Heart Failure Flashcards
Definition of Heart Failure
Clinical syndrome leading to inadequate Cardiac Output from the heart to meet the metabolic requirements of the body.
Causes of Heart Failure
MI/IHD
Hypertension
Cardiomyopathy
Alcohol/drugs
Valvular Disease
Arrhythmias
Pathophysiology of Heart Failure
Vantricular damage occurs reducing CO.
This is sensed and neurohormonal mechanisms SNS/RAAS/Vasopressin activate.
There is peripheral vasoconstriction/Renal H2O and Na+ retention increasing Preload and Afterload.
This stimulates the myocardium to become hypertrophied to maintain CO
This causes Ischaemic damage and the cycle continues.
Presentaiton of Heart Failure: Symptoms
Symptoms
Dyspnoea, Fatigue, Peripheral oedema, Reduced exercise tolerance, Orthopnoea,
Paroxsymal Noctual Dyspnoea, Anorexia, Cardiac Asthma
Signs of Heart Failure
Signs
Raised JVP, Pitting oedema/Ankle oedema, Pleural effusion - bibasal crackles, tachycardia, hypotension, Displaced apex beat, 3rd HS, Ascites/hepatomegaly
X-ray signs of Heart Failure
Alveolar Oedema - Bat wings
Kerley B Lines
Cardiomegaly
Upper love vessel diversion/dilated upper vessels
Pleural Effusion
Others: Fluid in horizontal fissue, peribronchial cuffing, enlarged hilar region
Acute HF management
Assess patient ABCDE
Sit patient upright start high flow O2
IV access, ECG and treat any arrhythmias
CXR, Bloods - FBC, troponin, U+Es, LFTs, TFTs, BNP/ANP levels
Diamorphine if in pain +/-metaclopramide
GTN if not hypotensive
IV furesomide - repeat if no improvement
CPAP considered
Chronic HF management
Daily weights and aim for 0.5kg/day loss
Lifestyle advice - salt and fluid restriction, weight and diet control, rehab and increase exercise, smoking cessaton,
Drug therapy:
Diuretics - Furesomide/spironolactone
Beta blockers
ACEi/ARB
Digoxin can be used as rate and ionotropic effects
