Heart Failure Flashcards
10% of those over 70 have HF. Define Heart failure
Heart failure is a clinical syndrome characterised by structural/functional cardiac abnormalities leading to reduced cardiac output and increased intracardiac pressure (=> dilatation)
What method is used to determine the ejection fraction on an ECHO?
Simpson’s Biplane method
Is an ECHO performed at the bedside or in the radiology lab?
It can be performed in both settings
Bedside for acute cases
Radiology lab for more accurate figures
The ejection fraction is calculated from which part of the heart?
Left ventricle => LVEF
HF can be classified into 3 types. What are they and what is used to obtain this classification?
What are the criteria necessary for this
ECHOcardiogram is used to calculate the ejection fraction, Hypertrophy, enlargement, and diastolic dysfunction (below)
HFreducedEF: LVEF <40%
+ Signs and Sx of HF
HFmoderately-reducedEF: LVEF 40-49%
+ Elevated BNP
+1 of the additional criteria on ECHO
a) LV hypertrophy/LA enlargement
b) Diastolic dysfunction
HFpreservedEF: LVEF 50+%
+ Elevated BNP + Both additional criteria
The epidemiology of HFrEF is that of young males whereas the epidemiology of HFpEF is more of older women. What is meant by diastolic dysfunction when trying to meet the criteria in this classification? Honours if you can go into detail
What investigation is used to determine this?
ECHO is used to determine diastolic dysfunction
It assesses the ability of the ventricle to relax and fill during diastole (which is more difficult with hypertrophy)
Honours:
It uses the following:
E/A ratio (early/late ventricular filling velocities)
E/e’ ratio (early diastolic filling velocity/early diastolic mitral annular velocity)
List the causes of HF
1) Diseased myocardium:
a) Ischaemic heart disease - previous MI, CAD
b) Toxic Damage - Alcohol, chemotherapy agents, thiamine deficiencies, hypothyroidism
c) Infiltrative Disease - Amyloid, sarcoidosis, haemochromatosis
d) Genetic Abnormalities - Hypertrophic and Diastolic cardiomyopathy
2) Abnormal loading:
a) HTN
b) AVSD
c) Valvular disease
d) Fluid overload (renal failure/insufficiency, iatrogenic)
3) Arrhythmias - Atrial/ventricular tachyarrhythmia and bradyarrhythmias
4) Cocaine Use
5) Diabetes is also a RF
Describe the typical cough in HF
Productive cough with Pink frothy sputum (pulm oedema)
What are the symptoms of HF?
SOB
Orthopnoea
PND
Cough with pink frothy sputum (oedema)
Chest pain
Weight gain/Increased shoe size, tighter trousers/jeans
What tool is used to grade the severity of symptoms and exercise intolerance in HF?
NYHA - New York Heart Association Classification
What is the NYHA classification used for?
Get into it
Used to determine the severity of the symptoms and exercise intolerance
Class I: No limitation in normal physical activity
Class II: Comfortable at rest, mild sx with normal activity
Class III: Comfortable at rest, marked sx with normal activity
Class IV: symptomatic at rest, increased discomfort with any physical activity
You are performing a cardiovascular exam on a patient presenting to the ED. You note a midline sternotomy scar. What should you then look for?
Look for a GSV or LSV harvesting scar on leg
You are asked to perform an examination on a patient giving a hx of HF. Go through the examination stating the findings you are looking for.
General Inspection: Dyspnoea, trouble lying flat/extra pillows
Closer inspection: Peripheral cyanosis, raised JVP, Scars (midline sternotomy -> check legs)
Palpation: Displaced apex beat (LVH), Parasternal heave
Auscultation:
Heart: S3 heart sound/ Gallop rhythm/tricuspid regurg.
Lungs: Reduced breath sounds, bibasal coarse crackles
Special/offer: Ankle oedema, sacral oedema, ascites
What is required for the diagnosis of HF?
BNP >500
ECHO - ejection fraction via Simpson’s Biplane method for type
What is the full role of the ECHO as an investigation for HF?
I am asking for the specific findings for HF as well as other things it looks at
Must include:
1) Determining EF for type of HF based on Simpson Biplane method
2) LV hypertrophy/LA enlargement (also part of criteria for typing)
3) Diastolic dysfunction
4) !!Dilated inferior vena cava
Others: Atrial, ventricular size, Valvular disease, LV hypertrophy/LA enlargement, Pericardial disease, RV systolic pressure