Heart failure Flashcards
What is heart failure ?
A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction, either at rest or on exertion, with accompanying neurohormonal activation’’
What is the prevalence of heart failure ?
2% at 50 years
10% at 80 years
Increases with age
What is the mortality rate of heart failure ?
50% at 50 years
What is the most commonest cause of heart failure ?
Ischaemic heart disease
What drugs can cause heart failure ?
Chemotherapy
Alcohol
How does valvular dysfunction cause heart disease ?
Predominantly diastolic dysfunction
AS-> pressure overload-> LVH
AR/MR-> volume overload-> cardiomegaly
How does cardiomyopathy cause heart failure ?
HOCM: LVH and outflow obstruction
Dilated: drug-induced or post-viral
Restrictive: MI
How does high output failure cause heart failure ?
Hyperdynamic circulation
Uses a lot of ATP
What pericardial diseases cause heart failure ?
Pericardial infiltration and effusions
What is the symptoms of heart failure ?
SOB
Fatigue
Oedema
Reduced exercise capacity
What are the signs of heart failure ?
Oedema Tachycardia Raised JVP Chest creps or effusions 3rd heart sound Displaced or abnormal apex beat
What is the European soc cardiology guideline ?
- Symptoms or signs of HF (rest or exercise) and
- Objective evidence of cardiac dysfunction and (in doubtful cases)
- Response to therapy (diuretics)
What are the potential screening tests for heart failure ?
12 lead ECG
BNP (brain-Btype natriuretic peptide)
What other structural cardiac abnormalities will cause heart failure ?
LV systolic dysfunction – many causes
Valvular heart disease
Pericardial constriction or effusion
LV diastolic dysfunction/heart failure with preserved systolic function/heart failure with normal ejection fraction
Cardiac arrhythmias: tachy or brady
Myocardial ischaemia/infarction (usually via LVSD)Restrictive cardiomyopathy eg amyloid, HCM
Right ventricular failure: primary or secondary to pul hypertension
What are the causes of LV systolic dysfunction ?
Ischaemic heart disease
Dilated cardiomyopathy
Severe aortic valve disease or mitral regurgitation
What are the causes of LV systolic dysfunction ?
Ischaemic heart disease
Dilated cardiomyopathy
Severe aortic valve disease or mitral regurgitation
What is the presentation of LV ejection fraction ?
LV ejection fraction is a continuous biological variable
Disease/ physiological changes can both decrease and increase the LVEF
The LVEF may be lower than previous but not pathologically low
Analogous to haemoglobin/ aneamia
ECHO
What is the prognosis of HF ?
The 1 year survival rate for HF is worse than that for cancer of the breast, uterus, prostate and bladder Expensive condition Common hospital admission illness High re-admission rates High morbidity and mortality
What are the investigations of HF ?
ECG NT-ProBNP ECHO Bloods: - FBC - U+E - Troponin Cardiomyopathy screen Urinalysis CXR Cardiac MRI
What is the treatment of HF ?
Diuretics ACEI B-blockers Aldosterone receptor blocker Angiotensin receptor and neprolysin inhibitors
