Heart failure Flashcards
Question: What is heart failure?
Answer: Heart failure is a complex syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a physiological circulation.
Question: What are the two main causes of chronic heart failure?
Answer: Chronic heart failure can be caused by either impaired left ventricular contraction (systolic heart failure) or left ventricular relaxation (diastolic heart failure).
Question: What are the main causes of heart failure?
Answer: The main causes of heart failure include ischaemic heart disease, dilated cardiomyopathy, and hypertension. Other causes include other forms of cardiomyopathy, valvular disease, arrhythmias, pericardial disease, infections, alcohol, diabetes, and congenital heart disease.
Question: What is ejection fraction?
Answer: Ejection fraction refers to the percentage of blood that is pumped out of the heart during each beat.
- It is calculated as stroke volume divided by end-diastolic volume, multiplied by 100.
Question: What is heart failure with reduced ejection fraction?
Answer: Heart failure with reduced ejection fraction is characterized by an ejection fraction less than 40%. It is caused by reduced contractility, commonly due to ischaemic heart disease, but can also occur with valvular heart disease and hypertension.
Question: What happens to contractility and preload in heart failure with low stroke volume or low ejection fraction?
Answer:
- contractility is reduced, and preload is increased due to conditions such as
- anterior or lateral myocardial infarction,
- dilated cardiomyopathy,
- mitral regurgitation, and
- aortic regurgitation.
Question: What is heart failure with preserved left ventricular ejection fraction?
Answer: Heart failure with preserved left ventricular ejection fraction is characterized by symptoms and signs of heart failure with an ejection fraction greater than 50%. It is caused by decreased ventricular compliance, leading to diastolic ventricular dysfunction, reduced ventricular filling, increased diastolic pressure, and decreased cardiac output.
Question: What happens to contractility and preload in diastolic heart failure or heart failure with preserved ejection fraction?
Answer:
- contractility may be normal, but preload is decreased due to conditions such as myocardial infarction, restrictive cardiomyopathy, and constrictive pericarditis.
- Afterload may also increase due to hypertension, aortic stenosis, coarctation of the aorta, or hypertrophic obstructive cardiomyopathy.
Question: What are the symptoms of left-sided heart failure?
Answer:
- dyspnoea (shortness of breath), dry cough,
- orthopnoea (needing to prop up with pillows while lying down),
- paroxysmal nocturnal dyspnoea (PND) sudden awakening from sleep with difficulty breathing, fatigue, and
- inspiratory rales or crackles (abnormal lung sounds).
Question: What are the symptoms of right-sided heart failure?
Answer:
- raised jugular venous distention,
- hepatomegaly,
- ascites,
- splenomegaly,
- abdominal pain,
- peripheral oedema (swelling in the lower extremities), and
- cool, pale, sweaty, and clammy extremities.
Question: What is high-output cardiac heart failure?
Answer:
usually occurs due to an increased demand for cardiac output, such as in
* severe anaemia,
- thyrotoxicosis,
- arteriovenous fistula,
- beriberi,
- severe systemic arteriovenous shunting.
Question: What are the compensation mechanisms in heart failure?
Answer:
* sympathetic nervous system activation,
- renin-angiotensin-aldosterone system activation,
- increased heart rate,
- myocardial hypertrophy, and
- ventricular dilation.
Question: What is the New York Heart Association (NYHA) functional classification for heart failure?
Answer:
The New York Heart Association (NYHA) functional classification is a system used to categorize heart failure based on the severity of symptoms.
It has four classes:
Class I (no limitation of physical activity),
Class II (slight limitation of physical activity),
Class III (marked limitation of physical activity), and
Class IV (severe limitation of physical activity).
Question: What are some diagnostic tests used for heart failure?
Answer:
- echocardiography,
- electrocardiogram (ECG),
- chest X-ray,
- cardiac biomarkers (e.g., B-type natriuretic peptide),
- stress tests,
- cardiac catheterization, and
- coronary angiography.
Question: What is the treatment approach for heart failure?
Answer:
involves a combination of
- lifestyle modifications (such as sodium restriction, weight management, and regular exercise),
- medications (such as diuretics, ACE inhibitors, beta-blockers, and aldosterone antagonists), and,
- in some cases, interventions like cardiac resynchronization therapy or implantable cardioverter-defibrillators.
Question: What is the goal of pharmacological treatment in heart failure?
Answer:
- to improve symptoms,
- slow disease progression,
- reduce hospitalizations, and
- prolong survival.
- It involves optimizing medication regimens based on the type and stage of heart failure.
Question: What is cardiac resynchronization therapy (CRT)?
Answer:
- treatment option for selected heart failure patients with impaired ventricular function and electrical dyssynchrony.
- It involves the placement of a specialized pacemaker that coordinates the contraction of the heart’s chambers to improve overall cardiac function.
Question: What are the complications of heart failure?
Answer:
- arrhythmias,
- pulmonary edema,
- cardiogenic shock,
- kidney dysfunction,
- liver dysfunction, and
- increased risk of thromboembolic events such as stroke or deep vein thrombosis.
Question: Can heart failure be prevented?
Answer:
- adopting a healthy lifestyle, managing risk factors (e.g., controlling hypertension, quitting smoking), and
- early management of underlying cardiac conditions can significantly reduce the risk of developing heart failure.
Question: What is the prognosis for heart failure?
Answer:
varies depending on the underlying cause, severity of symptoms, and response to treatment.
With appropriate management, including lifestyle modifications and medication, many individuals with heart failure can lead fulfilling lives and experience improved outcomes
What is the difference between systolic and diastolic heart failure?
- Systolic heart failure is caused by impaired left ventricular contraction, ( siff, fibrotic and non complinace)
- while diastolic heart failure is caused by impaired left ventricular relaxation. (Flappy, DIlated and high compliancey)
What is the precentage of heart failure with reduced ejection fraction?
The ejection fraction in heart failure with reduced ejection fraction is less than 40%.
What causes heart failure with reduced ejection fraction?
commonly caused by ischaemic heart disease,
- but it can also occur with valvular heart disease and hypertension.
What are the causes of heart failure with preserved left ventricular ejection fraction? 2
include
- increased stiffness of the ventricle (e.g. in long-standing hypertension with ventricular wall hypertrophy) and
- impaired relaxation of the ventricle (e.g. constrictive pericarditis).
What happens to contractility and preload in heart failure with low stroke volume or low ejection fraction?
contractility is reduced, and preload is increased.
What are the causes of right-sided heart failure?
- increased right ventricular afterload (e.g. pulmonary hypertension) and
- increased right ventricular preload (e.g. tricuspid valve regurgitation).
What is high-output cardiac heart failure?
usually occurs with an underlying cardiovascular disease and is characterized by increased oxygen demand but low oxygen supply to the heart.
- UNDERLINE DISEASE -> Diabetes, sleep apnea, smoke, hypertension, CAD, etc
How do compensatory mechanisms in heart failure work?
Compensatory mechanisms in heart failure include
- increased SA node stimulation,
- increased myocardial stimulation,
- vasoconstriction in the venous and arterial system,
- activation of the renin-angiotensin-aldosterone system (RAAS),
- increased adrenergic activity, and
- secretion of BNP.
How can compensatory mechanisms lead to exacerbation of heart failure?
Compensatory mechanisms can lead to exacerbation of heart failure by increasing heart rate and vasoconstriction, which can worsen afterload and preload and further strain the weakened heart.
What type of drugs can help reduce compensation mechanisms in heart failure?
Drugs such as beta blockers, ACE inhibitors, diuretics, and vasodilators can help reduce compensation mechanisms in heart failure.
What are the consequences of decompensated heart failure? 2
The consequences of decompensated heart failure include
- forward failure, which can lead to multisystem organ failure, and
- backward failure, which can cause pulmonary edema and systemic venous congestion.
What is paroxysmal nocturnal dyspnea (PND)?
Paroxysmal nocturnal dyspnea is a symptom of heart failure characterized by sudden shortness of breath that wakes the person up from sleep, often accompanied by a feeling of suffocation.
What signs can be observed in heart failure?
the new ones include
* Elevated jugular venous pressure (JVP)
* Hepatojugular reflux (an increase in JVP when pressure is applied to the liver)
* Peripheral edema (swelling in the legs, ankles, or feet)
* S3 gallop (an extra heart sound indicative of impaired ventricular filling)
* Pulmonary rales (abnormal lung sounds caused by fluid accumulation)
* Cyanosis (bluish discoloration of the lips or extremities due to poor oxygenation)
* Pleural effusion (fluid accumulation in the pleural cavity)
* Cardiomegaly (enlarged heart) on chest X-ray
* Ascites (fluid accumulation in the abdominal cavity)
* Weight gain due to fluid retention
- what causes S3
caused by dialtoed ventricles stretch during diastole and you hear S3 sound
- what causes S4
thick non compliance ventricles fill to short point where filling Stops producing S4