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year 3 exam 1 > heart failure > Flashcards

heart failure Flashcards

1
Q

What is heart failure

A
  • Results from structural and/or functional cardiac disorders - usually of gradual onset
    Unable to sustain adequate blood delivery around the body
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2
Q

HF epidemiology

A

0.3-2% population
50% dead at 5 years
10% AF associated

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3
Q

aetiology of HF

A

pump failure - damage has lead to a decrease in contractility (IHD)
overloading - extra workload causes decreased contraction force and delayed relaxation

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4
Q

what can cause pump failure in the heart

A

MI
cardiomyopathy
arrythmias
inflammation
infection

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5
Q

what can cause the heart to be overloaded

A

excessive afterload - high systemic/pulmonary, vascular resistance, valve dysfunction
excessive preload - fluid retention

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6
Q

what are some other less common causes of HF

A

arrythmias
pregnancy
obesity

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7
Q

what is acute HF

A

usually after MI
- cardiac output drops - decompensated
- contractility drops - compensated

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8
Q

what is chronic HF

A

same as acute, but slower onset, pt can remain in compensated HF indefinitely

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9
Q

3 clinical features of HF

A

exercise limitation and fatigue - less blood flow to muscles
SOB - back pressure from heart causes fluid accumulation on lungs
oedema - salt/water retention

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10
Q

what are the main causes of symptoms of HF

A

hypoperfusion and oedema

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11
Q

what is hypoperfusion

A

Impaired flow ahead of heart/chamber affected

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12
Q

what does hypoperfusion cause

A

peripheral vasoconstriction
fatigue
cold extremities
fluid retention
tachycardia/tachypnoea

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13
Q

what is oedema inHF

A

increase in pressure in veins draining to the heart

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14
Q

what does right sided oedema cause

A

peripheral oedema
liver enlargement
raised jugular pressure
fluid retention

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15
Q

what does left sided oedema cause

A

pulmonary oedema
SOB
cough/wheeze

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16
Q

how is HF diagnosed

A

swelling, jugular pressure, lung sounds
natriuretic peptides
ejection fraction
xray/ecg/bp

17
Q

what is HFrEF

A

HF with reduced ejection fraction - drugs!! (<40%)

18
Q

what is HFpEF

A

HF with preserved ejection fraction (>50%)

19
Q

what is HFmrEF

A

HF with mid range ejection fraction (41-50%)

20
Q

how do you treat HF caused by myocardium disease

A

increasing inotropy

21
Q

how do you treat HF caused by excessive load

A

reduce pre/after load

22
Q

what is 1st line treatment for HFrEF and what are they used for

A

loop diuretic - furosemide - decreased preload and oedema
ACEi - ramipril - reduce pre/after load
B blockers - bisoprolol - reduce pre/after load
aldosterone antagonists - spironolactone- reduce pre/after load and LVH risk

23
Q

which medicines can be added on to control HF

A

digoxin - myocardial stimulation
isosorbide dinitrate - preload
hydralazine - afterload
ARNI - pre/after load
SGLT2 - pre/after load

24
Q

which 3 types of diuretic can be used in HF

A

thiazide - bendro 5mg max for mild HF
loop- mainstay
metolazone - atypical for resistant AF (2.5-5mg stat or every 2-3 days)

25
Q

what are ARNIs and how do they work

A

angiotensin receptor neprilysin inhibitors - valsartan ARB and sacubitril neprilysin inhibitor - stops degradation of natriuretic peptide

26
Q

ESC 1st line for HF guidelines

A

ACEi/ARNI
B blocker
MRA (spironolactone)
SGLT2
loop diuretic

27
Q

what is starlings law of the heart

A

The greater the volume of blood entering the heart at diastole, the greater the volume of blood ejected during systolic contraction

28
Q

what are the 4 mechanisms of compensation in HF

A

cardiac enlargement
arterial constriction
increased sympathetic drive
salt/water retention

29
Q

how does cardiac enlargement work in HF compensation

A
  • Cardiac muscle is stretched from increased residual volume after contraction - impairment as a pump - Left ventricular hypertrophy (LVH) - enlargement and thickening of left ventricular wall
30
Q

how does arterial constriction work in HF compensation

A
  • Arteries constrict when blood output is reduced to direct blood to essential organs
31
Q

how does increased sympathetic drive work in HF compensation

A

Reduced tissue perfusion activates sympathetic nervous system via baroreceptors, Exposes heart to catecholamines with positive inotropic and chronotropic effects - increase force and rate of contraction (noradrenaline, angiotensin, aldosterone)

32
Q

how does salt/water retention work in HF compensation

A

reduced cardiac output = decreased renal perfusion
renin release, aldosterone I and II produced = aldosterone increased - increases pre-load via water retention at renal tubule
- atrial natriuretic peptide release

33
Q

what symptoms are associated with class I of the new York heart associations classification of HF symptoms

A

no limitations

34
Q

what symptoms are associated with class II of the new York heart associations classification of HF symptoms

A

slight limitation
comfortable at rest
ordinary activity = fatigue, palpitation, angina

35
Q

what symptoms are associated with class III of the new York heart associations classification of HF symptoms

A

marked limitation on activity
still comfortable at rest
less than ordinary activity = symptoms

36
Q

what symptoms are associated with class IV of the new York heart associations classification of HF symptoms

A

inability to do anything without discomfort
symptoms still present even at rest

year 3 exam 1 (44 decks)

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