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- 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
2- heart failure with preserved ejection function (HF-PEF)
What is HF-REF characterised by?
the inability to contract properly
LVEF less than 40%
what is HF-PEF characterised by?
normal LVEF
inability to relax effectively
what are the two types of heart failure you can get?
Acute heart failure(decompensated)
chronic heart failure(compensated)
what are the 4 features of acute heart failure?
rapid onset
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
characterised by the ability to maintain cardiac perfusion in the face of long term cardiac dysfunction
what are the 4 classifications of causes of heart failure
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
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
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 central nervous system?
increase of circulating catecholamines (noradrenaline & adrenaline)
Increased secretion of renin-activation of the Renin-Angiotensin-Aldosterone System (RAAS)
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
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,
where do ANP and BNP cells come from?
ANP come from the atria, but ventricular cells also secrete them when under pressure.
BNP cells come from ventricular 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
what are the two clinical features of heart failure in relation to the right and left ventricular failure?
left
forward=hypofusion( decrease in CO) -pulmonary oedema backward=congestion
right forward=hypofustion- ankle/hepatic odeema backward=congestion
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
What is stage 2 of NYHA?
⚫Comfortable at rest
⚫Ordinary physical activity results in fatigue, palpitation or dyspnoea
what is stage 3 of NYHA?
⚫Comfortable at rest
⚫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
⚫lf any physical activity is undertaken, discomfort is increased
what is the AAC/AHA classification of HF?
A-D ,d being the worse
