Heart failure Flashcards
What is the definition for heart failure
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
What are the main causes for heart failure
Ischaemic heart disease
Dilated cardiomyopathy
Hypertension
What are other causes for Heart failure
Other forms of Cardiomyopathy
Pericardial disease
Arrhythmias
Valvular disease
Alcohol
Diabetes
Congenital heart disease
What is ejection fraction
percentage of blood that is pumped out of the heart during each beat (SV/EDV(end diastolic volume) x 100)
What are the types of heart failure
Heart failure with reduced ejection fraction
Heart failure with preserved left ventricular ejection fraction
Left sided heart failure
Right sided heart failure
What is the ejection fraction % for HF with reduced ejection fraction
<40%
How does reduced ejection fraction HF occurs
Reduced contractility->systolic ventricular dysfunction->decreased LVEF (Left ventricular ejection fraction)->decreased cardiac output
What is HF with reduced ejection fraction commonly caused by
Ischaemic heart disease
Valvular heart disease
Hypertension
What is HF with preserved left ventricular ejection fraction
Consisting of symptoms and signs of heart failure with an ejection fraction of >50&
How does HF with preserved left ventricular ejection occurs
Decreased ventricular compliance->diastolic ventricular dysfunction->reduced ventricular filling and increased diastolic pressure->decreased cardiac output
What are the causes for HF with preserved left ventricular ejection fraction
Increased stiffness of ventricle
Impaired relaxation of ventricle
What are the 2 types of Left-side heart failure
Heart failure with reduced ejection fraction (HFrEF)
heart failure with preserved ejection fraction (HFpEF)
What 2 things can lead to left-side heart failure
Increased left ventricular after load
Increased left ventricular preload
How does increased left ventricular after load lead to left-sided HF
It increases the mean aortic pressure (e.g. arterial hypertension) or by outflow obstruction (e.g. aortic stenosis)
How does increased left ventricular preload lead to left-sided HF
left ventricular volume overload (e.g. back flow into the left ventricle caused by aortic insufficiency)
What can cause right-sided HF
Increased right ventricular after load - increased pulmonary artery pressure
Increased right ventricular preload - right ventricular volume overload
What are the bodies compensation mechanisms
Increased adrenergic activity
Increase of RAAS (renin-angiotensin-aldosterone system)
Increased angiotensin 2 secretion
Increased aldosterone secretion
Secretion of BNP
What does increased adrenergic activity lead to
Increased heart rate, blood pressure and ventricular contractility
What is increased RAAS activated by
activated following decrease in renal perfusion secondary to reduction of stroke volume and cardiac output
What does increased angiotensin 2 secretion result in
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
What does increased aldosterone secretion result in
Increased renal N+ and H2O resorption which increases preload
What is BNP secreted in response to
secreted by the ventricles in response to increased myocardial wall stress, works to decrease blood pressure
What is the forward failure
Reduced cardiac output results in poor organ perfusion leading to organ dysfunction
What does backward failure in the left ventricle lead to
increased left ventricular pressure leads to backup of blood into the lung, increasing pulmonary capillary pressure which causes pulmonary oedema
what is the effect of backwards failure on the right ventricle
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
Is biventricular HF of left and right side more likely than isolated failure of one ventricle?
Biventricular HF is more likely
What are symptoms of heart failure
Exertional dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea
Fatigue
What are signs of heart failure
Tachycardia
Elevated jugular venous pressure
Cardiomegaly
Third and fourth heart sounds
Bi-basal crackles
Pleural effusion
Peripheral ankle oedema
Ascites
Tender hepatomegaly
What is class 1 HF (NYHA classification)
No limitation of physical activity
Activity doesn’t cause SOB
What is class 2 HF (NYHA classification)
Slight limitation of physical activity
comfortable at rest but normal activity causes SOB
What is class 3 HF (NYHA classification)
Marked limitation oh physical activity
Comfortable at rest but less than normal activity causes SOB
What is class 4 HF (NYHA classification)
Unable to carry out any activity without symptoms can be symptomatic at rest
What is the first line of testing for HF
ECG
CXR
Natriuretic peptides
What do you do if the first line of testing is abnormal
Enchocardiography
What do you do if the Enchocardiograph is abnormal
Asses aetiology
Precipitation factors
Type of cardiac dysfunction
Additional diagnostic tests
What may be additional diagnostic tests
Angiogram
MRI
What are the general measures to manage HF
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
What is the management of HFpEF
Loop diuretic e.g. furosemide to relieve symptoms of fluid overload
Manage cause/precipitating factors
What is the management for HFrEF
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
What are the other odd treatments for HFrEF if symptoms are not controlled
Sacubitril/valsartan - stop ACEi/ARB, continue beta-blocker and spironolactone
Ivabradine - sinus rhythm >75 bpm
Digoxin
Hydralazine + nitrates
What is the management of acute HF presentation
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
What can be the complications of HF
Arrhythmia - most commonly AF and ventricular
Depression
Cachexia - ongoing muscle loss
Chronic kidney disease
Sudden cardiac death
