Heart Failure

Question 1

Causes of heart failure (around 12 on this card)

Answer 1

Main 3:
Hypertension (15%
Cardiomyopathy (dilated - 30%)
Ischaemic Heart Disease (35-40%)

Valvular heart disease
Undilated Cardiomyopathy
Congenital Heart disease
Right Heart failure
Arrythmias (AF, SB, Pericardial disease
Infections
Alc/ drugs

Question 2

What are 8 pathophysiological changes in heart failure?

Answer 2

Ventricular dilation
Myocyte hypertrophy
Increased collagen synthesis
Altered myosis gene expression
Increased ANP secretion
Sympathetic stimulation
Perhiperal vasoconstriction

Question 3

Pathophysiology of heart failure (in terms of how/ why it gets worse)

Answer 3

Heart failures and body tries to respond –> these are compensatory mechanisms to maintain CO and perfusion.

As HF progresses, system overwhelmed and become pathophysiological instead causing cardiac decompensation.

Question 4

What are some pathophysiological factors associated with worsening heart failure

Answer 4

Preload

Afterload

Myocardial contractibility

Nuerohormonal and sympathetic system activation (salt/ water retention)

Myocardial remodelling

Apoptosis

Calcium homeostasis gets abnormal

Natriuretic peptides

Endothelial fun in heart failure

Question 5

Write up all of previous card … Kumar and clarke

Question 6

Left vent systolic dysfunction/ Heart failure with reduced EF are all generally caused by what

Answer 6

Ishcaemic heart disease
Valvular heart disease
Hypertension

Question 7

Diastolic heart failure/ HF with preserved ejection fracture caused by …

Answer 7

Decreased in compliance due to increase in wall thickness (impairs diastolic filling)

Question 8

Right ventricular systolic dysfunction

Answer 8

secondary to chronic LVSD

Question 9

Clinical features of Heart failure …? symptoms + signs (many signs)

Answer 9

Sympts -
Exertional dyspnoea

Orthopnoea

Paroxysmal nocturnal dyspnoea

Fatigue

Signs -
Tachy
JVP Elevated
Cardiomegaly
Bi basal crackles
3rd/ 4th heart sounds (gallop)
Ankle oedema/ ascites
Pleural effusion
Hepatomegaly (tender)
Cardiomegaly

Question 10

There’s 11 listed investigations for heart failure - list and describe what they would tell us.

Answer 10

Blood Test -
FBC, U/E Liver, BNP/ NT-proBNP, cardiac enzymes

Chest xray-
Cardiomegaly, pulm congestion, fluid in fissures, pulm oedema, Kelley B lines

Electrocardiogram -
Hypert, ischaemia, arrhythmia

Question 11

finish above invests.. in k and C