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CR 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

In heart failure more common in men or women?

A

Men

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2
Q

How does heart failure incidence change as you age?

A

Between the ages and 40 and 80, incidence doubles with each decade

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3
Q

2 widely accepted definitions of heart failure

A

1) A cardiac disorder that prohibits delivery of sufficient output to meet perfusion requirements of metabolising tissues
2) A clinical syndrome caused by abnormality o the heart and recognised by characteristic pattern of haemodynamic and hormonal responses

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4
Q

4 main causes of heart failure

A
  • Coronary artery diseases
  • Hypertension
  • Cardiomyopathy
  • Valvular heart disease
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5
Q

4 aggravating factors of heart failure

A
  • Cardiac arrhythmias
  • Hypertension
  • Anaemia
  • Infections
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6
Q

What main 3 physiological changes cause the majority of signs and symptoms in heart failure?

A

Reduced cardiac output (peripheral hypoperfusion)
Fluid retention (congestions)
Increased sympathetic activity

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7
Q

What symptoms and signs result from reduced cardiac output

A 
Symptoms= fatigue
Signs= cool skin, peripheral cyanosis
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8
Q

What signs and symptoms result from fluid retention

A 
Symptoms= dyspnoea, oedema
Signs= Basal crackles, raised JVP, ankle swelling, ascites
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9
Q

What are ascites

A

abnormal fluid collection in perineal cavity

Distended stomach

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10
Q

What signs result from increased sympathetic activity

A

Tachycardia

Sweating

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11
Q

How might the pulse appear in somebody with heart failure

A

Alternating pulse

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12
Q

Name 6 complications that can result from heart failure

A 
Intravascular thrombosis
Infection
Functional valvular dysfunction
Multi organ failure 
Cardiac arrhythmias
Sudden death
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13
Q

What examples of intravascular thrombosis can result from heart failure

A

Pulmonary embolism

Systemic embolism

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14
Q

What infections most commonly result from heart failure

A

Chest infection

Ulcerated cellulitic legs

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15
Q

What functional valvular dynsfunctions can occur from heart failure?

A

Mitral regurgitation

Tricuspid regurgitation

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16
Q

Which organs are most likely to fail as a result of heart failure

A

Renal failure

Liver failure

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17
Q

What cardiac arrhythmias are most commonly detected in heart failure?

A

Atrial fibrillation
Ventricular fibrillation
Ventricular tachycardia

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18
Q

How may an ECG of somebody with heart failure appear

A
  • Inferior Q waves
  • Anterior T waves and ectopics
  • Left bundle branch block
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19
Q

What may a chest x-ray of somebody with heart failure show?

A
  • Pulmonary congestion

- Pulmonary oedema

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20
Q

Where in BNP secreted from? In response to what?

A

Secreted by myocardial cells in response to raised left atrial pressure

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21
Q

4 changes that occur when BNP levels increase

A
  • Promotes natriuresis
  • Promotes vasodilation
  • Inhibits ADH release
  • Inhibits aldosterone release
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22
Q

What is natriuresis

A

Excretion of sodium in urine

23
Q

How can BNP levels be used to diagnose heart disease

A

Levels of >100pg/ml

24
Q

Describe diagnostic pathway for heart failure if patient has had previous MI

A

Specialist assesment and doppler echo
Abnormal echo= systolic or diastolic dysfunction
Normal echo= heart failure unlikely

25
Q

Describe diagnostic pathway for heart failure if patient has no previous MI

A

Measure BNP levels in blood
If >100pg/ml then do an echo
If abnormal, systolic or diastolic dysfunction
If BNP/ echo is normal, heart failure in unlikely

26
Q

What is the most common kind of heart failure?

A

Systolic heart failure

27
Q

Define systolic heart failure

A

Inability of heart to contract efficiently to eject adequate volumes of blood to meet bodys metabolic demand

28
Q

Define diastolic heart failure

A

Reduction in heart compliance resulting in compromised ventricular filling and less ejection

29
Q

Define left sided heart failure

A

Inability of the left ventricle to pump adequate amount of blood–> pulmonary circulation congestions and pulmonary oedema.

30
Q

Why does left side heart failure often lead to right side heart failure

A

Due to pulmonary hypertension

31
Q

Define right sided heart failure

A

Inability to right ventricle to pump blood leading to systemic venous congestion therefore peripheral oedema and hepatic congestion and tenderness

32
Q

What is congestive heart failure

A

Failure of both left and right ventricles

33
Q

How should a combination of systolic and diastolic heart failure be treated?

A
  • Treat aetilogical and aggravating factors

- Treat fluid retention with diuretics

34
Q

How should systolic heart failure be treated?

A
  • Ace and BB for all grades of heart failure
  • ARBs if ACE is not dolerated
  • Spironolactone (for grade 3 and 4 only)
  • Cardiac resynchronisation therapy
  • Angiontensin receptor neprilysin inhibitor
35
Q

What is spironolactone

36
Q

When is a heart transplant advised for heart failure?

A

Congestive heart failure without any major organ failure, any major co-morbitity, any psychological disability or any severe pulmonary hypertension

37
Q

What procedure is used in heart transplant for heart failure

A

Orthotopic transplant (fully replaced with donor heart)

38
Q

Prognosis for heart transplant patients/

A

80% survive a year

39
Q

Another way of saying diastolic heart failure?

A

Heart failure with normal ejection fraction (HeFNEF)

40
Q

Why is there impaired left ventricular filling in diastolic heart failure?

A

Increased chamber stiffness/ decreased relaxation

41
Q

What % of heart failures are HeFNEF?

A

50% of adult heart failure

42
Q

How are HeFNEFs treated?

A
  • Treat the underlyign cause
  • Treat systolic components
  • Treat fluid retention
  • RAAS inhibition
  • Beta blocker
43
Q

What is acute heart failure?

A

Acute onset of symptoms due to acute event (mi, ruptured valve, ventricular aneurysm)

44
Q

What immediate pharmacological treatments can be offered to a patient in acute heart failure

A

Iv diuretic

Oxygen

45
Q

What immediate non pharmacoligcal treatments can be offered to a patient in acute heart failure

A

Ventilation

Ultrafiltration is diuretic resistant

46
Q

What treatment should be offered to a patient in acute heart failure after theyve been stabilised

A
  • ACE inhibitor/ ARB
  • BB
  • Aldosterone inhibitor
  • Monitor renal function, electrolytes, BP and HR
47
Q

What can cause acute heart failure?

A
  • Acute MI
  • Cardiac tachyarrhythmia
  • Valvular heart disease
  • Acute on chronic heart failure (can be triggered by infection, failure of take drugs)
48
Q

What 4 things occur in acute heart failure that can explain signs and symptoms

A
  • Pulmonary oedema
  • Desaturation
  • Reduced CO
  • Sympathetic activation
49
Q

How does pulmonary oedema present in acute heart failure

A

Severe dyspnoea

50
Q

How does desaturation present in acute heart failure

A

Central cyanosis

51
Q

How does reduced cardiac output present in acute heart failure

A

Cool skin, peripheral cyanosis

52
Q

How does sympathetic activation present in acute heart failure

A

Tachycardia, sweating

53
Q

What heart sound is present in heart failure

CR 2 (33 decks)

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