heart failure Flashcards
definition of heart failure?
inability of the heart to pump the required amount of blood to the tissues and vital organ.
types of heart failure?
left vs right ventricular failure systolic vs diastolic forward vs backward acute vs chronic low output vs high output
causes of left and right ventricular failure?
left: HTN ischemic heart disease most common dilated cardiomyopathy aortic stenosis AR,MR alcohol DM sarcoidosis scleroderma restrictive and hypertrophic myopathy right: left failure atrial septal defect tricuspid regurgitation pulmonary hypertension pulmonary stenosis
in which disease systolic and diastolic both coexist?
coronary artery disease
conditions which are associated with high output failure?
anemia, hyperthyroidism, wet beri beri, paget’s disease
what is remodelling?
after MI cardiac contractility impaired which causes hypertrophy of non infarcted segment with thinning and dilation and expansion of the infarcted segment.
what is compensatory changes in chronic heart failure?
increase heart rate, dilation of heart chambers, hypertrophy of cardiac muscles by activation of sympathetic system, RAAS, and remodelling
potential precipitate of acute on chronic heart failure?
upper respiratory tract infection and inapporpiate ceasseation of diuretics
features of left heart failure?
exertional dyspnea, orthopnea, dyspnea at rest, pumonary edema, PND, nocturia, chronic cough
on examination of left heart failure?
apex beat of not displaced in acute, heaving in characcter if left ventricular hypertrophy triple gallop rythm basal crepitations loud p2 pan systolic murmur
what is framingham criteria for diagnosis?
1 major+2 minor requried for diagnosis of congestive cardiac failure
major: PND, neck vein distension, crepitations, cardiomegaly, acute pulmonary edema, s3 gallop, + hepatojuglar reflex, increase venous pressure >16cmh2
minor: pedal edema, night cough, dyspnea on exertion, hepatomegly, pleural effusion, tachycardia,vital capacity reduce by 1/3
features of right heart failure?
raised JVP, tender hepatomegaly, pitting edema,
evidence of heart disease
ascites
investigation?
1,ecg
2,xray to check karley b lines and effusion
3,echo(best test) TTE more acccurate
TEE for vulular diseases
4, BNP act as physiological aldosteron antagonist
BNP <400pg/ml normal ( if bnp is normal CHF is excluded)
400-2000 hf uncertain
>2000 heart failure lkely
other investigations
blood cbc lfts urea and creatinine serum electrolytes cardiac enzymes thyroid function test
drugs which lower mortality in systolic dysfunction?
ACE/ARBS beta blocker spironlactone hydralazine nitrates defibrillator
