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CVS Lecture Reviews > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart failure?

A

A clinical syndrome of ruduced CO, tissue hypofusion and increased pulmonary pressurs and tissue congestion (oedema)

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2
Q

What is the name for when both the left and right ventricles fail?

A

Congestive heart failure

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3
Q

What are the signs and synptoms of left sided heart failure?

A
  • Fatigue
  • Breathless (around exertion)
  • Orthopnoea (shorting breath laying flat)
  • Paroxysmal nocturnal dysponea (waking up breathless neeing fresh air)
  • Basal pulmonary crackles
  • Cardiomegaly (displaced apex beat)
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4
Q

What are the signs and symptoms of right sidede heart failure?

A
  • Fatigue
  • Breathless
  • Pheripheral oedema (pitting)
  • Raised jugular venous pressure
  • Tender, smooth enlarged liver
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5
Q

What are the key presentations of a patient with heart failure?

A

Dysponea and fatigue (due to tissue hypofusion)

Increased fluid retention
LV failure= pulmonary, RV failure= peripheral

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6
Q

What causes heart failure?

A

Remodelling of cardiac muscle (loss of myoctes/ fibrosis) in response to changing ventricular function and shape/ size

Impairment of filling (decreased chamber size)
Impairment of ejection (decreased contraction)

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7
Q

What are common causes of heart failure?

A

Isceamic heart disease
Hypertension
Valvular disease
(Other)

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8
Q

What is a less common cause of heart failure?

A

High output failure

Increased demand on cardiac output NOT heart function decreasing

Eg, Sepsis

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9
Q

How is heart failure caused by ejection problems?

A

Contractility effected in systolic
Heart cant pump with enough force

Space available for filling NOT reduced just can’t empty ventricles

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10
Q

How is heart failure caused by a filling problem?

A

Less blood into ventricles in diastole
Volume available for blood to fill ventricles is reduced
End diastolic volume decreased

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11
Q

What results in ejection problems?

A

Muscle walls fibrosed
Chamber spaced enlarged (overstretched)
Abnormal myocyte contraction

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12
Q

What results in Filling problems?

A

Chambers stiff

Ventricular walls thickened

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13
Q

How to tell the differnece between ejection/ filling problem?

A

SV/ EDV= ejection fraction (EF)

If less than 50%= ejection (HFrEF)
If normal= filling (HFpEF)

EDV=end diastolic volume
HFrEF= heart failure with reduced ejection fraction
P= preserved

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14
Q

How can a preserved ejection fraction cause heart failure?

A

The contraction is not impaired so 50% of ventricle volume is still ejected but this is a small CO as origionally filled less

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15
Q

How can you determine between if heart failure if HFeEF or HFpEF?

A

Carry out an echocardiogram

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16
Q

What is the normal relationship between CO and end diastolic volume?

A

As EDV increases so does CO

Up to a certain point the CO dips

17
Q

What allows CO to increase with EDV?

A

Properties of cardiac myocytes

  • more stretch in ventricle during diastole= greater SV ejected in systole
  • more myocytes stretched harder they contact
18
Q

How does EDV and CO relationship different in a patient suffering from LV systolic heart failure?

A

Increased filling in failing heart = little increase in CO
(Eventually worsening CO)
Large increases in EDV (to try and increase SV) lead to reduced CO and pulmonary oedema

19
Q

How does the RAAS system contribute to heart failure?

A

Worsens the heart failure by increasing the cardiac work load

Has cardiotoxic effects from long term activation of sympa system and angiotensin 2

20
Q

How does the RAAS increase workload on the heart?

A

Increased the preload (larger EDV)-increased circulating blood volume by stimulating ADH

Increases the afterload- enhances sympathetic activity
-vasoconstriction

21
Q

How does the sympathetic nervous system respond to heart failure?

A

Increases cardiac demand

In response to lower CO and BP, increased sympa drive
Increased afterload

22
Q

How does pulmonary oedemas develop?

A

Increased pressure in LV (failure in ejection)
Increased pressure in pulmonary circulation (backtracks)
Increased pres at venuole end of cap bed
Less favourable hydro/oncotic press gradient
Increased fluid accumulation

23
Q

How do peripheral oedemas develop?

A

Increased pressure in RV (ejection failure)
Increased pressure in systemic circulations
Increased CVP= increased jugular VP
Unfavourable hydro/oncotic gradient at venule end cap beds
Increased volume of tissue fluid= oedema

24
Q

What drugs reduce CO and therefore reduces workload of the heart?

A

B-blockers (reduce BP and CO)
ACE inhibitors (stop effects of angiotensin 2)
Diuretics (reduce blood volume)
Ca channel blockers (reduce peripheral vasoconstriction)
Nitrates (vendodilation)

25
Q

What key drug is given in the general management of heart failure?

A

Furosemide

Immediately vendilatory
Later onset diuretic action

26
Q

What is the main blood test used to detect if actually heart failure?

A

NTpro-BNP

Which is a hormone released in response to stretch/ overfilling of fluid in chambers

27
Q

What is BNP

A

A natriuretic peptide realised in response to severe heart failure in an attempt to reduce workload on heart

28
Q

What is the sequence of treatments for heart failure?

A 
Furosemide 
O2 (to raise sats)
Resp support (cpac can reduce pulmonary oedema)
Second line (eg, nitrates)

EGC
CXR
Transthorasic echocardiogram
Surgery? (Fix cause is structural/ valve related)

29
Q

How might anaemia effects heart failure?

A

Could worsen symptoms as heart having to work harder still as o2 carrying capacity reduced

30
Q

How do Biventricular pacemakers aid in heart failure?

A

In HF right and left sides may not pump together and if out of sync left not able to pump enough

Stimulates both sides to contract at the same time

31
Q

How does a biventricular defibrillator work in heart failure treatment?

A

Detects dangerous/ abnormal rhythms and shocks heart back into normal

Prevents life threatening rhythms developing in patients with heart failure

32
Q

Why does prognostic treatment not work for HFpEF?

A

As due to stiffness of heart not high bp ect

Use only symptomatic treatments

CVS Lecture Reviews (9 decks)

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