Heart Failure Flashcards by Alice Scholfield

In heart failure more common in men or women?

Men

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How does heart failure incidence change as you age?

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

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2 widely accepted definitions of heart failure

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 main causes of heart failure

Coronary artery diseases
Hypertension
Cardiomyopathy
Valvular heart disease

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4 aggravating factors of heart failure

Cardiac arrhythmias
Hypertension
Anaemia
Infections

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

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

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What symptoms and signs result from reduced cardiac output

Symptoms= fatigue
Signs= cool skin, peripheral cyanosis

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What signs and symptoms result from fluid retention

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

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What are ascites

abnormal fluid collection in perineal cavity

Distended stomach

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What signs result from increased sympathetic activity

Tachycardia

Sweating

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How might the pulse appear in somebody with heart failure

Alternating pulse

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Name 6 complications that can result from heart failure

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

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What examples of intravascular thrombosis can result from heart failure

Pulmonary embolism

Systemic embolism

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What infections most commonly result from heart failure

Chest infection

Ulcerated cellulitic legs

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What functional valvular dynsfunctions can occur from heart failure?

Mitral regurgitation

Tricuspid regurgitation

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

Renal failure

Liver failure

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What cardiac arrhythmias are most commonly detected in heart failure?

Atrial fibrillation
Ventricular fibrillation
Ventricular tachycardia

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How may an ECG of somebody with heart failure appear

Inferior Q waves
Anterior T waves and ectopics
Left bundle branch block

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

Pulmonary congestion

- Pulmonary oedema

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Where in BNP secreted from? In response to what?

Secreted by myocardial cells in response to raised left atrial pressure

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4 changes that occur when BNP levels increase

Promotes natriuresis
Promotes vasodilation
Inhibits ADH release
Inhibits aldosterone release

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What is natriuresis

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Excretion of sodium in urine

How can BNP levels be used to diagnose heart disease

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Levels of >100pg/ml

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

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

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

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

What is the most common kind of heart failure?

Systolic heart failure

Define systolic heart failure

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

Define diastolic heart failure

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

Define left sided heart failure

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

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

Due to pulmonary hypertension

Define right sided heart failure

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

What is congestive heart failure

Failure of both left and right ventricles

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

- Treat aetilogical and aggravating factors | - Treat fluid retention with diuretics

How should systolic heart failure be treated?

- 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

What is spironolactone

Diuretic

When is a heart transplant advised for heart failure?

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

What procedure is used in heart transplant for heart failure

Orthotopic transplant (fully replaced with donor heart)

Prognosis for heart transplant patients/

80% survive a year

Another way of saying diastolic heart failure?

Heart failure with normal ejection fraction (HeFNEF)

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

Increased chamber stiffness/ decreased relaxation

What % of heart failures are HeFNEF?

50% of adult heart failure

How are HeFNEFs treated?

- Treat the underlyign cause - Treat systolic components - Treat fluid retention - RAAS inhibition - Beta blocker

What is acute heart failure?

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

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

Iv diuretic | Oxygen

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

Ventilation | Ultrafiltration is diuretic resistant

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

- ACE inhibitor/ ARB - BB - Aldosterone inhibitor - Monitor renal function, electrolytes, BP and HR

What can cause acute heart failure?

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

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

- Pulmonary oedema - Desaturation - Reduced CO - Sympathetic activation

How does pulmonary oedema present in acute heart failure

Severe dyspnoea

How does desaturation present in acute heart failure

Central cyanosis

How does reduced cardiac output present in acute heart failure

Cool skin, peripheral cyanosis

How does sympathetic activation present in acute heart failure

Tachycardia, sweating

What heart sound is present in heart failure

Heart Failure Flashcards

(53 cards)