Heart failure Flashcards
What is cardiac output
FOrmula
amount of blood theheartpumps through the circulatory system in a minute – expressed in litres per minute
Cardiac Output (CO) = Heart Rate (HR)×Stroke Volume (SV))
Stroke volume- ml heart pumps out L ventricle in one pump
What is ejection fraction
s a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction.
What’s a normal EF
What’s not normal
What’s borderline
Above 50%
Below 40% (HF)
40-50
How to classify HF
Systolic dysfunction- HFrEF (insufficient pumping action or impaired contraction. Occurs when EF <40%
Diastolic dysfunction (insufficient filling of the ventricle due to decreased compliance and impaired relaxation)
Causes of HF
Ischaemic heart disease
Chronic hypertension
Dilated cardiomyopathy
Myocarditis
Causes of diastolic dysfunction
HTN with LVH Restrictive cardiomyopathy Hypertrophic cardiomyopathy Fibrosis Amyloidosis Sarcoidosis Constrictive pericarditis Haemochromatosis Aging
Symptoms of HF
Shortness of breath (dyspnea) when you exert yourself or when you lie down
Fatigue and weakness
Swelling (oedema) in your legs, ankles and feet
Rapid or irregular heartbeat
Reduced ability to exercise
Persistent cough or wheezing with white or pink blood-tinged phlegm
Increased need to urinate at night
Swelling of your abdomen (ascites)
Very rapid weight gain from fluid retention
Lack of appetite and nausea
Sudden, severe shortness of breath and coughing up pink, foamy mucus( In keeping with pulmonary oedema)
Chest pain if your heart failure is caused by a heart attack
L sided failure
Paroxysmal nocturnal dyspnoea
Restlessness (as poor perfusion of brain)
Defunctioning of kidney (undwrperfusion)
Pulmonary congestion- cough, crackles, blood sputum tinge
R sided failure
Fatigue Peripheral venous pressure Ascites Enlarged liver and spleen Distended JVP Anorexia and complaints of GI distress
Clinical signs of L sided heart failure
Crackles in lung bases initially then throughout lung field if left untreated.
Gallop rhythm (an abnormal heart rhythm marked by the occurrence of three distinct sounds in each heartbeat like the sound of agallopinghorse.)
Laterally displaced apex beat
Signs of Right sided heart failure:
Clinical signs of R heart failure
Signs of Right sided heart failure: Remember that in right sided heart failure the blood backed up will cause swelling to the veins, interstitial space and organs. - Lower limb and sacral pitting edema - Raised Jugular Venous pressure (JVP) - Organomegaly (Liver and spleen) - Ascites
Investigations
ECG CXR BNP cardiomyopathy Echocardiogram
May need MRI/angiography/dobutamine stress ECHO/ Trans-oesophageal echo
Time course of HF
Acute or chronic
Or can be acute on chronic
Goals of treatment
identify / treat any cause (valvular disease; IHD)
Reduce cardiac workload
Increase cardiac output
Counteract maladaptation
Relieve symptoms
Prolong quality life – reduce hospitalization
Management of acute heart failure (sudden onset pulmonary oedema)
Sit the patient up!
High flow oxygen
IV diuretics (furosemide) at escalating doses
Consider IV nitrates (caution in hypotension and heart failure secondary to severe aortic stenosis!)
(Consider iv opiates and antiemetics)
Consider non-invasive ventilation (CPAP)
Consider inotropic support
Consider device therapy (intra-aortic balloon pump/Impella device)
Consider referral for Left Ventricular Assist Device (Bridge or destination therapy) or Cardiac transplantation
