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HLB > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Life Expectancy from heart failure diagnosis:

A
  • 5 year mortality: 50%
  • <1 year for advanced HF
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2
Q

3 Clinical Syndromes of Heart Failure:

A
  • chronic heart failure: peripheral oedema
  • acute heart failure: pulmonary oedema
  • cardiogenic shock: low BP <90mmHg
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3
Q

LV systolic heart failure:

A
  • LV weakness +- dilation/thinning
  • due to:
    - IHD (acute MI or chronic ischaemia) c.70%
    - Hypertension
    - Inherited (autosomal dominant)
    - Alcohol excess
    - Post viral
    - Toxins (eg chemotherapy drugs)
    - Metabolic (eg hypothyroid, iron overload,
    thiamine deficiency)
    - Unknown cause (‘idiopathic’)
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4
Q

How can we measure LV function:

A
  • no single perfect measure
  • LV function depends on loading: preload = venous
    return, afterload = blood pressure)
  • LV contractility measurement should be independent
    of loading: isovolumic dP/dt, end-systolic elastance (
    difficult to measure)
  • LV ejection fraction
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5
Q

Ejection fraction =
Stoke Volume =

A

stroke volume/ end-diastolic volume
end-diastolic volume - end-systolic volume

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6
Q

Systolic Heart Failure - Haemodynamics:

A
  • decreased LV contractility (WEAK): reduced stroke
    volume
  • increased LV diastolic pressure
  • increased LV end diastolic volume (DILATED)
  • reduced LV ejection fraction: systolic heart failure =
    Left ventricular ejection fraction <40%, normal LVEF = 55-70%
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7
Q

Signs and symptoms of systolic heart failure occur at what %

A

<40% of left ventricular ejection fraction

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8
Q

Heart Failure pathophysiology:

A

insert
right and left sided heart failure can occur independently

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9
Q

Heart Failure Symptoms:

A
  • breathlessness: exertional, orthopnoea, paroxysmal
    nocturnal dysponea
  • fatigue
  • leg swelling
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10
Q

How do we classify heart failure?

A
  • NYHA, New York Heart Association severity
    classification
  • class 1 = asymptomatic
  • class 2 = mild symptoms with day to day activities
  • class 3 = moderate symptoms with minor exertion
  • class 4 = symptoms at rest
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11
Q

The patient with heart failure diagram

A

insert

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12
Q

Signs of Heart Failure:

A
  • elevated JVP = right atrial pressure
  • oedema: ankles, shins, thighs, genitals, trunk, ascites,
    pleural effusion
  • Lung Crackles (Inspiration, Bases):
    - low volume pulse, low BP
    - tachycardia, increased RR
    - displaced apex beat
    - murmur (functional MR (mitral regurgitation)
    - liver enlargement (hepatomegaly) (tender right
    quadrant) (mildly low liver function)
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13
Q

Ascites

A

swelling in abdomen

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14
Q

Heart Failure Investigations:

A
  • ECG
  • BNP = brain natriuretic peptide
  • echocardiogram
  • cardiac MRI
  • cardiac catherterisation
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15
Q

ECG in heart failure:

A
  • rarely normal in patients with heart failure
  • tall complexes = LV hypertrophy
  • broad complexes = left bundle branch block
  • T wave inversion
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16
Q

BNP in heart failure:

A
  • brain natriuretic peptide (blood test)
  • released by the left atrium (LA), in response to
    increased LA pressure
  • sensitive for HF, therefore used as a screening test
  • not specific
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17
Q

Investigations 1 diagram

A

insert

18
Q

Echocardiogram in heart failure:

A
  • LV dimensions/functions
  • LV ejection fraction
  • estimate intra-cardiac pressuresnnbfb
19
Q

Cardiac MRI in heart failure:

A
  • LV dimensions/function
  • LV ejection fraction
  • characterise myocardial pathology
20
Q

Cardiac Catheterisation:

A
  • LV dimensions/function
  • direct measurement of intra-cardiac
    pressures
  • coronary angiography
21
Q

Left Sided Heart Failure:

A
  • acute presentation (MI)
  • elevated left heart pressures transmitted
    back to the pulmonary capillaries
  • pulmonary oedema occurs when
    pulmonary capillary pressure >25mmHg,
    serum albumin = c.25g/L
  • in the most extreme cases, unable to
    maintain cardiac output: CARDIOGENIC
    SHOCK:
    - cold, clammy
    - thready pulse
    - SBP <90mmHg
22
Q

Right Heart Failure Mechanisms:

A

insert diagram
- decreased left ventricular contractility,
which increases PA pressure, which
increases RV pressure, which increases RA
pressure leading to peripheral oedema

23
Q

Left Heart Failure Mechanisms:

A

insert diagram
- decreased LV contractility, which increases
left ventricular end diastolic pressure,
which increases left atrial pressure
- which increases pulmonary venous
pressure

24
Q

Right Sided Heart Failure:

A
  • chronic presentation
  • most commonly due to left hearted
    disease
  • elevated left heart pressures BUT
  • LA dilates and LA/PV pressure <25mmHg
  • pressure transmitted back to
    PA,RV,RA,SVC/IVC:
    - elevated JVP
    - leg oedema
    - pleural effusion/ ascites
25
Q

Cor Pulmonale:

  • is
  • caused by
  • results in
A
  • right sided heart failure due to chronic lung
    disease
  • many causes: COPD, lung fibrosis,
    pulmonary hypertension
  • elevated pulmonary artery pressures
  • pressure transmitted back to RV, RA,
    SVC/IVC: high JVP, leg oedema, pleural
    effusions/ ascites
26
Q

Preload diagram

A

insert
- preload is important, degree of preload is
important to make sure the heart is
stretched enough
- but if preload is too high, increases cardiac
output because increased venous return to
the heart

27
Q

Renin-Angiotensin-Aldosterone System

A

insert diagram

28
Q

Neuro-endocrine activation in heart failure:

  • low cardiac output activates
  • mechanisms
  • results/consequences
A
  • low cardiac output activates:
  • RAAS
  • Reduced renal perfusion
  • by multiple mechanisms:
    • low BP
    • low NaCl delivery to kidneys (macula
      densa cells in the DCT)
    • sympathetic division
  • increases preload, increased cardiac
    output but
  • oedema/ascites/pleural effusion
  • increased afterload: angiotensin mediated
    vasoconstriction
29
Q

RAAS activation diagram

A

insert

30
Q

RAAS activation 2 diagram

A

insert

31
Q

Sympathetic Activation in the heart:

A

insert
- sympathetic activation is meant to restore
the patient back to normal
- if over activated , heart becomes weak and
tired
- increases heart rate (beta 1 receptors
activated) and hence increases contractile
force
- short term: increases cardiac output
- long term: worsens heart failure (flogging a
dead horse)

32
Q

Diastolic Heart Failure:

A
  • due to prolonged sympathetic activation
  • heart failure but LV systolic function is
    GOOD: HFpEF = heart failure with
    preserved ejection fraction
  • chronic heart failure syndrome but:
    - normal LV volume
    - LV ejection fraction >40%
  • due to increased LV stiffness, hence
    reduced compliance
  • causes same cascade of increased
    pressures
  • LV dilation
33
Q

Sympathetic activation and the arterial system:

A
  • vasoconstriction (alpha 1)
  • increases systemic vascular resistance
    (SVR)
  • increases afterload
  • in the short term: maintains arterial blood
    pressure
  • long term: increases workload on already
    weakened heart (making dying horse run
    uphill)
34
Q

Diastolic Heart Failure Mechanisms:

A
  • insert
  • LV stiffness increases, increases LA
    pressure, which increases pulmonary
    venous pressure causing pulmonary
    oedema, if prolonged can increase pressure on RV, RA, PA
35
Q

Therapeutic targets of chronic heart failure:

A
  • fluid retention: loop diuretic (furosemide)
  • angiotensin II production: ACE inhibitor
    (ramipril)
  • Angiotensin II receptors: Angiotensin
    receptor inhibitor
    (Losarten)
  • Aldosterone antagonists: Spironolactone
  • Sympathetic system: beta blockers
    (bisprolol)
36
Q

LV diastolic failure is commonly seen in

A

elderly patients
hypertension, diabetes, atrial fibrillation

37
Q

LV diastolic heart failure is classified as a ——– cardiomyopathy

A

restrictive

38
Q

LV diastolic heart failure aetiology:

A
  • amyloid heart disease
  • sarcoidosis
  • severe LV hypertrophy: hypertension,
    hypertrophic cardiomyopathy
39
Q

Chronic heart failure: advanced therapeutics: Fluid Retention:

A
  • Dapaglifozin:
  • SGLT-2 inhibitors
  • reduces glucose reabsorption in the kidney
  • osmotic diuresis
  • Neprilysin inhibitors:
  • sacubatril usually used with an angiotensin
    antagonist (Valsartan)
  • I(small f) inhibitor: Ivabradine
40
Q

Acute Heart Failure Management:

A

PODMAN
INSERT SLIDE

HLB (49 decks)

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