Heart Failure Flashcards
What are the symptoms of heart failure?
SOB
Fatigue
Oedema
Reduced exercise capacity
What are the signs of heart failure?
Oedema Tachycardia Raised JVP Chest crepitations or effusions 3rd heart sound Displaced/abnormal apex beat
What are the criteria for diagnosing heart failure?
Symptoms or signs of HF AND Objective evidence of cardiac dysfunction AND (if in doubt) Response to therapy (diuretics)
What investigations might be done to obtain evidence of cardiac dysfunction causing heart failure?
Echo
Radionuclide ventriculography
MRI
Left ventriculography
What potential screening tests might be used for heart failure?
12 Lead ECG
- LVSD unlikely is ECG normal
BNP
- measured in blood
- elevated in HF
- highly sensitive
- if elevated, do ECHO/cardiac assessment
What are some causes of heart failure?
Almost any structural cardiac abnormality will cause heart failure
LVSD Valvular heart disease Pericardial constriction or effusion LVDD/HF with preserved systolic function Arrhythmias Myocardial ischaemia/infarction Restrictive cardiomyopathy RV failure, primary or secondary to hypertension
What can cause LV systolic dysfunction?
Ischaemic Heart Disease
Dilated cardiomyopathy - means LVSD is not due to IHD
- e.g. inherited, toxins, systemic disease, hypertension
Severe aortic valve disease or mitral regurgitation
How might you evaluate a patient with LVSD? What questions might you ask in a history? What tests might you do?
Detailed history Check Lyme's disease in hillwalkers IVDA/HIV? Consider familial Exclude renal failure, anaemia Check autoantibodies Consider other causes e.g. sarcoidosis, dystrophy
Do ECG and Echo, sometimes CXR
Consider angiography - essential if chest pain
CT-coronary angiogram
Cardiac MRI
Why is echocardiography essential in heart failure?
Identify and quantify:
- LVSD
- valvular dysfunction
- pericardial effusion/tamponade
- diastolic dysfunction
- LVH
- A/V shunts, congenital defects
- pulmonary hypertension/RH dysfunction
What is LVEF and what are the stages of reduced EF?
Fraction of blood ejected in systole by LV
Normal = 50-80%
Mild impairment = 40-50%
Moderate impairment = 30-40%
Severe impairment <30%
What techniques are used to measure LVEF?
Pros/cons of each?
Echo, but difficult to quantify accurately and reproducibly
- time consuming to perform accurate
- calculation method can vary
- use of contrast agents
MUGA (Radionuclide angiography)
- easier to get accurate figure
- reproducible
- uses radiation
Cardiac MRI also possible
How is heart failure graded?
NYHA Class
I - no exercise limitations or symptoms in normal activity
II - mild limitation, comfortable at rest/mild exertion
III - moderate limitation, comfortable at rest only
IV - severe limitation, any activity causes discomfort, symptoms at rest
How does heart failure affect cardiac output?
Doesn’t necessarily reduce CO due to compensation. (Can increase).
Reduced ejection fraction, but dilation means more blood in the actual ventricle. HR may also increase.
What are some risk factors for heart failure?
Hypertension #1 (and LVH) Coronary artery disease Valvular heart disease Alcoholism Infection Diabetes Congenital defects Others - obesity - age - smoking - OSAS
What are the treatment aims in heart failure?
Improve symptoms
Improve survival
