Heart failure Flashcards
What is heart failure?
When the heart is unable to pump sufficiently to maintain blood flow to meet the body’s demands
Is heart failure curable?
No, but it is treatable
What types of heart failure can you get?
- Left ventricular failure
- Right ventricular failure
- Congestive cardiac failure (both sides)
ALSO
Reduced ejection fraction (LV failure to contract properly)
Preserved ejection fraction (LV able to contract but unable to relax and fill properlY0
What are the symptoms of heart failure?
SOB:
- on exertion, then at rest
- orthopnoea
- paroxysmal nocturnal dyspnoea
Fatigue + weakness
Oedema: pulmonary, peripheral
What are the signs of heart failure?
SOB
Bilateral basal crackles
Murmurs, S3 (or S4) heart sounds Pleural effusion Raised JVP Oedema: pulmonary or peripheral Hepatomegaly
What is NTproBNP?
A hormone produced by the atria/ventricles when they are over-stretched
In heart failure the atria get stretched
Should you use NTproBNP as a tool for diagnosis?
If it is raised in may indicate HF, but it is not synonymous.
Use their symptoms mainly and NTproBNP to assist
What are the causes of heart failure?
Myocardial damage:
IHD, damaged ventricle
Hypertension
Alcohol excess
Cardiomyopathy (damage to cardiac muscles)
Valve problems
Endocarditis and pericarditis
Cor pulmonale
What is ejection fraction?
When blood is ejected from the ventricle it is not emptied completely, there is a residual volume left behind.
Ejection fraction is the % of blood that is ejected
What is a healthy ejection fraction in young people?
About 65%
What happens to ejection fraction in heart failure?
Can be preserved or reduced
Preserved: ventricle can contract ok but can’t relax and fill
Reduced: ventricle can’t contract properly
What is cardiomyopathy?
Chronic disease of the cardiac muscle
What are the 3 types of cardiomyopathy?
Dilated
Hypertrophic
Restrictive
Describe dilated cardiomyopathy.
Stretched ventricles
Can’t contract properly
Reduced EF
Describe hypertrophic cardiomyopathy.
Small cavity caused by hypertrophy of muscle walls
Thick muscular walls
Ventricle can’t relax and fill properly
Preserved EF
Describe restrictive cardiomyopathy.
Heart walls are rigid, so they can’t contract or relax properly
The heart can’t stretch or fill properly
What is myocarditis?
What is it caused by?
Inflammation of the myocardium
Viruses, alcohol, chemotherapies
What investigations would you do for heart failure?
ECG: may indicate cause, look for ischaemia, MI, hypertrophy
Bloods: FBC, U+E, NTproBNP
CXR: look for cardiomegaly, pleural effusions etc.
Echo: indicate the cause, look for LV dysfunction
What medical emergency can happen as a result of heart failure?
Clinical features?
Acute pulmonary oedema
Severe SOB: at rest, PND, orthopnoea
Sweaty, nauseated and anxious
Cough: dry or productive (pink, frothy sputum)
Tachypnoea Cyanosis Raised JVP Clammy Bilateral basal crackles S3 heart sounds or murmurs Cardiogenic shock: hypotension, oliguria, low cardiac output
How would you manage acute heart failure?
ABCDE
Sit patient upright
Nitrates (GTN)
IV Furosemide: treats oedema, lowers BP
Analgesia (opiates)
Consider CPAP
How would you manage chronic heart failure?
Treat the cause: arrhythmia, IHD etc.
Amend lifestyle: lose weight, stop smoking, eat less salt
Drugs
Transplant
Implantable pacemaker
Palliative care
What drugs are used to treat chronic heart failure?
ABCDD
ACEi/ARBs
Beta blockers
C: mineraloCorticoid receptor antagonist (aldosterone)
Diuretics (furosemide)
Digoxin
Ivabradine (slows HR)
Opiates in severe cases
What problems are caused by left sided cardiac failure?
Pulmonary congestion (blood is back logged into lungs) Overload of right side
Because blood can’t be pumped out of the LV properly
What problems are caused by right sided cardiac failure?
Venous hypertension (blood is backlogged into IVC)
Congestion
What is Cor Pulmonale?
Enlargement and failure of the right ventricle caused by increased vascular resistance in the lungs
What causes Cor Pulmonale?
Anything that causes vascular resistance in the lungs.
Pulmonary hypertension
Stenosis of pulmonary artery
