Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiology > Heart failure > Flashcards

Heart failure Flashcards

1
Q

What is heart failure?

A

Occurs when the heart can not maintain an adequate cardiac output to meet the demands of the body

This results from any structural or functional abnormality that impairs the heart’s function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name the 2 types of heart failure

A

Low output

High output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name examples of low output heart failure

A

Systolic heart failure

Diastolic heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is high output heart failure?

A

Heart functions normally but demands of body is increased beyond what the heart can supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name causes of high output heart failure

A

Thyrotoxicosis
Profound anaemia
Pregnancy
Pagets’ disease
Acromegaly
Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define systolic heart failure

A

Progressive deterioration of myocardial contractile function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name causes of systolic heart failure

A

Ischaemic injury

Volume overload

Pressure overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define diastolic heart failure

A

Inability of heart chamber to relax, expand and fill sufficiently during diastole to accommodate an adequate blood volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name causes of diastolic heart failure

A

Significant left ventricular hypertrophy (i.e., lumen severely narrowed)

Infiltrative disorders

Constrictive pericarditis

Restrictive cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name cause of heart failure (overall)

A

Coronary heart disease

Hypertensive heart disease

Valvular heart disease

Myocardial disease/cardiomyopathies

Congenital heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define cardiomyopathy

A

Diffuse disease of heart muscle leading to functional impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the different types of cardiomyopathy?

A

Dilated
-various causes (50% familial)
-ETOH, pregnancy, systemic diseases (e.g., SLE), drug toxicity, myocarditis

Hypertrophic cardiomyopathy
-hereditary

Restrictive cardiomyopathy
-Rare
-amyloid is main cause in the UK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the pathophysiology of heart failure?

A

Pump failure = ↑SV and ↓CO

This starts compensatory mechanisms

Frank Starling mechanism = vasoconstriction, ↑venous return to heart, increased preload, heart muscle fibres stretch, enhanced contractility

Myocardial structural change = augment muscle mass +/- cardiac chamber dilation

Activation of hormonal system
-noradrenaline relase = ↑HR + ↑myocardial contractility (causes vasoconstriction)
-BNP/ANP release
-Activation of RAAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How can compensatory mechanism worsen heart failure?

A

Vasoconstriction
-↑ resistance against which heart has to pump = ↓CO

Na + H2O retention
↑fluid = ↑ preload - if stretch too much ↓ contractile strength and CO

Excessive tachycardia
↓diastolic filling time = ↓ventricular filling = ↓SV and ↓CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

True or False

Chamber dilation happens in both pressure and volume overload

A

FALSE

Chamber dilation happens in volume overload - the muscle mass and thickness are increased in proportion to chamber diameter

Augmentation of muscle happens in pressure overload (e.g., left ventricular hypertrophy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the clinical types of HF?

A

Left vs right sided

Acute vs chronic

Compensated vs decompensated

17
Q

What is left-sided HF?

A

Failure of left side of heart

Blood backs up from heart to pulmonary circulation

18
Q

What are the causes of left-sided HF?

A

Ischaemic heart disease

HTN

Valvular heart disease

Myocardial disease

19
Q

What are the complications of left-sided HF?

A

Lungs - pulmonary oedema. Presents with:
-breathlessness
-orthopnoea
-paroxysmal nocturnal dyspnoea

Kidney
↓renal perfusion = RAAS activation = retention of salt + water

Brain - hypoxic encephalopathy. Presents with
-irritability
-loss of attention
-restlessness
-stupor or coma

20
Q

What is right-sided HF?

A

Usually a consequence of left-sided HF (together they are called congestive heart failure)

NOTE: CCF can also be due to the same pathological process happening on each side of the heart

21
Q

What is cor pulmonale?

A

Right-sided HF due to pulmonary HTN/increased resistance in pulmonary circulation

Usually due to respiratory disease e.g., COPD or pulmonary emboli

22
Q

Name other causes of right-sided HF

A

Valvular heart disease

Congenital heart disease

23
Q

What are the systemic effects of right-sided HF?

A

Liver and portal system
-congestive hepatomegaly
-centrilobular necrosis (when severe)
-cardiac cirrhosis

Spleen
-congestive splenomegaly

Abdomen
-ascites (accumulation of transudate in peritoneal cavity)

Subcutaneous tissue
-peripheral oedema (esp. ankle and preitibial)
-sacral oedema is bed-ridden

Pleural and pericardial space
-effusions

24
Q

What are the clinical presentations of HF?

A

Orthopnoea

Paroxysmal nocturnal dyspnoea

Oedema

Hepatic congestion

Ascites

Fatigue

Weakness

25
Q

What are the New York Heart Association (NYHA) classifications of HF?

A

Class I = no limitations of physical activity

Class II = slight limitation of ordinary activity

Class III = marked limitation, even during less than ordinary activity

Class IV = severe limitations with symptoms at rest

26
Q

What are the clinical signs of HF?

A

Tachypnoea

Crackles/reduced breath sounds on auscultation

Cool peripheries

Cyanosis

Elevated JVP

Third heart sound (S3) - gallop rhythm

Displaced apex - LV enlargement

Peripheral oedema

Ascites

Hepatomegaly

27
Q

True or false

Acute pulmonary oedema is a medical emergency

A

TRUE

The signs are:

Acute breathlessness
Pallor
Cyanosis
Sweating
Rapid pulse
Hypoxia
Crackles in lungs

28
Q

Name clinical investigations for HF

A

Bedside -ECG

Bloods - baseline + BNP

Imaging
-CXR (check for cardiomegaly)
-Echocardiogram/
-Cardiac MRI/CT/CT.PET
-CTCA/coronary angiography

29
Q

What are the current drug treatments for AF

A

ACEis/ARBs

ARNI

Aldosterone antagonists - e.g., spironolactone, eplerenone

Beta-blockers

SA node blockade - e.g., Ivabridine

Diuretics
-loops e.g., furosemide
-thiazides e.g., bendroflumethiazide
-quinazolines e.g., metolazone

Digoxin
-↑ cardiac motility
-slows conduction at AV node
-excreted by kidney

30
Q

What is the immediate treatment of acute pulmonary oedema?

A

High flow O2

IV morphine

IV nitrates

IV furosemide

31
Q

What is the definitive treatment of acute pulmonary oedema?

A

Identify causes

Oral diuretics

Medical therapy

Revascularisation (if appropriate)

32
Q

Which drugs should not be used in heart failure? Why?

A

CCBs

depress heart function further and exacerbate symptoms

33
Q

Which CCB can be used in HF? Why?

A

Amlodipine

Does not affect the myocardial contractility

34
Q

Sources

A

https://bnf.nice.org.uk/treatment-summaries/calcium-channel-blockers/#:~:text=Amlodipine%20and%20felodipine%20also%20resemble,clinical%20deterioration%20in%20heart%20failure.

Cardiology (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions