Heart Failure Flashcards
Heart failure symptoms
Exertional dyspnea
Orthopnea
PND
Exertional fatigue
Peripheral oedema
Ascites
Three neurohormonal system?
Sympathetic nervous system
Renin-angiotensin
Natriuretic peptide
How does sympathetic system compensate?
Increase heart rate
Activate RAAS
Peripheral vasoconstriction(increases BP)
Increased contractility
(This increases stroke volume. Mechanism work via epinephrine and norepinephrine)
How does RAAS compensate?
a) angiotensin I and II (lead to hypertrophy of myocytes, increase vasoconstriction, BP and muscle tone) and aldosterone (salt and water retention, increased cardiac volume, can lead to fluid overload and oedema)
If heart gets too hypertophied it leads to a stiff and non compliant heart.
Natriuetic peptide compensation mechanism?
ANP and BNP get released when volume and pressure exceed threshold. NP leads to vasodilation in peripheries, diuresis and natriuresis. Good guys!
Three NP’s and signs that show heart failure
ANP(vol overload)
BNP(pressure overload)
CNP
When NT-pro-BNP and BNP is detected in blood you know they are in heart failure
Patient present with crackles,ascites,oedema,pleural effusion.
Cardiomegaly on x-ray?
Cardiothoracic ratio more than 50%
CXR of heart failure
Cardiomegaly
Left atrial enlargement
Pulmonary congestion
Pulmonary oedema
Causes of heart disease
Hypertension
Cardiomegaly
Valvular
Ischaemic
Pericardial
Congenital
Precipitance of heart failure cardiac and other
Cardiac
-hypertension (huge afterload,heart needs to work very hard to get rid of that blood)
-endocarditis
-ischemic
-tachyarrhytmia
-PE
-natural progress
Remote from heart
-infection or sepsis
-anaemia
-pregnancy (trimester 1 and 2)
-hyperthyroidism
-drugs
Ischamic cardiomegaly heart sound
S3 gallop because ischaemia cause fibrosis and fibrosis makes heart non compliant leading to S3
ECG of LAH
Broad and bifid P wave in lead 2
(Eg due to hypertension)
