Heart Failure Flashcards
(21 cards)
Definition of HF?
Inability for heart to deliver O2 blood to tissues at satisfactory rate for tissues metabolic requirements
What are the 2 types of heart failure?
Left sided
Right sided
Left sided HF
What happens because of it?
Most common
Left ventricle doesn’t pump efficiently, blood backs up in lungs, shortness of breath due to pulmonary oedema
Right sided HF
What happens because of it?
RV pumps blood to lungs, normally triggered by LHF (accum of blood in lungs means RV works harder - causing it to fail)
Due to disease of lungs + / pulmonary vessels
Peripheral oedema = systemic backlog (around feet ankles)
Causes of HF?
IHD/MI (main cause)
Cardiomyopathy (heart muscle weaker)
Valvular disease
Cor pulmonale
Anything increasing cardiac work (obesity, hypertension, pregnant, hyperthyroid, anemia, arrhythmias (eg. AF)
Risk factors of HF
Age (65+)
Smoking
Male
Obese
History of MI
African descent
Pathology of HF
Normally - high preload = high afterload = high CO by frank starling law
Failing hearts = low CO due to dysfunctional starlings law
- Compensatory mechanism activates ; RAAS + sympathetic NS (temporarily until Increased BP) high aldosterone + ADH + adrenaline +NAd
- Soon compensation fails and heart undergoes cardiac remodeling (low CO) in response to compensation
Heart less well adapted to function therefore increased RAAS and SNS will exacerbate fluid overload
What is heart failure affecting both left and right circuits called?
Congestive heart failure
HF can be time classified as..
Acute or chronic
What is the normal ejection fraction?
50-70%
Preserved ejection fraction (>50%)
cause?
Diastolic failure (heart pump function is preserved)
Filling issue
Eg. Hypertrophic cardiomyopathy, LVH (aortic stenosis), cardiac tamponade
What is HF with an ejection fraction of 41-49% called?
mildly reduced ejection fraction
Ejection fraction Reduced [<40%]
Cause?
Systolic failure (heart pump fails)
Decreased CO due to pump issues
Eg. IHD - ischemic tissues, myocarditis, dilated cardiomyopathy
Signs and symptoms of HF
3 cardinal non specific signs (SOBASFAT)
shortness of breath - exertion, PND
Ankle swelling
Fatigue
Orthopnia (dyspnoea worse lying flat)
cough + oedema (peripheral or pulmonary = due to back flow from reduced CO, cough with pink frothy sputum)
Bibasal crackles (pul oedema)
3rd and 4th heart sounds
Increased jugular venous pressure (JVP)
Hypotensive and tachycardia, cyanosis
Hepatomegaly + ascites
What is the NY heart association 1-4 of HF severity?
- No limit on physical activity - ASx
- Slight limit on moderate activity - mild Sx
- Marked limit on moderate + general activity - comfortable at rest
- Symptoms even at rest! - severe limitation of ADL - bed bound commonly
How would you diagnose HF?
- Bloods - FBC, NT-Pro BNP
(BNP - brain natriuretic peptide) high >400g/mL - key marker = Released from stressed ventricles in response to increased mechanical stress, very high In HF patients
<400 = HF unlikely
400-2000 = specialist referral + ECHO 6wks or less
2000+ = specialist referral + ECHO 2 or less wks
ECG = abnormal,
GS = ECHOcardiogram
chest xray
What do you look for in the chest x ray in heart failure?
ABCDE
Alveolar oedema
B lines
Cardiomegaly
Dilated upper lobe vessels
pleural Effusion (blunted costophrenic angles)
Treatments for chronic HF?
conservative management
Conservative = lifestyle changes (low BMI, exercise, stop smoking, alcohol)
Cardiac rehab
annual flu vaccine + one off pneumococcal
Treatments for chronic HF?
pharmacological management
- ACE-i + BB (proven to increase life expectancy)
- Aldosterone antagonist (spironolactone/eplerenone)
- SGLT2-i
what can be given as Sx relief in Heart failure?
what dose?
Furosemide 40mg OD
Tx for acute heart failure?
Naughty SOD
what else would you consider depending on BP?
No more fluid (stop only IV)
Sit Px up
O2 (if hypoxic)
Diurese (furosemide IV 40mg stat)
+ consider:
Ionotropes if sys BP <100
Nitrate infusion BP >100
CPAP
