Heart Failure Flashcards
What is Heart Failure?
Heart Failure is described as when the cardiac output is inadequate for the body’s requirments
What is the incidence of Heart Failure in the general population?
1-3%
What is the incidence of heart failure in the elderly population?
~10%
What are 3 classifications of heart failure
Systolic and Diastolic
Left and Right Heart Failure
Acute and Chronic
What is Systolic Heart Failure
The inability of the ventricles to contract normally resulting in a decreased cardiac output
In systolic heart failure, what is the ejection fraction
<40% HFrEF
List three causes of Systolic Heart Failure
Ischaemic Heart Disease
Cardiomyopathy
Myocardial Infarction
What is Diastolic Heart Failure
This is when the ventricles are unable to relax and fill normally, which then leads to increased filling pressures
What is the ejection fraction in diastolic heart failure
> 50% HFpEF
List 5 causes of diastolic heart failure
Ventricular Hypertrophy
Constrictive Pericarditis
Tamponade
Restrictive Cardiomyopathy
Obesity
List symptoms of Left Sided (Ventricular) Heart Failure
Dyspnoea
Paroxysmal Noctornal Dyspnoea
Orthopnea
Wheezing
Nocturia
Night Time Dry Cough
Fatigue
Weight loss
Cold peripheries
List 3 causes of Right sided (ventricular) failure
Pulmonary Stenosis
Lung Disease
Left ventricular (sided) failure
List symptoms of Right sided (ventricular) failure
Pulmonary Hypertension
Peripheral Oedema (thighs, sacrum, abdomen)
Ascites
Anorexia
Facial engorgement
Epistaxis
Nausea
Left Ventricular and Right Ventricular Heart Failure is collectively called
Congestive Cardiac Failure
How does congestive heart failure cause nocturia
When in the recumbent position, the fluid in the legs is no longer being held down by gravit. It can now moore easily enter the veins and the kidney for filtration, leading to the nocturia
What is acute heart failure?
Acute heart failure is new onset acute or decompensated heart failure characterized by the onset of pulmonary/peripheral odema with or without hypoperfusion signs.
What is Chronic Heart Failure
This is a gradual and slow progression of heart failure. Venous congestion is common but arterial pressures are well maintained until late
What is Low output cardiac failure?
This is when cardiac output is decreased and fails to increase on exertion to meet requirements.
List three cause of Low cardiac output failure
-excessive preload : Preload is the force that stretches the cardiac muscle prior to contraction. This force is composed of the volume that fills the heart from venous return.
-pump failure
-excessive afterload :
The afterload is the amount of vascular resistance that must be overcome by the left ventricle to allow blood to flow out of the heart
List some causes of excessive preload in Low Cardiac Output Failure
Mitral Regurgitation
Fluid Overload (renal failure, excess IV fluids)
List some causes of pump failure in Low Cardiac Output Failure
Systoli/Diastolic Heart Failure
B Blockers
Myocardial Infaction
Heart Block
Negative Inotropes
List some causes of chronic excessive afterload Low Output Cardiac Failure
Aortic Stenosis
Hypertension
The afterload is the amount of vascular resistance that must be overcome by the left ventricle to allow blood to flow out of the heart
What is High Output Cardiac Failure
Cardiac output is higher than normal due to increased peripheral demand. There is circulating overload which may lead to pulmonary edema secondary to elevated diastolic level in left ventricle
List some causes of High Output Cardiac Failure
Anemia
Pregnancy
Hyperthyroidism
List one complication of High Output Cardiac Failure
Right sided failure becomes left sided failure
List some clinical signs of Heart Failure
Cyanosis
Decreased BP
Narrow Pulse Pressure
Pulsus Alterans
Displaced apex (LV dilatation)
Right Ventricle Heave (pulmonary hypertension)
Signs of valve disease (murmur?)
Severity (according to NYHA)
What could a displaced apex beat indicate
Left Ventricle dilatation
What could a right ventricle heave indicate
Pulmonary Hypertension
Which investigations are done in Heart Failure?
CBC : Anemia, Infection
UandE : Kidney & Thyroid Function Tests
ECG : Heart Blocks, Bradycardia
BNP - B-type natiuretic protein:
Echocardiography:
Chest X-Ray:
What are the five (5) steps to management of Heart Failure
1) Lifestyle Changes
2) Treat the cause
3) Treat exacerbating factors
4) Avoid Exacerbating factors
5) Pharmacotherapy
What lifestyle changes should be advised in a patient with Heart Failure
Stop Smoking
Low salt intake
Stop drinking alcohol
Optimize weight and nutrition
What are some exacerbating factors of Heart Failure
anemia
thyroid disease
infection
high blood pressure
What are some drugs that can exacerbate Heart failure and should be avoided in treating these patients
NSAIDs (fluid retention)
Negative Inotropes - Verapamil (CCB)
What are the 4 (four) pillars of Heart Failure Treatment
- ACE-i (Lisinopril)
- SGLT2 inhibitors (Gliflozin)
- B-Blocker (Carvedilol)
- Aldosterone Antagonist (Spirinolactone/Eplerenone)
OR
2022 Edition
1) Neprilysin Inhibitor + ARB (Vymada)
2) SGLT2i (Dapagliflozin, Empagliflozin)
3) Beta Blocker ( Carvedilol, Metoprolol, Bisoprolol)
4) Aldosterone Antagonist (Spirinolactone, Eplerenone)
What does the FRAMINGHAM CRITERIA for Congestive Cardiac Failure State
Diagnosis of CCF requires simultaneous presence of 2 major criteria OR 2 minor and 1 major criteria
What is the threshold for B-type Natiuretic peptide that “confirms” heart failure
> 100mg/L
BNP at what value is used to rule out Heart Failure
<50ng/L (96% accurate)
What is Heart Failure with reduced Ejection Fraction
<40%
What is Heart Failure with mid-range Ejection Fraction
40-49%
What is Heart Failure with preserved Ejection Fraction
> 50%
What is normal Ejection Fraction
55-70%
