Heart Failure

Question 1

HF is a …. Not a disease

Answer 1

Syndrome

Question 2

Definition of HF?

Answer 2

Inability for heart to deliver O2 blood to tissues at satisfactory rate for tissues metabolic requirements

Question 3

What are the 2 types of heart failure?

Answer 3

Left sided
Right sided

Question 4

Left sided HF
What happens because of it?

Answer 4

Main cause
Left ventricle doesn’t pump efficiently, blood backs up in lungs, shortness of breath due to pulmonary oedema

Question 5

Right sided HF
What happens because of it?

Answer 5

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)

Question 6

Causes of HF?

Answer 6

IHD (main cause)
Cardiomyopathy (heart muscle weaker)
Valvular disease
Cor pulmonale
Anything increasing cardiac work (obesity, hypertension, pregnant, hyperthyroid, anemia, arrhythmias (eg. AF)

Question 7

Risk factors of HF

Answer 7

Age (65+)
Smoking
Male
Obese
History of MI
African descent

Question 8

Pathology of HF

Answer 8

Normally - high preload = high afterload = high CO by frank starling law
Failing hearts = low CO due to dysfunctional starlings law

1. Compensatory mechanism activates ; RAAS + sympathetic NS (temporarily until Increased BP) high aldosterone + ADH + adrenaline +NAd
2. 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

Question 9

What is heart failure affecting both left and right circuits called?

Answer 9

Congestive heart failure

Question 10

HF can be time classified as..

Answer 10

Acute or chronic

Question 11

What is the normal ejection fraction?

Answer 11

50-70%

Question 12

Preserved ejection fraction (>50%)

Answer 12

Diastolic failure (heart pump function is preserved)
Filling issue
Eg. Hypertrophic cardiomyopathy, LVH (aortic stenosis)

Question 13

Ejection fraction Reduced [<40%]

Answer 13

Systolic failure (heart pump fails)
Decreased CO due to pump issues
Eg. IHD - ischemic tissues

Question 14

Signs and symptoms of HF

Answer 14

3 cardinal non specific signs (SOBASFAT)
shortness of breath, ankle swelling, Fatigue

Orthopnia (dyspnoea worse lying flat)

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

Question 15

What is the NY heart association 1-4 of HF severity?

Answer 15

1. No limit on physical activity
2. Slight limit on moderate activity
3. Marked limit on moderate + general activity
4. Symptoms even at rest!

Question 16

How would you diagnose HF?

Answer 16

Bloods (BNP - brain natriuretic peptide) high >400g/mL - key marker = Released from stressed ventricles in response to increased mechanical stress, very high In HF patients

ECG = abnormal,

Chest x ray

ECHOcardiogram

Question 17

What do you look for in the chest x ray?

Answer 17

ABCDE
Alveolar oedema
B lines
Cardiomegaly
Dilated upper lobe vessels
pleural Effusion

Question 18

Treatments for HF?

Answer 18

Conservative = lifestyle changes (low BMI, exercise, stop smoking, alcohol)

Pharmacological =
1. ACE-i + BB for all patients
2. + spinonolactone , + furesomide (loop)
3. Consider cardiac resynchronization therapy (improves A-V coordination)

Surgery = consider revascularisation, valve surgery, heart transplant (last resort)