heart failure Flashcards
-Heart failure is a condition in which the — isunable to — blood as efficiently as it shouldtomeet the body’s demands
-Heart Failurecan be systolic: — blood out of the heart is impaired during —
Or diastolic: — of the ventricles is impaired during —
cardiac muscle
pump
ejecting
ventricular contraction
filling
ventricular relaxation
Ejection fraction (EF) is a term commonly used in— and to refers to how — the — are emptied during —
EF = —-
EF is usually determined by —- (—-)
heart failure
efficient
ventricles
contraction
stroke volume ÷ end-diastolic volume
cardiac ultrasound( echocardiogram)
1- electrocardiogram:
— ECG unlikely HF
May have evidence of —
Evidence of — / — may be apparent
2- echocardiogram:
Most — and — , — step
Confirms —
Quantifies — of ventricular disease
Rules out fixable valvular —
estimates the — fraction
normal
ishcmeia
cardiomyopathy / cardiac strain
complete and cost effective first step
confrims diagosis
severity
lesions
ejection
symptoms of heart failure:
1- — overload
—- (on exertion)
Lower extremity —
—-
—- dyspnoea
—- cough
—-
2- Low —
Fatigue
Decreased – tolerance
fluid
dysponea
oedema
orthoponea
Paroxysmal nocturnal
nocturnal
weight gain
cardiac output
excerisse
signs of heart failure:
1- Elevated left sided filling pressure / overload
— on lung auscultation
—– usually bilateral
— rhythm with S3
Displaced or prominent apex
—- from previous valvopathy such as AS/MR
2-Elevated RIGHT sided filling pressure / overload
Elevated —
Positive— reflux
Lower extremity — : ankle/sacral
—
crackles
pleaural effusion
gallop rhythm
murmurs
JVP
hepatojugular
oedema
ascites
pathophysiology:
1- Heart failure may result from damage to — that impairs its ability to —
Eg: myocardial infarction
2- Excessive — of the myocardium impairs its ability to — during diastole
Eg: long term high blood pressure
3- A — (—) or—- heart valve can impair cardiac — and — fraction
Eg: mitral regurgitation
4-A — or — pericardium can impair —
Eg: constrictive pericarditis from viral infection
myocardial muscle
contract
stinffiness
relax
narrowed ( stenosed )
leaky
filling and ejection
thickened or stif
cardiac filling
pathophysiology:
5-Generally resulting from myocardial muscle — or —
6- Characterized by —
7-Leading to — and — abnormalities
8- Left untreated, usually progressive at the levels of cardiac function and clinical symptoms
9-Severity of clinical symptoms may vary substantially during course of the disease process and may not correlate with changes in underlying cardiac function
dysfunction or loss
left ventricular dilatation or hypertrophy
neurohormonal ad circulatory
Neurohormonal model of Heart Failure:
1- Myocardial injury to the heart (CAD, HTN, CMP, Valvular disease) leads to initial fall in — performance and wall stress
2- activation of — and — ( Fibrosis, apoptosis,hypertrophy, cellular/molecular alterations,motoxicity )
3- leading to Morbidity and mortality
Arrhythmias
Pump failure
FatigueActivity altered Chest congestionEdemaShortness of breath
left ventricle
RAS and SNS
pump failure:
-Reduced —- heart does not meet bodies’ — demands
-Leads to fatigue, dyspnoea, — oedema, reduced exercise tolerance
-Reduced cerebral perfusion causes — leading to light-headedness, syncope, collapse
- Fluid build-up in the lungs leads to — and causes the ‘—’ heard on—
-Chest pain usually occurs as a result of concomitant angina/IHD/severe AS
-Failure of right side of the heart causes pooling of — in the — (—) which builds up as fluid fails to return to the heart
cardiac output
metabolic demands
ankle oedema
hypotension
dyspnea
crackles
ausuclations
fluids
peripheries
ankle oedema
Cardiac differential diagnosis:
Myocardial infarction:
But patient likely to have —
Arrhythmia:
May cause — and result in –
Pericardial effusion:
— in the pericardium that may restrict cardiac — mimicking — dysfunction
chest pain
breathlessness
fluid overload
fluid
cardiac filling
diastolic
Respiratory differential diagnosis:
Interstitial lung disease:
May cause — and – on lung auscultation
Bronchiectasis:
May cause — and — on lung auscultation
Pleural effusion
Pleural effusion may be caused by — or other conditions, such as —
COPD
Causes — and has similar risk factors such as —
Pulmonary embolism
Causes — but likely also to have –
breathlessness and crackles
breathlessness and crackles
heart failure
penumonia
dusponea
smoking
acute breathlessness
chest pai
other differentials:
Anaemia:
Shares some symptoms such as — and —
Renal failure
May result in similar— / —
Liver failure
May result in similar—- and —
fatigue and dysponea
peripheral /pulmonary oedema
peripheral and pulmonary oedema
summary:
Heart failure – failure of the—. Diagnosis is based on:
Combination of history, examination, and tests including echocardiogram and blood tests
Heart failure largely thought of as:
Reduced ejection fraction
Preserved ejection fraction
Main cause is — heart disease
Differential diagnosis is broad but consider whether dyspnoea is acute or chronic and whether there are common risk factors for heart failure
pump
ishcemic
