Heart failure Flashcards
Most common cause of heart failure
IHD
- with lack of adequate blood flow in coronary arteries the heart muscle will thin and become imparied , referred to as an ischemic cardiomyopathy
Common causes of heart failure
- Asking the pump to do too much work
HTN (LVH hypertrophy)
Obesity
Tachycardia-Induced Heart Failure
Common causes of heart failure
- Abnormality of the pump itself
Dilated cardiomyopathy (XSOH,cocaine, coronary disease)
Hypertrophic cardiomyopathy
Restricting cardiomyopathy (amyloid, scleroderma)
ejection fraction
=Stroke volume/total volume in LV
Most common causes of acute heart failure include
acute myocardial dysfunction (ischaemic, inflammatory), acute valvular disease, pericardial tamponade.
Heart failure pathophysiology
As a heart fails the amount of blood left after each contraction increases i.e. the ejection fraction decreases. This increased end-systolic volume (ESV) means the myocardium experiences greater stretch,in a failing heart, this causes a reduction in stroke volume and therefore CO
renal hypoperfusion leads to activation of RAS –> sodium retention –> oedema
Reduced CO activates the sympathetic nervous system via baroreceptors –>increases myocardial contractility and heart rate, and increases cardiac workload
Heart failure symptoms
Shortness of breath (SOB)
Wheeze
Fatigue
Weight loss
Paroxysmal nocturnal dyspnoea
Orthopnoea
Ankle swelling
Heart failure signs
cyanosis, narrow pulse pressure, pulsus alternans (arterial pulse waveform showing alternating strong and weak beats), displaced apex (LV dilatation), RV heave (pulmonary hypertension), signs of valve diseases, cold peripheries, often AF, cardiomegaly, tachycardia, wheeze, bibasal crepitations , hepatomegaly, raised jvp, ankle swelling,Heart sounds S3/S4,S3 gallop rhythm (due to filling of a stiffened ventricle)
Heart failure investigations
FBC- Ferritin,B12, Folate
U&E, - exclude renal failure as a cause of oedema
Creatinine
CK high in muscular dystrophy
Cholesterol and HbA1c - cardiovascular risk stratification.
TFT - exclude thyroid disease.
TSG- amyloid screen?
NT-pro BNP- if very high > 2000, then refer to be seen within 2 weeks for transthoracic ECHO, if above 400 then 6w
ECG may indicate cause (look for evidence of ischaemia, MI, or ventricular hypertrophy).
ECHO is key
Cardiomagenetic resonance imaging
Chest x-ray findings in heart failur
A: Alveolar oedema (with ‘batwing’ perihilar shadowing)
B: Kerley B lines (interstitial oedema)
C: Cardiomegaly (cardiothoracic ratio >0.5/ > 50% on PA film)
D: upper lobe blood diversion
E: Pleural effusions (typically bilateral transudates)
F: Fluid in the horizontal fissure
Natriuretic peptides
hormones produced by heart , heart stretched, myocytes release more ANP and BNP, cause natriuresis/ will pee out more.
New York Heart Association classification NYHA
Class I:No limitation of physical activity. Ordinary physical activity does not cause symptoms.
Class II: Mild. Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitations, or dyspnoea.
Class III: Moderate. Marked limitation of physical activity.
Class IV: Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.
Lifestyle Mx for heart failure
Decrease CVS risk
Stop smoking
Modify diet
Lost weight
exercise/rehab
vaccinations
- annual vaccination against influenza.
- once only vaccination against pneumococcal disease, but those with asplenia, splenic dysfunction or chronic kidney disease need a booster every 5 years
Chronic heart failure treatment
ABAL ACEi Betal blocker Eg bisoprolol Aldosterone antagonist eg spironolactone Loop diuretic
ACE-inhibitors and beta-blockers have no effect on mortality in
heart failure with preserved ejection fraction (diastolic HF)
