Heart Failure ☺️ Flashcards
Describe hypertrophic cardiomyopathy
- epidemiology
- pathophysiology
- signs, symptoms
Genetic (AD) => main cause of sudden cardiac death in young due to ventricular arrythmias
Can be due to HTN
Diastolic dysfunction or increased afterload => LV hypertrophy and radius decreases
Signs and symptoms
- asymptomatic
- syncope, ventricular arrythmias,
Describe dilated cardiomyopathy
- epidemiology
- pathophysiology
- signs, symptoms
Most common due to CHD, HTN
Systolic dysfunction or systolic valve problems => LV radius and wall thickness increases
Signs and symptoms
- systolic murmur
- HF signs, S3
What is acute heart failure
- pathophysiology
- etiology
Sudden onset/worsening of HF
-low CO from functional/structural abnormality => reduced CO, perfusion => pulmonary edema
- ISCHEMIA (most common)
- ACS
- HTN crisis
- acute arrythmias
- valvular disease
- infectious myopathy
Presentation of AHF
SOB, fatigue, reduced exercise tolerance
Cyanosis High HR High JVP Displaced apex beat Bibasal crackles, peripheral edema S3
Investigations for AHF
Bloods
- FBC - rule out anemia, infective causes
- U&E - electrolyte imbalances
- BNP - 100+ indicates myocardial damage
Scans -CXR Alveolar edema B lines - interstitial edema Cardiomegaly Diversion of vessels => upper zones Effusion -Echocardiogram - any cardiac tamponade?
Management of AHF
- management of regular HF meds
- treatment for all
- if resp failure
- if hypotensive/cardiogenic shock
Continue regular meds for HF (Bb, ACEi)
-stop Bb if bradycardic/heart block
IV loop - furosemide or bumetanide
O2 - aim for 94-98%
VD - GTN if HTN/aortic regurg/mitral valve disease
-CI/SE - hypotension
If in resp failure - CPAP
If hypotensive/cardiogenic shock
- inotropes - dobutamine
- vasopressors - NA
- mechanical circulatory assistance
What is chronic heart failure
-pathophysiology
Neurohormonal - short term protection but long term damage
Vicious cycle of
- poor contractility => inadequate CO
- poor renal perfusion => activates RAAS, SNS
- increased fluid retention, VC => HTN
- increased stress on heart => cardiac remodelling but cannot be adequately be perfused => scar formation
Presentation of chronic heart failure
SOB, orthopnea, paroxysmal noctural dyspnoea
Cough with pink, frothy sputum
Cachexia - but can be hidden by edema weight
Bibasal crackles
RHF, high JVP, ankle edema, hepatomegaly
Investigations for chronic heart failure
- definitive
- bloods
- scans
Definitive - BNP
-if 400+ - LV strain
-FBC => anemia due to chronic poor renal perfusion
ECG, CXR, Echo => electrical, effusions, physical abnormalities
Management of CHF
1st line -ACEi and Bb 2nd line -Aldosterone antagonist => monitor K 3rd line -Ivabradine/sacubitril-valsartan/digoxin
Annual influenza vaccine
One off pneumococcal vaccine