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5TH YR- CMS2 > Heart failure > Flashcards

Heart failure Flashcards

1
Q

What does the term heart failure refer to

A

The inability of the heart to pump blood strongly enough to meet the body needs

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2
Q

What can heart failure result in

A

Too little forward flow into the arterial circulation resulting in low blood pressure and poor tissue perforation

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3
Q

What happens to the venous circulation in heart failure

A

Becomes congested with blood resulting in an increased capillary pressure which forces fluid from the circulation into the tissues

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4
Q

What is oedema

A

Increase in extravascular fluid

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5
Q

When does heart failure occur in physiological terms

A

When the heart is unable to pump sufficient blood to supply the body demand

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6
Q

List some of the clinical syndrome of heart failure

A

Combination of:
1. Breathlessness
2. Oedema
3. Fatigue

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7
Q

List three clinically important considerations we should make in regards to heart failure

A
  1. What is the nature of the cardiac malfunction
  2. What are the boys adaptive mechanism
  3. What other conditions may be aggravating or precipitating the heart failure
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8
Q

What can heart failure be caused by

A

Disease of the:
1. Heart muscle (myocardium)
2. The valves
3. Disturbances of the heart rhythm

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9
Q

What is heart muscle dysfunction most commonly due to

A

Ischemic heart disease or hypertension

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10
Q

What can cause damage to the myocardium

A
  1. Drugs and alcohol
  2. Nutritional deficiencies
  3. Infections
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11
Q

What is cardiomyopathy

A

A therm used to cover a group of heart muscle disorders of uncertain cause

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12
Q

What does myocardial disease commonly result in

A

Left ventricular systolic dysfunction

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13
Q

What is left ventricular systolic dysfunction

A

Weakness of the left ventricle

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14
Q

What does Weakness of the left ventricle cause

A

Reduction in ejection fraction

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15
Q

How much blood Is normally ejected from the ventricle with each beat?

A

More than 60%

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16
Q

What does the term diastolic dysfunction refer to

A

Poor reaction of the ventricle resulting in impaired fill-in

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17
Q

In whom is diastolic dysfunction more commonly seen

A

Elderly and hypertensive patients

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18
Q

What happens to the myocardium in myocardial disease

A

Myocardium is less able to adapt to increasing filling pressures

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19
Q

What is stenosis

A

Narrowing of a valve

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20
Q

What does valve stenosis result in

A

Pressure overload of the chamber upstream of that valve

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21
Q

What does aortic stenosis require

A

An increased left ventricular pressure to eject the blood and the ventricle becomes hypertrophies and can eventually fail

22
Q

What does mitral stenosis result in

A

Raised left atrial pressure resulting in dilation of the left atrium

23
Q

What does calculate regurgitation result in

A

Volume overload

24
Q

What can precipitate heart failure

A

Arrhythmias

25
Q

What can a severe tachycardia result in

A

Impairment of cardiac filling during the shortened diastole

26
Q

What can a severe bradycardia result in

A

Reduction in the number of contractions to maintain cardiac output

27
Q

Name the most common chronic arrhythmia

A

Atrial fibrillation

28
Q

What are some of the circulatory consequences of heart failure

A
  1. Reduced cardiac output
  2. Increased intracardiac pressure
  3. Increased back pressure in venous circulation
29
Q

What can increased back pressure in the venous circulation result in

A

Increased capillary pressure and leakage of fluid into eh tissues (oedema)

30
Q

What can result in imbalance of fluids and blood pressure

A
  1. Haemorrhage
  2. Dehydration
  3. Fluid overload
31
Q

What does reduced cardiac output result in

A

Activation of the sympathetic nervous system and the renin–angiotensin– aldosterone system

32
Q

What does the release of catecholamines adrenaline and noradrenaline stimulates

A

The force and rate of contraction of the heart
Constricts the blood vessel to maintain blood pressure

33
Q

What is angiotensin

A

A vasoconstrictor

34
Q

What does aldosterone do

A

Stimulates sodium retention in the kidney and consequently water retention increasing circulatory volume

35
Q

What can sodium and water retention aggravate

A

Oedema

36
Q

What can constant stimulation of the myocardium by catechol- amines result in

A

Further myocardial damage

37
Q

Give examples of non cardiac condition that can aggravate heart failure

A
  1. Anaemia and hypoxia
  2. Artery venous shunts
  3. Hyperthyroidism
  4. Severe renal failure
  5. Excessive intravenous fluid therapy
38
Q

What effect can anaemia and hypoxia have on heart failure

A

Increases cardiac workload

39
Q

What effect can Arterio-venous shunts have on heart failure

A

Require an increased cardiac output

40
Q

What effect can hyperthyroidism have on heart failure

A

Causes sympathetic stimulation and concomitant peripheral vasodilation resulting in tachycardia and high cardiac output

41
Q

What effect can severe renal failure have on heart failure

A

Impairs excretion of salt and water resulting in fluid overload

42
Q

What effect can excessive intravenous fluid therapy have on heart failure

A

Can precipitate pulmonary oedema

43
Q

What clinical features does left sided heart failure tend to cause

A

breathlessness due to pulmonary congestion

44
Q

What clinical features does right sided heart failure tend to cause

A

Systemic venous congestion with raised beaus pressure and pitting oedema

45
Q

What is the immediate first aid treatment for a patient with acute pulmonary oedema

A
  1. They require hospital admission
  2. Sit the patient up to optimise both the haemodynamic stress on the heart and the mechanics of breathing.
  3. Oxygen should be given, and patients with ischaemic heart disease should take their GTN
46
Q

Give examples of some drugs used to manage heart failure

A
  1. ACE inhibitors
  2. Angiotensin
  3. spironolactone in low doses
  4. Beta blockers
  5. Diuretics
  6. Vasodilators
  7. Digoxin
  8. Phosphodiesterase inhibitors
47
Q

What can ACE inhibitors do

A

Reduce mortality by 25% at all levels of severity

48
Q

What can ACE inhibitors cause

A

Renal impairment and hyperkalaemia

49
Q

What do spironolactone do

A

Reduce mortality in severe heart failure patients that are already being treated with ACE inhibitors

50
Q

Give examples of Phosphodiesterase inhibitors

A

enoximone and milrinone.

51
Q

What can inhibition Phosphodiesterase cause

A

ntracellular accumulation of cAMP, which results in a rise in calcium entry. This increases the force of myocardial contraction.

52
Q

Which drugs should we be careful about giving to patients with heart failure and why

A

NSAIDs as they may cause fluid retention and acute renal failure in patients already taking diuretics and ACE inhibitors

5TH YR- CMS2 (7 decks)

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