heart failiure Flashcards

Question

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

Answer 1

1. sympathetic stimulation 2. RAAS 3. cardiac changes

Answer 2

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

Answer 3

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

Answer 4

1. ventricular dilation 2. Myocyte hypertrophy (ventricular remodelling)

Answer 5

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.

Answer 6

Heart failure and a reduced ejection fraction. Usually caused by systolic (pumping) dysfunction.

Answer 7

1. IHD 2. hypertension 3. cardiomyopathy 4. aortic stenosis

Answer 8

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

Answer 9

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

Answer 10

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

Answer 11

narrowin of aortic valve

Answer 12

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

Answer 13

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

Answer 14

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

Answer 15

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

Answer 16

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

Answer 17

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)

Answer 18

SOB Peripheral oedema Ascites Nausea Anorexia

Answer 19

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)

Answer 20

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

Answer 21

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

Answer 22

may show evidence of underlying causes e.g. arrhythmias, IHD, LV hypertrophy in hypertension

Answer 23

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

Answer 24

Creatinine kinase Troponin I Troponin T Myoglobulin

Answer 25

If ECG and BNP abnormal do an echocardiography

Answer 26

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

Answer 27

Education Obesity control Diet Smoking cessation Cardiac rehab

Answer 28

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

Answer 29

dilate blood vessels

Answer 30

must give a lose dose 🡪 slow up titration

Answer 31

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

Answer 32

digoxin (inhibits Na/K pump) 🡪 slower HR

Answer 33

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

Answer 34

ABCD ACE inhibitors beta blockers calcium channel blockers diuretics

Answer 35

medical emergency Left or right HF developing over minutes or hours. Causes and investigations (CXR, ECG, bloods, echocardiogram) are similar to chronic heart failure

Answer 36

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

Answer 37

arrthymias

Answer 38

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

heart failiure Flashcards

(62 cards)