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PHASE 2 cardio conditions > heart failiure > Flashcards

heart failiure Flashcards

1
Q

is heart failure a specific disease

A

no it is a clinical syndrome

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2
Q

define heart failiure

A

A symptomatic condition where breathlessness, fluid retention and fatigue are associated with a cardiac abnormality that reduces cardiac output (HR x SV)

A state where the heart is unable to pump enough blood to satisfy the needs of metabolising tissues

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3
Q

what does heart failure result from

A

from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump and maintain CO to meet body’s demands

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4
Q

why can body’s CO demands not be met

A
  1. can be high output - the requirements of the body are too high eg pregnancy
  2. can be low output - the heart is not functioning properly
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5
Q

most common cause of heart failiure

A

ischaemic heart disease

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6
Q

other causes of heart failure

A
  • hypertension
  • cardiomyopathy
  • valvular heart disease
  • congenital heart disease
  • alcohol & chemotherapy
  • any factors that increase myocardial work
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7
Q

what is the main cardiomyopathy cause of heart failiure

A

dilated

hypertrophic and restrictive are less common but can still cause HF

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8
Q

which valvular heart disease causes heart failiure

A

aortic stenosis

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9
Q

5 factors that increase myocardial work

A
  1. arrhythmias
  2. anaemia
  3. pregnancy
  4. obesity
  5. hyperthyroidism
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10
Q

risk factors for heart failiure

A
  • age over 65
  • obesity
  • being male
  • people who have had a previous MI
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11
Q

2 types of heart failiure

A

systolic

diastolic

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12
Q

what is systolic heart failiure

A

failure to contract

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13
Q

ejection fraction of systolic heart failiure

A

<40% (SV/EDV)

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14
Q

4 causes of systolic heart failure

A

IHD
MI
Hypertension
Cardiomyopathy

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15
Q

what is diastolic heart failure

A

inability to relax and fill
there is reduced preload because there is abnormal filling of the LV

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16
Q

ejection fraction of diastolic heart failure

A

Ejection fraction >50%

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17
Q

3 causes of diastolic heart failure

A
  • constrictive pericarditis
  • cardiac tamponade
  • hypertension
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18
Q

what does low output heart failure mean

A

Decreased CO, fails to increase with exertion

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19
Q

3 causes of low output heart failure

A
  1. pump failure
  2. excessive pre load
  3. chronic increased after load
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20
Q

what is pump failure

A

systolic HF, may be due to decreased heart rate e.g. anti-arrhythmic drugs

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21
Q

what is excessive pre load

A

Mitral regurgitation, fluid overload

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22
Q

what is chronic increased afterload

A

occurs in aortic stenosis, hypertension – difficult for the heart muscle to push against it

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23
Q

what conditions does high output heart failure occur in

A

Anaemia
Pregnancy
Hyperthyroidism

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24
Q

pathology of heart failure

A

Once the heart begins to fail, compensatory changes occur

As heart failure progresses, these compensatory changes become overwhelmed 🡪 they become pathological

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25
Q

give 3 compensatory changes that occur when the heart begins to fail

A
  1. sympathetic stimulation
  2. RAAS
  3. cardiac changes
26
Q

what happens in sympathetic stimulation when heart begins to fail

A

Activation of SNS improves ventricular function by increasing HR and myocardial contractility

Constriction of venous capacitance vessels redistributes centrally, and increased preload further augments ventricular function (via Frank-Starling mechanism)

Also increases afterload by causing arteriolar constriction which eventually reduces CO

27
Q

what happens in RAAS when heart begins to fail

A

Fall in CO and increased sympathetic tone lead to diminished renal perfusion :
- increased activation of RAAS
- increased increased salt and water retention

Further increases venous pressure and maintains stroke volume by Starling mechanism

As salt and water retention increases, peripheral and pulmonary congestion causes oedema and contributes to dyspnoea

Angiotensin II also causes arteriolar constriction which increases afterload

28
Q

what are the 2 cardiac changes that occur when heart begins to fail

A
  1. ventricular dilation
  2. Myocyte hypertrophy (ventricular remodelling)
29
Q

what is ventricular dilation

A

Myocardial failure leads to a reduction of blood ejected with each heartbeat and therefore an increase in the volume of blood remaining after systole.

The increased diastolic volume stretches the myocardial fibres and myocardial contraction is restored

Once HF is established, the compensatory effects become limited by the flattened contour of the Starling curve

Eventually, increased venous pressure contributes to the development of pulmonary and peripheral oedema.

30
Q

define left sided heart failure

A

Heart failure and a reduced ejection fraction.

Usually caused by systolic (pumping) dysfunction.

31
Q

4 causes of left sided heart failure

A
  1. IHD
  2. hypertension
  3. cardiomyopathy
  4. aortic stenosis
32
Q

how does hypertension cause left sided heart failure

A

As arterial pressure increases, harder for LV to pump blood out

🡪 LV hypertrophy
🡪 greater demand for oxygen

Coronaries squeezed by extra muscle 🡪 less blood delivered to tissue

33
Q

how does dilated cardiomyopathy cause left sided heart failure

A

heart chamber dilates (grows in size)

in order to fill the ventricle with more blood (increased preload)

Over time, muscle wall gets thinner and weaker 🡪 systolic HF

34
Q

how does restricted cardiomyopathy cause left sided heart failure

A

heart wall becomes stuff
🡪 less compliant
🡪 can’t stretch

35
Q

what is aortic stenosis

A

narrowin of aortic valve

36
Q

symptoms of left sided heart failure

A

Exertional dyspnoea
Fatigue
Weight loss
Paroxysmal nocturnal dyspnoea – attacks of severe SOB and coughing at night
Nocturnal cough – pink, frothy sputum
Orthopnoea – dyspnoea (SOB) that occurs when lying down

37
Q

signs of left-sided heart failure

A

Cardiomegaly (displaced apex beat)
Pulmonary Oedema
3rd and 4th heart sounds
Pleural effusion
Crepitations in lung bases
Tachycardia
Reduced BP
Cool peripheries
Heart murmur

38
Q

5 causes of right sided heart failure

A
  1. Left ventricular failure
  2. hypertension
  3. pulmonary stenosis
  4. lung disease
  5. Atrial/ventricular shunt
39
Q

how does left ventricular failure cause right sided heart failure

A

Fluid build-up
🡪 increased pressure in pulmonary artery
🡪 harder for right side to pump blood into

40
Q

how does lung disease cause right sided heart failure

A

Pulmonary arterioles constrict
🡪 increase pulmonary BP
🡪 harder for RV to pump against
🡪 hypertrophy and failure

41
Q

how does atrial/ventricular shunt cause right sided heart failur

A

blood moves from L to R
Leads to increased volume on right side 🡪 RV hypertrophy

More prone to ischaemia (systolic dysfunction) and has a small filling volume (diastolic dysfunction)

42
Q

symptoms of right-sided heart failure

A

SOB
Peripheral oedema
Ascites
Nausea
Anorexia

43
Q

signs of right-sided heart failure

A

Raised JVP – JVP distension
Hepatomegaly/Splenomegaly
Pitting oedema – sacral/leg oedema in bed-bound patients which causes a “pit” when pressed
Ascites
Weight gain (fluid)

44
Q

investigations for heart failure

A
  1. chest x ray
  2. ECG
  3. bloods
  4. cardiac enzymes
  5. Echocardiogram (TTE)
45
Q

what to look for in chest x ray

A

ABCDE
Alveolar oedema (“Bat’s wings”)
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated upper lobe vessels of lung
Effusion (pleural)

46
Q

what would heart failure ECG show

A

may show evidence of underlying causes

e.g. arrhythmias, IHD, LV hypertrophy in hypertension

47
Q

what blood tests to do for heart failure

A

Brain Natriuretic Peptide – not specific as may be raised in acute PE
Secreted by ventricles in response to increased myocardial wall stress
Increased in patients with HF
Levels correlate with ventricular wall stress and severity of HF

FBC
LFTs – may be altered due to hepatic congestion
U&Es
TFTs

48
Q

what cardiac enzymes to look for

A

Creatinine kinase
Troponin I
Troponin T
Myoglobulin

49
Q

when do u do an echocardiogram for heart failure

A

If ECG and BNP abnormal do an echocardiography

50
Q

8 ways to manage heart failure

A
  1. lifesty;e
  2. ACE inhibitors
  3. beta blockers
  4. diuretics
  5. Calcium glycoside
  6. Ventricular Assist Device
  7. surgery
  8. heart transplant
51
Q

lifestyle factors to control when managing heart failure

A

Education
Obesity control
Diet
Smoking cessation
Cardiac rehab

52
Q

side effects of ACE inhibitors

A

Cough - due to accumulation of bradykinin
Hypotension
Hyperkalaemia
Renal dysfunction

If cough is a problem then give angiotensin-II-receptor blocker e.g. candesartan, losartan

53
Q

what do ACE inhibitors do

A

dilate blood vessels

54
Q

how to give beta blockers for hF

A

must give a lose dose 🡪 slow up titration

55
Q

what do diuretics do for HF

A

promote Na+ and water loss 🡪 reducing ventricular filling (preload) 🡪 decreasing congestion

56
Q

what does calcium glycoside do for HF

A

digoxin (inhibits Na/K pump)
🡪 slower HR

57
Q

acute heart failure treatment

A

100% oxygen

Nitrates – GTN spray (dilates vessels and allows adequate perfusion of heart)

IV opiates – diamorphine

IV furosemide – to reduce fluid overload

Consider inotropic drugs to increase contractility of dilated vessels

58
Q

chronic heart failure treatment

A

ABCD

ACE inhibitors
beta blockers
calcium channel blockers
diuretics

59
Q

what is acute heart failure

A

medical emergency

Left or right HF developing over minutes or hours.

Causes and investigations (CXR, ECG, bloods, echocardiogram) are similar to chronic heart failure

60
Q

clinical features of acute heart failure

A

Acute decompression of chronic heart failure

Hypertensive HF – high BP, preserved LV function, pulmonary oedema on CXR

Acute pulmonary oedema – acutely breathless, tachycardia, profuse sweating (SNS overactivity), wheezes and crackles throughout chest, hypoxia, pulmonary oedema on CXR

Cardiogenic shock – hypotension, tachycardia, oliguria, cold extremities

High output HF – septic shock, warm peripheries, pulmonary congestion, BP may be low

Right HF – low CO, elevated jugular venous pressure, hepatomegaly, hypotension

61
Q

complication of acute heart failure

A

arrthymias

62
Q

what is hypertensive heart disease

A

refers to heart problems that occur because of high blood pressure that is present over a long time

PHASE 2 cardio conditions (20 decks)

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