Heart Failure Flashcards
What is the definition of heart failure?
When the heart is unable to clear blood from the left and right ventricles
What can cause heart failure?
Ineffective pumping due to ischaemia or heart valve disease
What is the pathophysiology of heart failure?
- Decreased cardiac output
- Decreased GFR
- Activation of RAAS
- Retention of Na+ and water
- Fluid overfilled in veins
What happens as a result of congestive heart failure?
Back pressure of venous blood
What effects of congestive heart failure can be seen in the lungs?
Associated with left sided heart failure
Pulmonary oedema causing crepitations and tachycardia
What effects of congestive heart failurecan be seen in the liver?
Associated with right sided heart failure
Increased JVP, hepatomegaly and peripheral oedema
What is Starling’s Hypothesis?
The components affect net flux and filtration are hydrostatic and oncotic pressure along with permeability of endothelium
What is the difference between transudate and exudate?
Transudate - fluid thats pushed out
Exudate - fluid that leaks out
What process is usually associated with the presence of exudate?
Inflammatory process - due to high vascular permeability
What can be said about the composition of exudate?
Higher protein/albumin content
Some water and electrolytes
High specific gravity
What can be said about the composition of transudate?
Not much protein/albumin content
Lots of water and electrolytes
Low specific gravity
What is the prevalence of heart failure in the UK as a percentage?
0.4-2%
What is the prevalence of asymptomatic LVSD in the UK as a percentage?
0.4-2%
What is the mean age at which incident usually occurs with regards to heart failure?
74 years old
What is the definition of heart failure?
A clinical syndrome comprising of dyspnoea, fatigue or fluid retention, either at rest or on exertion, with accompanying neurohormonal activation
How is Heart Failure graded?
Using the New York Association classification for HF
Class I - no limitation
Class II - mild limitation
Class III - moderate limitation
Class IV - Severe limitation
What are the typical signs of HF?
Oedema, tachycardia, raised JVP, chest crepitation/effusions, third heart sound, displaced or abnormal apex beat
What are the symptoms of HF?
Breathlessness, fatigue, oedema and reduced exercise capacity
List the three essential investigations for heart failure
- 12 lead ECG
- Brain natriuretic peptide
- LVEF-MUGA
What things can be identified and quantified from an ECG pertinent to heart failure?
- LV systolic dysfunction
- Valve dysfunction
- LVH
- Pulmonary hypertension
What is the BNP screening test a good predictor of?
Mortality and morbidity
What is the left ventricular ejection fraction?
Continuous biological variable showing the ratio of ejected blood to total volume
How can LVEF be measured?
Biplane modified Simpsons rule
MUGA-LVEF
What are loop diuretics?
Diuretics which work on the ascending limb of the loop of Henlé in the kidneys
What are two examples of loop diuretics?
Furosemide and bumetamide
What is the goal of diuretic therapy for heart failure?
Improves symptoms
Does not improve morbidity/mortality
What pharmacological agents combat the neurohormonal activation associated with heart failure?
ACE-inhibitors target the RAAS
What ADRs are associated with treatment for heart failure?
Dehydration Hypotension Hypokalaemia Hyponatraemia Gout Impaired glucose tolerance
What drug-drug interactions are common with furosemide?
Aminoglycosides - aural and renal toxicity
Lithium - renal toxicity
NSAIDs - renal toxicity
Antihypertensives - profound hypotension
Vancomycin - renal toxicity
What are the different roles of the AT1 and AT2 receptors to angiotensin II?
AT1 - vasoconstriction Vascular proliferation Aldosterone secretion Cardiac myocytes proliferation Increased sympathetic tone
AT2
Vasodilation
Antiproliferation
Apoptosis
What is the benefit of using beta-blockade in the treatment of heart failure?
Reduce sympathetic tone
