Heart failure Flashcards

1
Q

Define HF

A

clinical syndrome characterised by impaired cardiac pumping leading to the inability to pump blood and O2 to metabolising tissue despite normal filling pressures

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2
Q

What is ejection fraction (EF)?

A

Amount of blood pumped by the heart in one contraction

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3
Q

What is congestive HF?

A

HF with fluid retention/congestion

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4
Q

What are the different classifications of HF?

A

Systolic -REF
Diastolic - PEF
Acute
Chronic

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5
Q

Explain systolic -REF

A
  • LVEF less than 35%

- LV can’t contract so heart can’t pump enough blood out therefore blood can not get in

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6
Q

Explain Diastolic - PEF

A
  • LVEF more than 50%

- LV cannot relax so heart can not fill with blood therefore blood can not get out

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7
Q

What is acute HF

A
  • rapid onset of sudden cardiac decline

- Life threatening

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8
Q

what is chronic HF?

A
  • slow/progressive cardiac decline

- usually due to chronic conditions such HPT and diabetes

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9
Q

Describe the pathophysiological mechanisms of HF-REF.

A
  • cardio renal - Forward failure causes water retention and reduced blood flow
  • cardio circulatory - forward failure results in peripheral vasoconstriction and increased PVR
  • neurohormonal activation and cardiac dysfunction results in reduced cardiac out and BP which increases SNS, RAAS and ADH this leads to cardiac remodelling
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10
Q

Describe the effects of neurohormonal activation.

A
  • activation of SNS increases HR, contractility and vasoconstriction - increased catecholamines leads to ischaemia and cardiac remodelling. the increased renin activates RAAS.
  • RAAS activation increases Ang II which increases vasoconstriction, SNS activation and cardiac remodelling. it increases aldosterone which leads to water and Na+ retention
  • increases ADH increases water retention and vasoconstriction
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11
Q

What are the congestive symptoms of HF

A

Sacral/ankle oedema, productive cough, SOB/breathlessness and unable to lay flat

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12
Q

what are the hypo perfusion symptoms of HF?

A

decreased exercise tolerance, cold hands and feet and fatigue

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13
Q

What are the non-pharmacological treatments for chronic HF and state examples

A

Lifestyle modifications - increase activity to min 30mins a day, lose weight if needed, smoking cessation, alcohol moderation, decrease salt intake in diet, reduce fluid intake

Surgical - heart transplant.

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14
Q

Describe the current drug management treatment pathway for chronic HF/HF-REF. Give examples of drugs

A
  1. Diuretics e.g. Furosemide for water retention
  2. 1st line - BBs and ACEI/ARB e.g. atenolol and lisinopril/candesartan
  3. aldosterone -RA e.g. spironolactone
  4. ARNI e.g. Sacubitril/Valsartan - must STOP ACEI/ARB
  5. If channel inhibitor e.g. Ivabradine if resting HR > 75bpm
  6. Vasodilator e.g. Hydralazine/ISDN - this FIRST LINE if patient intolerant to AECI/ARB
  7. Inotropic agent e.g. digoxin
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15
Q

What is the mechanism of actions of Diuretics e.g.furosemide?

A

inhibit Na+/K+ exchange in DCT to promote diuresis which decreases plasma volume.

arterial and venodilation reduces preload increasing exercise tolerance and decreasing congestive symptoms

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16
Q

What are the adverse side effects of diuretics?

A

hyperkalaemia, hypercalcemia, hyperuricemia, hyperglycaemia, hyperlipidemia

17
Q

What is the mechanism of action of ACEIs?

A

inhibit Ang II and RAAS which decreases vasoconstriction, preload and afterload - decreasing contractility, HR and SNS activation - reducing cardiac remodelling

increases bradykinin increases vasodilation and reduces plasma volume

Decreases aldosterone which reduces water retention and congestive symptoms

18
Q

what are the adverse side effects of ACEIs?

A

Ang II - 1st dose hypotension, hyperkalaemia and worsening of renal function.

bradykinin - cough and angioedema

19
Q

What is the mechanism of action of BBs?

A

Antagonise effects of adrenaline and noradrenaline at B-adrenoceptors

inhibit neurohormonal activation to inhibit SNS activation and reduce HR

20
Q

what are the adverse side effects of BBs?

A

fluid retention, fatigue, bradycardia and hypotension

21
Q

What is the mechanism of action of Spironolactone and what are the side effects?

A

Block aldosterone-R to reduce aldosterone - decrease plasma volume and congestive symptoms

SEs - hyperkalaemia