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Cardio Vascular Year 1 > Heart failure > Flashcards

Heart failure Flashcards

1
Q

What is the definition for heart failure

A

Can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support physiological circulation

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2
Q

What are the main causes for heart failure

A

Ischaemic heart disease
Dilated cardiomyopathy
Hypertension

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3
Q

What are other causes for Heart failure

A

Other forms of Cardiomyopathy
Pericardial disease
Arrhythmias
Valvular disease
Alcohol
Diabetes
Congenital heart disease

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4
Q

What is ejection fraction

A

percentage of blood that is pumped out of the heart during each beat (SV/EDV(end diastolic volume) x 100)

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5
Q

What are the types of heart failure

A

Heart failure with reduced ejection fraction
Heart failure with preserved left ventricular ejection fraction
Left sided heart failure
Right sided heart failure

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6
Q

What is the ejection fraction % for HF with reduced ejection fraction

A

<40%

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7
Q

How does reduced ejection fraction HF occurs

A

Reduced contractility->systolic ventricular dysfunction->decreased LVEF (Left ventricular ejection fraction)->decreased cardiac output

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8
Q

What is HF with reduced ejection fraction commonly caused by

A

Ischaemic heart disease
Valvular heart disease
Hypertension

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9
Q

What is HF with preserved left ventricular ejection fraction

A

Consisting of symptoms and signs of heart failure with an ejection fraction of >50&

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10
Q

How does HF with preserved left ventricular ejection occurs

A

Decreased ventricular compliance->diastolic ventricular dysfunction->reduced ventricular filling and increased diastolic pressure->decreased cardiac output

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11
Q

What are the causes for HF with preserved left ventricular ejection fraction

A

Increased stiffness of ventricle
Impaired relaxation of ventricle

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12
Q

What are the 2 types of Left-side heart failure

A

Heart failure with reduced ejection fraction (HFrEF)
heart failure with preserved ejection fraction (HFpEF)

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13
Q

What 2 things can lead to left-side heart failure

A

Increased left ventricular after load
Increased left ventricular preload

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14
Q

How does increased left ventricular after load lead to left-sided HF

A

It increases the mean aortic pressure (e.g. arterial hypertension) or by outflow obstruction (e.g. aortic stenosis)

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15
Q

How does increased left ventricular preload lead to left-sided HF

A

left ventricular volume overload (e.g. back flow into the left ventricle caused by aortic insufficiency)

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16
Q

What can cause right-sided HF

A

Increased right ventricular after load - increased pulmonary artery pressure
Increased right ventricular preload - right ventricular volume overload

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17
Q

What are the bodies compensation mechanisms

A

Increased adrenergic activity
Increase of RAAS (renin-angiotensin-aldosterone system)
Increased angiotensin 2 secretion
Increased aldosterone secretion
Secretion of BNP

18
Q

What does increased adrenergic activity lead to

A

Increased heart rate, blood pressure and ventricular contractility

19
Q

What is increased RAAS activated by

A

activated following decrease in renal perfusion secondary to reduction of stroke volume and cardiac output

20
Q

What does increased angiotensin 2 secretion result in

A

Peripheral vasoconstriction which increases systemic BP which increases after load
Vasoconstriction of the efferent arterioles which decreases renal blood flow and increases intraglomerular pressure which maintains GFR

21
Q

What does increased aldosterone secretion result in

A

Increased renal N+ and H2O resorption which increases preload

22
Q

What is BNP secreted in response to

A

secreted by the ventricles in response to increased myocardial wall stress, works to decrease blood pressure

23
Q

What is the forward failure

A

Reduced cardiac output results in poor organ perfusion leading to organ dysfunction

24
Q

What does backward failure in the left ventricle lead to

A

increased left ventricular pressure leads to backup of blood into the lung, increasing pulmonary capillary pressure which causes pulmonary oedema

25
Q

what is the effect of backwards failure on the right ventricle

A

Increased pulmonary artery pressure from left ventricular failure decreases right sided cardiac output resulting in systemic venous congestion which produces peripheral oedema and progressive congestion of internal organs

26
Q

Is biventricular HF of left and right side more likely than isolated failure of one ventricle?

A

Biventricular HF is more likely

27
Q

What are symptoms of heart failure

A

Exertional dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea
Fatigue

28
Q

What are signs of heart failure

A

Tachycardia
Elevated jugular venous pressure
Cardiomegaly
Third and fourth heart sounds
Bi-basal crackles
Pleural effusion
Peripheral ankle oedema
Ascites
Tender hepatomegaly

29
Q

What is class 1 HF (NYHA classification)

A

No limitation of physical activity
Activity doesn’t cause SOB

30
Q

What is class 2 HF (NYHA classification)

A

Slight limitation of physical activity
comfortable at rest but normal activity causes SOB

31
Q

What is class 3 HF (NYHA classification)

A

Marked limitation oh physical activity
Comfortable at rest but less than normal activity causes SOB

32
Q

What is class 4 HF (NYHA classification)

A

Unable to carry out any activity without symptoms can be symptomatic at rest

33
Q

What is the first line of testing for HF

A

ECG
CXR
Natriuretic peptides

34
Q

What do you do if the first line of testing is abnormal

A

Enchocardiography

35
Q

What do you do if the Enchocardiograph is abnormal

A

Asses aetiology
Precipitation factors
Type of cardiac dysfunction
Additional diagnostic tests

36
Q

What may be additional diagnostic tests

A

Angiogram
MRI

37
Q

What are the general measures to manage HF

A

Education
Dietary modification
Smoking cessation
Alcohol reduction
Low intensity exercise
Keep vaccines up to date
Lorry/Bus drivers need to notify DVLA
Consider anti platelet and Statin

38
Q

What is the management of HFpEF

A

Loop diuretic e.g. furosemide to relieve symptoms of fluid overload
Manage cause/precipitating factors

39
Q

What is the management for HFrEF

A

ABAL:
ACE inhibitor (e.g. ramipril)
Beta blocker (e.g. bisoprolol)
Aldosterone antagonist when symptoms not controlled with A and B (spironolactone or eplerenone)
Loop diuretics improve symptoms

40
Q

What are the other odd treatments for HFrEF if symptoms are not controlled

A

Sacubitril/valsartan - stop ACEi/ARB, continue beta-blocker and spironolactone
Ivabradine - sinus rhythm >75 bpm
Digoxin
Hydralazine + nitrates

41
Q

What is the management of acute HF presentation

A

LMNOP:
Lasix (furosemide) IV
Morphine IV
Nitrates - sublingual or oral
Oxygen
Position - sit patient up
Treat cause of decompensation (MI, arrhythmia, myocarditis)
Beta-blocker contraindicated

42
Q

What can be the complications of HF

A

Arrhythmia - most commonly AF and ventricular
Depression
Cachexia - ongoing muscle loss
Chronic kidney disease
Sudden cardiac death

Cardio Vascular Year 1 (23 decks)

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