESERVED EJECTION FRACTION)
Impaired ventricular filling during diastole
- Cardiomyopathy
- LVH/ aortic stenosis
What is high output cardiac fail
The CO is normal but the demand is raised
What causes High ouput cardiac fail
Anaemia Paget's Pregnancy Thyrotoxicosis Wet Beri-Beri (Thiamine deficiency)
What is the New York Heart classification for heart fail
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
What are the general symptoms of heart fail
Fatigue
Palpitation
Dyspnoea
What are the investigations for heart fail
ECG - might reveal cause NT-prBNP - Released with myocardial stretch Echo - ventricular dysfunction Bloods - U/E, LFT, TFT, Glucose and BNP CXR (ABCDEF)
Why is BNP investigated in heart fail
myocardial stretch of ventricles
It has high negative predictive value (if not raised = not heart fail)
If raised = Transthoracic echo needed
What does a chest X ray show for heart fail
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
What is the pharmacological treatment for Heart fail
1st = ACEI w/BB
Add = Spiranolatone/Loop
Consider = CRT (Improve av conduction)
Digoxin (AF) but poor mortality
What is the Surgical management of Heart Fail
Cardiac Revascularisation
Valve surgery
Heart transplant
What are the features of Left heart fail
Pulmonary congestion(pressure behind left heart/lungs) Systemic hypoperfusion (Reduced Left output)
What are the symptoms of pulmonary hypoperfusion (Decreased left output)
SOB on exertion
Orthopnoea
Paroxysmal nocturnal dyspnoea
Nocturnal cough with pink frothy sputum
What are the signs of Pulmonary congestion
Tachypnoea
Bibasal crackles during lung auscultation
What are the signs of systemic hypoperfusion
Cyanosis
Long CRT
Hypotension
Can show mitral regurgitation
What are the features of Right heart fail
Presence of venous congestion (pressure behind right heart) and pulmonary hypoperfusion (reduced right output)
What symptoms does venous congestion cause
Ankle swelling Weight gain Abdo discomfort Anorexia Nauseau
What signs presents with venous congestion
Raised JVP Ankle oedema Tender hepatomegaly Ascites Transudative pleural effusion
What is the pathology behind heart fail
- Myocardium fails so less CO
- Preload increases so ventricular load increases causing Myocardial Hypertrophy
- Myocardium gets thicker with hypertrophy so the muscle wall can’t get enough O2 and becomes ischemic (fibrous and stiff)
What is Cor. Pulmonale
Right heart fail caused by chronic pulmonary arterial HTN
What causes Co. Pulmonale
Chronic Lung disease
Vascular disorders
Rheumatological disease
What are the symptoms of Cor. Pulmonale
Dyspnoea
Fatigue
Syncope
What are the signs of Cor. Pulmonale
Cyanosis Tachycardia Raised JVP Ankle oedema Pan-systolic murmur as Tricuspid Regurgitation Hepatomegaly
What investigation is used in Cor. Pulmonale
THINK HEART FAIL
w/ ABG - Hypoxia and Hypercapnia
How do you manage Cor.Pulmonale
Treat cause
OXYGEN - Resp fail
Venesection - if haematocrit over 55
Heart/Lung transplant
What are the causes of Heart fail
IHD Cardiomyopathy Valvular Disease Cor Pulmonale (RHF) Increased CO causes
What is the pathology of Heart fail
Low CO (Dysfunctional Frank Starling) Compensation -RAAS and SNS Increase BP Compensation fails and Cardiac remodelling = RAAS and SNS cause fluid overload
What are the 3 cardinal signs of Heart fail (SOBAsFat)
SOB
Ankle swelling
Fatigue
What are the general signs of heart fail
Orthopneao Oedema S3 nd S4 Raised JVP Bibasal crackle
What is the NYHA classification for heart fail
1 = no limit w/exercise 2 = sight limit w/moderate exercise 3 = limitation w/mild exercise 4 = symptomatic at rest