Heart Failure Flashcards
What is heart failure?
Heart failure is a complex clinical syndrome in which the heart fails to meet the metabolic demands of the body. It can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood
How is heart failure diagnosed?
A diagnosis of heart failure is based on the presence of a triad of typical symptoms (shortness of breath on exertion and at rest, fatigue), signs (tachycardia, tachypnoea, raised jugular venous pressure, peripheral oedema, and pulmonary congestion), and objective evidence of a structural or functional cardiac abnormality (cardiomegaly, abnormal echocardiogram, raised natriuretic peptide concentration).
NT-proBNP > 400-2000 –> heart failure
What are the end-stage results of heart failure?
Progressive pump failure
Sudden cardiac death
What pathologies can lead to heart failure?
Ischaemic heart disease
Idiopathic dilated cardiomyopathy
Valve disease
Hypertension
What are the physiological causes of heart failure?
- Volume overload
- Pressure overload
- Contractile dysfunctioni
What remodeling changes occur in heart failure?
- Myocardial damage leads to increased myocardial wall stress
- Wall thickness increases to reduce wall stress –> increase of myocardiocytes isn’t functional and decrease in CO (diastolic failure)
- Hyperdilation of ventricles and severely decreased CO
What are the signs of heart failure?
- Tachycardia
- Hypotension
- Raised JVP
- Displaced apex beat
- 3rd heart sound
- Cachexia
- Cardiomegaly
- Pleural effusion
- Ascites
- Peripheral ankle oedema
- Tender hepatomegaly
- Bi-basal crackles
What are the 4 steps in the NYHA classification of heart failure?
- No limitation pf physical activity
- Slight limitation of physical activity (walking up stairs)
- Marked limitation of physical activity (getting dressed)
- Symptoms at rest
What are the specific symptoms of left-sided heart failure?
Nocturnal dyspnoea Orthopnea Tachycardia Pulmonary congestion -> cough, crackles, wheezes Fatigue Cyanosis Exertional Dyspnoea
What are the specific symptoms of right-sided heart failure?
fatigue Increased peripheral venous pressure Ascites Enlarged liver and spleen Weight gain
What does an ECG in heart failure show?
No definitive markers for heart failure, but only 2% of patients with heart failure have a normal ECG
- Often observed:
- Sinus tachycardia
- Arrhythmias
- LVH
- Evidence of ischaemia or infarction
- Conduction system defects
What does a CXR in heart failure show?
Pulmonary congestion
Cardiomegaly
What does an echocardiography in heart failure show?
Key in confirming diagnosis
What do natriuretic peptide levels in heart failure patients show?
A normal plasma concentration in an untreated patient has a high negative predictive value, making HF an unlikely cause of symptoms.
How would you pharmacologically manage heart failure?
First line: offer diuretics for congestive symptoms and fluid retention, then offer ACE-I and beta-blocker
What dose would you give furosemide?
40 mg daily in the morning
What do thiazides do?
Thiazides and related compounds are moderately potent diuretics; they inhibit sodium reabsorption at the beginning of the distal convoluted tubule
What are examples of thiazides?
Bendroflumethiazide
Chlortalidone
Xipamide
Metolazone
What do loop diuretics do?
The mechanism of action for loop diuretics like furosemide is by inhibiting the apical sodium/potassium/chloride transporter in the thick ascending limb of the loop of Henle
What are examples of loop diuretics?
Furosemide
Bumetanide
Torasemide
Name an example of an aldosterone antagonist
Spironolactone
Improves survival in heart failure patient
What dose would you give for spironolactone?
25-400 mg daily depending on the condition
How would you non-pharmacologically manage heart failure?
- Revascularisation
- Biventricular pacemaker
- Cardiac transplantation
