Heart Failure Flashcards
Signs and symptoms of HF
Typical: dyspnoea (usually with exertion) Orthopnoea Paroxysmal nocturnal dyspnoea Fatigue Less typical: Nocturnal cough Wheeze Abnormal bloating Anorexia Confusion palpitations Syncope Specific signs: Elevated jugular venous pressure Hepatojugular reflux Third heart sound Less specific signs: Weight gain >2kg/week Weight loss (advanced HF) Peripheral oedema (ankle, sacrum) Pulmonary crackles Pleural effusions Ascites Tachycardia/Tachypnoea
Acute pulmonary oedema (APO)
Medical emergency characterised by the acute development (minutes or hours) of pulmonary oedema as the dominant clinical feature of LHF with redistribution of fluid into the pulmonary interstitium and then alveoli flooding. APO results in rapid development of respiratory failure and potentially respiratory arrest and death without intervention.
Causes of HF
Ischaemia (infarction, ischaemia, micro vascular disease)
Inflammation: infection, immune
Toxic damage: alcohol, drugs (cytotoxic, stimulants, clozapine, radiation.
Infiltration: malignancy, amyloid, sarcoid, haemochromatosis or iron overload
Metabolic disorders
Nutritional abnormalities
Genetic abnormalities
HTN
High out put states
Volume overload: renal failure, iatrogenic fluid overload
Diagnostics investigations for Heart Failure
ECG- into assess cardiac rhythm, QRS duration and underlying conditions such as ischaemia of LV hypertrophy
Chest X-ray- look for signs of pulmonary congestion and identify cardiac and non cardiac causes.
Echocardiogram: assess cardiac structure and function.
Pathology: EUC, LFT’s, FBE, ECG, CXR
2 classifications of HF
Heart Failure with Reduced Ejection Fraction (HFrEF) : symptoms +/- signs of HF and LVEF <50%
Heart failure with preserved Ejection Fraction (HFpEF): symptoms +- signs HF EF at least 50%
Evidence of structural heart disease or diastolic dysfunction with out a alternate cause Eg: valve disease
HF classified as acute onset or chronic onset of symptoms
Acute: onset of significant worsening of symptoms sufficient to warrant treatment
Subgroups: APO, Cardiogenic shock, Acute deco pen dated HF, RHF
Chronic HF: patients diagnosed with HF for a period of time min 3 months and received treatment.
Potential HFReF causes
Ischaemia Infarction Infection Toxic damage Arrhythmias
APO
Is an abnormal accumulation of fluid in the interstitial tissue and alveoli of the lung
Fluid impairs gas exchange and lung compliance
Causes: HF, capillary injury, blockage of lymphatic system, MI, arrhythmias, fluid overload.
Cardiogenic APO
Occurs when decrease in CO despite increase in systemic vascular resistance.
Blood returning to left atrium exceeds that leaving the LV
Results in increased venous pressure
Causes hydrostatic pressure in the lungs to exceed oncotic pressure of the blood, leading to net filtration of protein poor fluid out of capillaries
APO non Cardiogenic
Pathological process acting directly on pulmonary vascular permeability.
Proteins leak from capillaries increasing the interstitial oncotic pressure so that it exceeds that of the blood and fluid is drawn from capillaries
Management of chronic HF
ACE inhibitors Beta-blockers Spirinonolactone Loop diuretics Angiotensin receptor blocker Digoxin
Non pharmacological management of HF
Collaborative care - GP, heart failure nurses and cardiologist. Self management - educating pts Fluid restrictions and daily weight If signs of congestion 1.5L FR Exercise Na intake <2g daily Sliding scale diuretics
Non Cardiogenic causes of APO
High output states - septicaemia, anaemia, thryotoxicosis
Pancreatitis, DIC, burns
Toxins
Head injuries
Clinical manifestations of APO
Tachycardia Tachypnoea Hypertension Diaphoesis Pink frothy sputum Cough Raised JVP
NIPPV in APO
Redistributes intra-alveolar fluid Splints alveoli open Increases area for gas exchange Increases lung compliance Decreases WOB For persistent hypoxaemia l, hypercapnia or acidosis: RSI for intubation and MV
