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Life support > Heart failure > Flashcards

Heart failure Flashcards

1
Q

What is the definition of heart failure?

A

Clinical syndrome that can result from structural or functional cardiac disorder that impairs the ability of the heart to fill or eject blood so that there is insufficient blood flow to meet the body’s needs

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2
Q

What are the 2 types of chronic heart failure?

A

-Heart failure with reduced ejection fraction (HFrEF) or Systolic HF
-Heart Failure with preserved ejection fraction (HFpEF) or Diastolic HF

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3
Q

What is Class 1 of heart failure?

A

No limitations. ordinary physical activity does not cause fatigue, breathlessness oor palpitation

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4
Q

What is class 2 of heart failure?

A

Slight limitation of physical activity. Such patients are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, breathlessness or angine pectoris

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5
Q

What is class 3 of heart failure?

A

Marked limitation of physical activity. Although patients are comfortable at rest, less than ordinary physical activity will lead to symptoms

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6
Q

What is class 4 of heart failure?

A

Inability to carry on any physical activity without discomfort. Symptoms of congestive cardiac failure are present even at rest. With any physical activity increased discomfort is experienced

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7
Q

What is diastolic HF(HFpEF)?

A

Ventricle unable to adequately relax
and fill at normal diastolic
pressures/volumes
to maintain stroke volume
Pressure-overload in ventricles
e.g. hypertension, aortic stenosis

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8
Q

What is systolic HF(HFrEF)?

A

Inability of heart to maintain
contractility producing reduction
in ejection fraction and stroke volume
Volume-overload in ventricles
e.g. MI, IHD

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9
Q

What are symptoms of heart failure?

A

Nocturnal dyspnoea
Dyspnoea on exertion
Orthopnoea
Rales/lung crackles
Acute pulmonary oedema
Neck vein distension
Increased venous pressure
Cardiomegaly
Cough
Ankle oedema
Renal dysfunction

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10
Q

What is the equation for prevelance?

A

Prevalence = Incidence x Duration

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11
Q

What are the 5 causes of heart failure?

A
  1. Impaired ventricular function (Reduced pump function)
    Myocardial infarction or cardiomyopathy
  2. Pressure overload of ventricle (increased afterload)
    Systemic or pulmonary hypertension
  3. Inflow obstruction of ventricle (Reduced filling)
    Restrictive cardiomyopathy
    Mitral stenosis
    Diastolic HF
  4. Valvular disease
    Aortic, Mitral or Tricuspid stenosis/regurgitation
  5. Volume overload of ventricle
    Ventricular and Atrial Septal defect (VSD and ASD)
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12
Q

What are the 3 stages in the onset and development of heart failure?

A

Stage 1 : Insult or stimulus
Myocardium injury / Increase chronic pressure load etc.
Decrease Contractility (pumping capacity)
Stage 2 : Compensated dysfunction
Initial preserved function
Myocardial hypertrophy and chamber dilatation
Moderate symptoms and treatment
Stage 3 : Decompensated overt failure
Gross change in heart shape - wall thinning, spherical, dilatation
Significant morbidity and mortality
Hospitalisations

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13
Q

What does a drop in stroke volume through ventricular failure lead to?

A

A drop in stroke volume through ventricular failure leads to
compensatory mechanisms to maintain cardiac output

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14
Q

What is the neurohormonal model for ventricular failure?

A

Memorise slide from ppt

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15
Q

What are problems with excessive increase in neurohormonal compensation?

A

excessive increase in neurohormonal compensation leads to
changes in O2 demand and long term changes to the heart

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16
Q

What are the effects of prolonged compensatory mechanism?

A
  1. Continuous sympathetic activaation
  2. Increased heart rate
  3. Increased preload
  4. Increased total peripheral resistance
  5. Continuous neurohumoral activation
17
Q

Why is continuous sympathetic activation negative?

A

β-adrenergic downregulation and desensitization
(less contractility/inotropic response)

18
Q

Why is increased heart rate a negative compensatory mechanism in the long run?

A

Increased metabolic demands and myocardial cell death

19
Q

Why is increased preload a negative compensatory mechanism in the long run?

A

Beyond limits of Starling’s law, pressure is transmitted to pulmonary vasculature leading to pulmonary oedema

20
Q

Why is increased total peripheral resistance a negative compensatory mechanism in the long run?

A

Higher afterload leading to decreased SV/CO

21
Q

Why is continuous neurohumoral activation a negative compensatory mechanism in the long run?

A

Chronically elevated RAAS, Ang II and aldosterone trigger inflammatory responses (cytokines - activate macrophages, fibroblasts) resulting in myocardial remodelling

22
Q

In diastolic HF, what type of hypertrophy occurs and therefore what happens to the heart and its muscles?

A

-Concentric hypertrophy
Hearts have thick walls and small cavities
-Sarcomeres added in parallel increase myocyte cell width

23
Q

In systolic HF, what type of hypertrophy occurs and therefore what happens to the heart and its muscles?

A

-Eccentric hypertrophy
Hearts have thin walls and large cavities
-Sarcomeres added in series increase myocyte cell length

24
Q

What is the diagnostic algorithm for heart failure?

A
  1. Heart failure suspected
  2. Request NT-proBNP test
    -Sensitive test for heart failure so won’t miss any cases
    -But its non specific as its also present with AF, hypertension
  3. If BNP is normal then look for other causes of breathlessness
  4. If BNP is elevated, carry out an echo to confirm/refute. This is the gold standard test and will also confirm caused such as valvular, IHD, hypertensive etc.
25
Q

What are the goals in the treatment of heart failure?

A

-Improve prognosis – reduce mortality
-Reduce morbidity – relieve symptoms, decrease frequency and length of
stay of hospital admissions
-Prevent cardiac and other end-organ damage
-Manage comorbidities - may contribute to pathogenesis of HF

26
Q

What is the rationale behind the treatment for heart failure?

A

-Reduce myocardial O2 demands and increase stroke volume
-Reduce cardiac dilation
-Prevent arrhythmias
-Improve myocardial contractility

27
Q

What are ways to reduce myocardial O2 demands and increase stroke volume in heart failure?

A

Surgical, e.g. valve replacement, coronary artery stents
Pharmacological – reduce preload, afterload, e.g. ACEi/ARBs

28
Q

What are ways to reduce cardiac dilation in heart failure?

A

reduce blood volume to reduce preload, e.g.
diuretics and prevent/reverse remodelling, e.g. ACEi/ARBs

29
Q

What are the ways to prevent arrhythmias in the treatment of heart failure?

A

reduce sympathetic nervous system activity,
e.g. β-blockers

30
Q

What are the ways to improve myocardial contractility in heart failure?

A

β-blockers

31
Q

What are pharmacological interventions for heart failure to reduce symptoms?

A

Loop diuretics : Reduce symptoms

32
Q

What are frontline pharmacological interventions for heart failure according to NICE guidelines?

A

ACEi/ARB : measure urea, creatinine, electrolytes, GFR
β-blockers : start [low], measure heart rate, blood pressure

33
Q

What are second line pharmacological intervention for heart failure according to NICE guidelines?

A

Life support (38 decks)

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