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HHD 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart failure?

A

it is a condition in which the heart is unable to generate a cardiac output sufficient to meet the demands of the body without increasing diastolic pressure (relaxation pressure; where the chambers are filling with blood)

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2
Q

Heart failure can result from…

A

any cardiac disease that compromise ventricular systolic of diastolic function or both

e.g. jugular vein distension, rhythm problem, valve problem

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3
Q

What are the wide range of clinical scenarios for heart failure?

A

breathlessness
oedema
tachycardia

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4
Q

How is heart failure classified?

A

classified by left ventricular ejection fraction

the amount of blood the left ventricle pumps out of the body with each heart beat

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5
Q

How much of the blood does the left ventricle empty itself of upon contraction?

A

the left ventricle empties itself of 50-60% of the blood it contains

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6
Q

Define the left ventricular ejection fraction

A

this is the percentage of the blood within the ventricle pumped out to the systemic circulation per heartbeat

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7
Q

What does the left ventricular ejection fraction measure?

A

it measures the pumping efficiency of the heart

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8
Q

How is the left ventricular ejection fraction percentage calculated?

A

Stroke volume (L)/end diastolic volume (L) x 100

end diastolic volume- volume in the chambers of the heart after diastole (relaxation)

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9
Q

What is the normal LVEF%?

A

50-65%

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10
Q

What is the LVEF% for heart failure with reduced ejection fraction?

A

<40%
here the heart is not ejecting much of the blood contained in the left ventricle

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11
Q

What is the LVEF% for heart failure with mildly reduced ejection fraction?

A

40-49%

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12
Q

What is the LVEF% for heart failure with preserved ejection fraction?

A

> 50%

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13
Q

What are the other methods of classifying heart failure?

A

side of heart (affected)
functional
symptoms
stage

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14
Q

What are the consequences of right hand side heart failure?

A

fluid collection
often leads to swollen ankles and lungs

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15
Q

Right side heart failure compromises ___________ whilst left side heart failure compromises ______________.

A

pulmonary flow
systemic flow

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16
Q

The New York Heart Association classes heart failure from I-IV. What does class I heart failure indicate?

A

indication of no limitation to any activity

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17
Q

The New York Heart Association classes heart failure from I-IV. What does class II heart failure indicate?

A

indication of a mild limitation, comfortable at rest

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18
Q

The New York Heart Association classes heart failure from I-IV. What does class III heart failure indicate?

A

marked limitation, only comfortable at rest

19
Q

The New York Heart Association classes heart failure from I-IV. What does class IV heart failure indicate?

A

symptoms occur at rest

20
Q

Heart failure can be classified by symptoms. The Framingham criteria attempts to this. Briefly explain the idea behind the framingham criteria

A

attempts to diagnose heart failure based on major and minor criteria
Major criteria include: cardiomegaly, hepatojugular reflux, acute pulmonary oedema, neck vein distension

Minor criteria include: ankle oedema, hepatomegaly, tachycardia, nocturnal cough, dyspnoea

21
Q

What is required for a definitive diagnosis of heart failure with the framingham criteria?

A

2 major criteria OR
1 major and 2 minor criteria

22
Q

Heart failure can be classified in stages. The American college of cardiology classes HF from stage A-D. What is stage A heart failure?

A

high risk but no functional/structural/symptoms

23
Q

Heart failure can be classified in stages. The American college of cardiology classes HF from stage A-D. What is stage B heart failure?

A

structural disease, no symptoms

24
Q

Heart failure can be classified in stages. The American college of cardiology classes HF from stage A-D. What is stage C heart failure?

A

structural disease with symptoms

25
Q

Heart failure can be classified in stages. The American college of cardiology classes HF from stage A-D. What is stage D heart failure?

A

advanced structural disease with symptoms

26
Q

What are common cause of of chronic heart failure?

A

coronary artery disease (e.g. angina)
hypertension
valvular disease
myocarditis (inflammation of the cardiac myocytes)- viral infection of muscle, can stop heart muscles from working

27
Q

What is the Frank- Starling Law?

A

this law states that the stroke volume increases in response to the end diastolic volume when all other factors remain constant

so stroke volume increases if the volume of the blood in the ventricles before contraction increases

If more blood is available in the ventricles, more blood will be pumped out of the ventricles

28
Q

What occurs in response to larger volumes of blood entering the ventricles?

A

the cardiac muscle stretches
this will as such lead to an increased force of contraction

sacromeres (unit of heart muscle contraction) may over stretched and become damages

29
Q

Briefly state the pathophysiology of heart failure

A

Myocardial insult ——> Myocardial remodelling—–> failure of frank-starling law —–> reduced cardiac output
—–> fluid retention and increased peripheral vascular resistance

failure of frank-starling law (stroke volume no longer increases with an increase in end diastolic volume)

30
Q

What occurs in systolic dysfunction ?

A

enlarged ventricles are filled with blood however the ventricles pump out <40-50% of the blood

31
Q

What occurs in diastolic dysfunction?

A

the stiff ventricles are filled with less blood than normal
the ventricles will pump out 60% of this (reduced) blood

32
Q

What does initial myocardial insult lead to?

A

over-expression of multiple peptides and neurohormonal activation

left ventricular remodelling

33
Q

What are the markers of left ventricular hypertrophy ? What does this lead to?

A

loss of myocytes
interstitial fibrosis

this leads to stretched and stiff myocardium
Sacromeres are over-stretched (leads to stiffness of the myocardium)

34
Q

Cardiac remodelling eventually leads to the failure of __________.

A

frank-starling curve - essentially LV is unable to pump as much blood as required out
[stroke volume increases with increased end diastolic volume if all other factors remain the same]

35
Q

Reduced stroke volume is a result of the failure of …?

A

diastole, systole or both

36
Q

Further strain of remodelled cardiac muscle leads to …

A

increased ischaemia
(loss of oxygen)

37
Q

What are the consequences of reduced cardiac output?

A

Fall in mean arterial pressure (diastole+systole) leads to sympathetic activity causing systemic vasoconstriction and increased peripheral vascular resistance

ADH released (reduced cardiac output would initially cause hypovolaemia which causes compensatory ADH mechanism?) due to sympathetic activity, leads to water retention at collecting ducts increasing blood volume

RAAS activated leading to periphera vasoconstriction (angiotensin II) and Na+/H2O retention (aldosterone)

Skeletal muscle atrophy

38
Q

What is the presentation of heart failure?

A

dyspnoea
neck vein distention
S3 gallop ?
cardiomegaly
hepatojugular reflex
basal crackles
orthpnoea
PND (paroxymal nocturnal dyspnoea) - sudden shortness of breath that comes shortly after falling asleep

Tachycardia
chest pain
ankle oedema
night cough
fatigue/muscle weakness
palpitations
syncope
confusion

(minor criteria)

39
Q

What are the strong risk factors for heart failure?

A

diabetes
myocardial infarction
dyslipidaemia
age
male
hypertension
cocaine abuse

40
Q

What are the weak risk factors for heart failure ?

A

low socio economic status
smoking
alcohol
obesity
coffee

41
Q

What investigations are carried out to diagnose heart failure?

A

Echocardiogram**
Electrocardiogram
chest xray
B-type natriuretic peptide
Serum: FBC, U&Es (urea and electrolytes), glucose, lipids, TFTs(thyroid functional test), LFTs (liver functional tests)
exercise test
cardiac MRI

42
Q

What is the medication often prescribed for heart failure?

A

ACEi
beta- blockers
diuretics (combat fluid build up)
digoxin
ivabradine
aldosterone antagonist (RAAS)

43
Q

What is the management of heart failure?

A

medication
lifestyle changes
implantable caridac defibrillator
heart transplant
pacemaker

44
Q

What are the dental considerations of patients with heart failure?

A

polypharmacy
dry mouth (diuretics)
anticoagulants - increased bleeding risk
poor healing
increased risk of infections
oxygen requirement
reduced exercise tolerance- carefully plan procedures in combination with cardiology team including heart failure nurses

DO NOT LIE PATIENT FLAT

HHD 2 (37 decks)

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