Heart Failure Flashcards
What is heart failure?
When the CO is too inadequate for the bodies requirements.
All the symptoms and signs resulting from an abnormality of cardiac structure or function
What might cause heart failure (parts of the heart)?
Vessels - coronary artery Hypertension Valvular disease Wiring - arrhythmias Muscle - cardiomyopathies caused by multiple things
What happens if the heart failure is caused by a problem with the right side of the heart?
Then there could be fluid/blood build up in the bodies circulation
Leading to: Peripheral oedema, ascities
What happens if the heart failure is caused by a problem with the left side of the heart?
Then is could cause fluid/blood build up into the lungs.
Leading to: Pulmonary oedema, SOB, orthopnoea + PND
What are the consequences of Right heart failure?
Congestion of peripheral tissues
Depended oedema and ascites
Liver congestion - signs related to impaired liver function
GI tact congestion - anorexia, GI distress, weight loss
What are the consequences of Left heart failure?
Decreased cardiac output - activity intolerance and signs of decreased tissue perfusion
Pulmonary congestion
Impaired gas exchange - cyanosis and signs of hypoxia
Pulmonary oedema - orthopnoea, cough with frothy sputum, PND
What are the symptoms of HF?
Shortness of breath Reduced exercise tolerance Orthopnoea Paroxysmal nocturnal dyspnoea Ankle Swelling
What are the signs of HF?
Elevated JVP Third heart sound Murmur Periperal oedema Lung crackles Tachycardia Dullness to percussion Hepatomegaly Ascites
What different types of HF can you get?
Systolic, diastolic
Left sided and right sided
Acute and chronic
What is systolic HF?
When there is a failure with the pump
The heart cant pump out blood effectively and cant contract normally resulting in reduced CO
What is diastolic HF?
When there is a failure with relaxing and filling of the heart
The heart is stiff, and cant fill properly causing increased filling pressures
Commonly caused by hypertension
What is acute HF?
When the signs and symptoms come on very quickly
New onset of heart failure characterised by pulmonary and/or peripheral oedema
Sudden, can be life threatening, needs immediate treatment
What is chronic HF?
When HF has developed or progressed slowly
Gradual onset, heart develops compensatory mechanisms, can be stable compensated or decompensated
What are some ‘signs’ in right sided heart failure?
Ascities Fatigue Distended jugular veins Enlarged liver and spleen Increased peripheral venous pressure Gi complaints
What are some ‘signs’ in left sided heart failure?
SOB Cough PND orthopnoea Tachycardia Restlessness Cyanosis Exertional dyspnea
Describe some investigations for HF?
Bloods (BNP - increased heart stress (atrial stretching)) ABG ECG - to find acute causes CXR ECHO
Describe the CXR of pulmonary oedema?
ABCDE
Alveolar oedema (bat wings) Kerly B lines (interstitial oedema) Cardiomegaly Dilated prominent upper lobe vessels Pleural effusion
What is the treatment of chronic heart failure?
Treat the case Make them feel better - Fluid balance, diuretics Make them live longer - ACE - BB - Aldosterone antagonist - Device (ICD)
What does ACEi do?
Blocks the RAAS system - which is linked with cardiac remodelling Start low go slow Can cause renal impairment Dry cough Hypotension (as its an antihypertensive)
(PRIL)
What does ARB do?
Block angiotensin 2 in RAAS
ARTAN
Describe BB in treatment of HF?
Good in the long term
Star low go slow
In acute can cause initial decrease in cardiac contractility
Can cause hypotension and worsening dysponoea
Describe spironolactone in HF?
Used in mod to severe CCF
Men can develop gynaecomastia - breasts
Aldosterone receptor antagonist
Describe ivabradine in the use of HF?
If channel blocker
Only use if HR fast despite BB usage
What is the new drug used in HF?
Sacubitril-Valsartan
- combo of ARB and Neprilysin inhibitor
Do not use alongside ACEI
What might be a rough treatment for acute HF?
IV fluosemide (diuretics) Opiates ( relax patient and dilate venous system reducing blood back to heart to give it a rest) Iv nitrates STOP FLUIDS Treat cause
