Heart Failure Flashcards
Define HF in one sentence
Inadequate pumping and/or filling of the heart, resulting in the inability of the heart to provide sufficient blood to meet the 02 needs of the tissues
What are the risk factors?
HTN Coronary Artery Disease (CAD) Diabetes Advanced age Tobacco use Obesity High cholesterol
Describe the pathophysiology of heart failure (briefly)
Caused by any interference with normal mechanisms regulating cardiac output. CO depends on preload, afterload, myocardial contractility and HR. Precipitating causes (whether primary or precipitating) often increase the workload of the ventricles, resulting in an acute condition and decreased heart function.
Primary causes= CAD, HTN, rheumatic heart disease, congenital heart defects, pulmonary heart defects, cardiomyopathy, hyperthyoidism etc.
Pricipitating causes= Anaemia, infection, hypothyoidism etc
What is the difference between right and left heart failure?
L= most common, from L) ventricular dysfunction. Prevents normal forward blood flow and causes blood to back up into L) atrium and pulmonary veins= pulmonary congestion.
R= RV fails to contract effectively. Venous congestion in systemic circulation results in jugular distention, heptomegaly, splenomegaly, vascular congestion of the GI tract and peripheral oedema. May result from an acute condition such as right ventricular infarction or pulmonary embolism.
Cor pulmonale= R ventricular dilation and hypertrophy caused by pulmonary disease- right sided HF.
What are the clinical manifestations of acute HF?
R)- Signs= RB heaves, murmurs, jugular distention, oedema, weight gain, increased HR, ascites, hepatomegaly (liver enlargement).
Symptoms= fatigue, anxiety, depression, dependent, bilateral oedema, RUQ pain, anorexia, bloating, nausea etc
L)- signs= LV heaves, pulsus alternans (alternating pulses: strong, weak), increasing HR, crackles, s3 and s4 heart sounds, pleural effusion, changes in mental status, restlessness, confusion
Symptoms: weakness, fatigue, anxiety, depression, dyspnoea, shallow resps, orthopnoea, dry, hacking cough, nocturia
What are the clinical manifestations of chronic HF?
Fatigue, dyspnoea, tachycardia, oedema, nocturia, skin changes, behavioural changes, chest pain, weight changes
Describe the management of acute HF?
Diuretics- decrease sodium reabsorption, increase sodium and water loss
ACE inhibitors and Angiotensin II receptor blockers
Morphine- decrease preload/after load of heart
Positive iontropes- dopamine, doubotamine, adrenaline
Describe the care of chronic HF?
O2 therapy, cardiac rehab, diruetics, ACE inhibitors, nitrates, positive iontropes, physical and emotional rest, B blockers, aldosterone antagonists (spironolactone)
