Heart failure Flashcards
What is heart failure?
The inability to deliver oxygenated blood to tissues at a satisfactory rate for the tissue’s metabolic requirements.
A syndrome, not a diagnosis
What is a syndrome?
A group of symptoms which consistently occur together or a condition that is characterised by a set of associated symptoms
What causes heart failure?
IHD (most common)
Cardiomyopathy
Valvular disease
Car pulmonale
Conditions increasing cardiac work (obesity, pregnancy, hypertension, hyperthyroidism, arrhythmias)
What is car pulmonale simply?
Right heart failure due to disease of lungs and/or pulmonary vessels
What are risk factors for heart failure?
Age 65+
Smoking
Obesity
Previous MI
Male
In a healthy heart, an increased preload means an increased afterload meaning increased _____ _____ due to the Frank Starling law
cardiac output
In failing hearts what happens to the cardiac output?
Decreases, dysfunctional Frank Starling law
What is the initial compensatory mechanism with heart failure?
RAAS and sympathetic nervous system activation to increase blood pressure
Soon, the compensatory mechanism to heart failure stops working and heart undergoes cardiac r______ which decreases CO
remodelling
In heart failure, the RAAS and SNS will exacerbate f____ o_____
fluid overload
What is it called when the heart failure affects both the left and right circuits?
Congestive heart failure
What is the normal ejection fraction?
50-70%
What kind of heart failure is it if the ejection fraction is over 50%?
Diastolic failure
Filling issues such as hypertrophic cardiomyopathy or aortic stenosis causing LVH
What kind of heart failure is it if the ejection fraction is lower than 40%?
Systolic failure
Pump fails due to ischaemic tissue in IHD
Left side heart failure results in p_____ v____ backlog and pulmonary o_____
pulmonary vessel
oedema
Right side heart failure results in s__ v____ backlog and p_____ odema
systemic vessel
peripheral
What are 3 cardinal non-specific signs of heart failure?
SOBASFAT
SOB
Ankle swelling
Fatigue
What other symptoms alongside SOB, ankle swelling and fatigue show in heart failure?
Orthopnoea (worse lying flat)
Oedema
3rd and 4th heart sounds
Raised JVP
Bibasal crackles (pulmonary oedema)
Hypotension
Tachycardia
What describes Class 1 of heart failure according to the NY heart association?
No limit on physical activity
What describes Class 2 of heart failure according to the NY heart association?
Slight limit on moderate activity
What describes Class 3 of heart failure according to the NY heart association?
Marked limit in moderate and gentle activity
What describes Class 4 of heart failure according to the NY heart association?
Symptoms even at rest
How is heart failure diagnosed?
Bloods:
Raised BNP levels (B-type natriuretic peptide)
Abnormal ECG, evidence of LVH
Chest XR:
Alveolar oedema, Kerley B lines, cardiomegaly, dilated upper lobe vessels, pleural effusion
Echo: assess heart chamber dimensions
What is an extremely high level of BNP?
Over 400 pg/ml
When is BNP released?
Released by stressed ventricle in response to increased mechanical stress
True or false: the more severe the heart failure, the higher the level of BNP?
True
What are some lifestyle changes for heart failure?
Lower BMI
Exercise
Stop smoking
Drink less alcohol
How is heart failure managed pharmacologically?
ABAL
ACE-i and B-blocker for all patients
Then spironolactone (aldosterone antagonist) and furosemide (loop diuretic)
What can improve A-V co-ordination?
Cardiac resynchronisation therapy
What surgical options are there for heart failure?
Revascularisation
Valve surgery
Heart transplant
