Heart failure Flashcards
How is heart failure defined?
Cardiac output is inadequate for the body’s requirements
What is systolic failure?
Inability of the ventricle to contract normally resulting in reduced cardiac output and ejection fraction <40%
What is diastolic failure?
Inability of the ventricle to relax and fill normally causing increased filling pressures. ejection fraction >50%
What causes systolic failure?
Ischaemic heart disease
MI
Cardiomyopathy
What causes systolic failure?
Constrictive pericarditis
Tamponade
Restrictive cardiomyopathy
What causes diastolic failure?
Constrictive pericarditis
Tamponade
Restrictive cardiomyopathy
Hypertension
N.B. systolic and diastolic failure usually co-exist
What is congestive heart failure?
Left and right sided heart failure occurring concurrently
What are the symptoms of left ventricular failure?
Dyspnoea Poor exercise tolerance Fatigue Orthopnoea Paroxysmal nocturnal dyspnoea Nocturnal cought, sometimes with pink frothy sputum Wheeze- cardiac 'asthma' Nocturia Cold peripheries Weight loss Muscle wasting
What are the symptoms of RV failure?
Peripheral oedema Ascites Nausea Anorexia Facial engorgement Pulsation in neck and face (tricuspid regurgitation) Epistaxis
What are the causes of RV failure?
LVF
Pulmonary stenosis
Lung disease
What is the definition of acute heart failure?
New onset or decompensation of of chronic heart failure characterised by pumonary and//or peripheral oedema with or without signs of peripheral hypotension
What is chronic heart failure?
Heart failure which develops and progesses very slowly. Venous congestion is common but arterial pressure is maintained well until very late
What is low output heart failure?
Cardiac output is low and fails to rise normally with exertion
What are the causes of low output heart failure?
Pump failure:
- Systolic and/or diastolic heart failure
- Reduced heart rate- e.g. due to beta blockers, heart block or post MI
- Negatively ionotropic drugs e.g. most anti-arrhythmic agents
Excessive preload
- Mitral regurgitation
- Fluid overload e.g. NSAID causing fluid retention. Fluid overload may cause LVF in a normal heart if renal function is impaired or big volumes are involved e.g. IVI running too fast. This is more common if there is simultaneous compromise of cardiac function, and in the elderly
Chronic excessive afterload
- Aortic stenosis
- Hypertension
What is high output failure?
Output is normal or increased in the face of increased need. Failure occurs when needs are greatly increased and cardiac output cannot meet these needs. It will occur with a normal heart but even earlier if there is heart disease. It is rare.
What are the causes of high output heart failure?
Anemia Pregnancy Hyperthyroidism Paget's disease Arteriovenous malformation
What are the ‘major’ Framingham criteria?
PND
Crepitations
S3 gallop
Cardiomegaly (cardiothoracic ratio >50% on chest radiography)
Increased central venous pressure (16cmH2O at right atrium)
Weight loss >4.5kg in 5 days in response to treatment
Neck vein distention
Acute pulmonary oedema
Hepatojugular reflux
What are the ‘minor’ Framingham criteria?
Bilateral ankle oedema Dyspnoea on ordinary exertion Tachycardia (heart rate >120/min) Decrease in vital capacity by 1/3 from maximal recorded Nocturnal cough Hepatomegaly Pleural effusion
According to the Framingham criteria, what does diagnosis of CHF require?
Either 2 major criteria
OR
1 major criteria in conjunction with 2 minor criteria
General signs of heart failure?
Exhaustion Cool peripheries Cyanosis Reduced BP Narrow pulse pressure Pulsus alternans Displaces apex- LV dilation RV heave- pulmonary hypertension Murmurs of mitral or aortic valve disease Wheeze- cardiac asthma
What investigations should be carried out?
BNP + ECG: if both are normal heart failure is unlikely
If either is abnormal, an echo is required
What features are seen on the CXR of a patient with heart failure?
Alveolar oedema (bat's wings) kerley B lines (interstitial oedema) Cardiomegaly Dilated, prominent upper lobe vessels pleural Effusion
(ABCDE)
What drugs may exacerbate heart failure?
NSAIDS
Verapamil
Why do NSAIDS exacerbate heart failure?
They may cause fluid retention
