Heart Failure 1&2 Flashcards
define heart failure
many definitions- preferred one: a clinical syndrome characterised by its impaired cardiac pumping, leading to the inability of the heart to deliver enough blood to its peripheral tissues and meet metabolic physiological demands, and by impede venous return, leading to its systemic and or pulmonary congestion.
what are the two clinical features that characterised heart failure
forward failure- reduced cardiac output
backward failure - elevated A / V filling pressures, pooling and congestion
how do you classify heart failure?
it is based on the left ventricular ejection fraction(LVEF) and predominant underlying cardiac dysfunction
what are the two classifications of heart failure?
1- heart failure with reduced ejection function (HF-REF, systolic)
2- heart failure with preserved ejection function (HF-PEF, diastolic)
What is HF-REF characterised by?
the inability to contract properly (systolic dysfunction)
LVEF less than 40%
what is HF-PEF characterised by?
normal LVEF > or = 50
inability to relax effectively (diastolic dysfunction)
What is HFmrEF
3rd HF with mid range/ mildly reduced LVEF btw 41-49
what are the two types of heart failure you can get based on clinical status and time course of syptom development?
Acute heart failure(decompensated)
chronic heart failure(compensated)
what are the 4 features of acute heart failure?
rapid onset of signs and symtoms (hours and days)
sudden decline in cardiac function
potentially life threatening
may be new or an exacerbation of chronic heart failure
what are the 2 features of chronic heart failure
slow more insidious symptoms of heart failure (months or years)
characterised by the reflex activation of adaptive physiological respons
Epidemiology of HF
-64m adults worldwide live with it
-incedence+prevelance inc steeply with age
-high early mortality (1 yr - 15 to 30%, 5 yr - 50 to 75%)
Indicators of poor prognosis of HF
lower LVEF
Renal dysfunction
Valvular Regurgitation
V. Arrythmias
what are the 4 classifications of causes of heart failure (HFrEF)
- intrinsic myocardial damage-CAD / IHD, cardiomyopathy
- pressure overload –hypertension, pulmonary HPT, aortic stenosis
- volume load –aortic or MV regurgitation, VS defect
-inadequate filling –AF, arrhythmia, constrictive pericarditis, etc
name 4 commodities associated with HF-PEF
obesity, hypertension, type 2 diabetes, atrial fibrillation
Main aetiology not clearly understood
Medical conditions associated with heart failure
anemia/kidney failure/diabetes/obesity/disordered breathing during/ thyroid disorders/ side effects of medicine
what are the 3 Pathophysiological mechanisms associated with HF-REF
‘Cardiorenal’ model
‘Cardio-circulatory’ model
Neurohormonal’ model
What is the cardiorenal model?
fluid retention 2to forward failure & reduced renal blood flow
what is the cardio-circulatory model?
forward failure in face of peripheral vasoconstriction &
increase PVR
what is the neurohormonal model?
maladaptive neurohormonal activation cardiac remodelling
cardiac dysfunction causes a drop in what?
CO= reduced bp and reduced organ perfusion= activation of neurohormonal pathways (SNS, RAAS, ADH)
what are the effects of these neurohormonal pathways long term and short term?
short term- beneficial
long term- progressive deterioration of cardia function
what effects does the neurohormonal model produce on the sympathetic nervous system?
- Increase of circulating catecholamines (noradrenaline & adrenaline)
- Increased secretion of renin-activation of the Renin-Angiotensin-Aldosterone System (RAAS)
- Inc myocardial contractility + HR
- Inc systemic + pulmonary vasoconstriction
what do catecholamines do?
aggravate ischaemia, potentiate arrhythmias, are directly toxic to myocytes, and promote cardiac remodelling
what does increasing circulating angiotensin 2 do?
inc systemic vasoconstriction
peripheral nervous system activation
what does increasing aldosterone do?
increases sodium & water retention
endothelial dysfunction
organ fibrosis
Angiotensin 2 + Aldosterone are directly related to ….
toxic to cardiac myocytes and promote cardiac remodelling
what happens when you increase ADH
increase in water retention and vasoconstriction
what is monocyte hypertrophy?
when one side of the heart wall increases in size to pump blood around the body,
The pathogenesis and pathophysiology of HF
The direct effects of decreased CO
What is the Natriuretic Peptide System
Benificial peptides released during pathogenesis of heart failure. Only system that produces long term benefits like dec post-MI remodelling, dec aldosterone, inc diuresis, inc vasodilatation, dec cardiac stress
where do ANP and BNP and CNP cells come from?
ANP (Atrial type) come from the atria, but ventricular cells also secrete them when under pressure.
BNP (Brain type) cells come from ventricular cells
CNP (C-type) mostly come from endothelial cells
what is cardiac remodelling? is it good or a bad thing?
Cardiac remodeling is defined as a group of molecular, cellular and interstitial changes that manifest clinically as changes in size, mass, geometry and function of the heart after injury.
it is a bad thing and can lead to heart failure
The 3 stages of Heart Failure
what are the clinical features of heart failure in relation to the right and left ventricular failure?
1) left and right ventricular failure FORWARD
- hypofusion (dec CO) –> peripheral vasocon, cold extremities, exercise intolerance, fatigue , tachycardia, tachpnoea, renal fluid ret
2) Left BACKWARD
- Pulmonary Venous Congestion –> pulmonary oedema, dyspnoea, orthopnea, cough/wheeze, central cyanosis
3) Right BACKWARD
- Systemic venous congestion –> elevated jugular vein pressure, ankle oedema, hepatic oedema, hepatomegaly, ascites, nausea, anorexia, abd pain, renal fluid retention, peripheral cyanosis
How is heart Failure Diagnosed
- Clinical Presentation, Medical History, Physical Examination
- Blood Tests
- Diagnotic Tests (chest x-ray, ECG, Natriretic peptides-BNP+NTproBNP, Echocardiogram)
Indications of the levels of NT-pro BNP
> 2000ng - refer urgently within 2 weeks
400-2000 ng - refer urgently within 6 weeks
<400 ng - HF unlikely
what are the signs of left heart failure?
decreased cardiac output/ pulmonary congestion-impared gas exhange/pulmonary oedmea- cough w/ froty septum and paroxymal noctunurl dyspnea
what are the signs of right heart failure
congestion of peripheral tissues- liver congestion- anorexia/ GI distress/ weightloss
what are the 3 diagnosis criteria of EF HF?
1- symptoms of a heart failure-breathlessness/fatigue
2-signs of typical heart failure
3- objective abnormality of a structural or functional abnormality of the heart
what is the NYHA ? and what is their classifications of HF?
New York Heart Association class 1-4, 4 being the moat severe
what is stage 1 of NYHA?
⚫Ordinary physical activity does not cause undue fatigue, palpitationor dyspnoea
No limitation of physical activity
What is stage 2 of NYHA?
⚫Comfortable at rest, slight limitation of physical activity
⚫Ordinary physical activity results in fatigue, palpitation or dyspnoea
what is stage 3 of NYHA?
⚫Comfortable at rest, marked limitation of physical activity
⚫Less than ordinary physical activity causes fatigue, palpitation or dyspnoea
what is stage 4 of NYHA?
⚫Symptoms of cardiac insufficiency may be present at rest, inability to carry out any physical activity without discomfort
⚫lf any physical activity is undertaken, discomfort is increased
what is the AAC/AHA classification of HF?
A-D ,d being the worse
