Heart failure Flashcards
what are 4 symptoms of heart failure
breathlessness
fatigue
oedema
reduced exercise capacity
what are signs of heart failure
oedema tachycardia raised JVP chest crepitations chest effusions 3rd heart sounds displaced apex beat abnormal apex beat
what are the 4 main tests used for heart failure
ECHO
radionucleotide scan - invasive test
left ventriculogram
cardiac MRI
what are potential screening tests for heart failure
12 lead ECG
BNP
what is BNP screening
brain natriuretic peptide testing
it is a blood test
it measures levels of a protein called BPN
what is BPN
it is a protein made by your heart and blood vessels
what do high levels of BNP indicate
high levels are normal when you have heart failure
what will cause heart failure
any structural heart disease
state some structural heart diseases that cause heart failure
left ventricular systolic dysfunction left ventricular diastolic dysfunction valvular heart disease pericardial constriction pericardial effusion cardiac arrhythmias myocardial ischaemia myocardial infarction restrictive cardiomyopathy right ventricular failure
what is left ventricular systolic dysfunction
it is a condition that often leads to heart failure, it may either be asymptomatic or also have symptoms of heart failure
what is left ventricular systolic dysfunction characterised by
dilation of the left ventricle and also by vasoconstriction
what are the 4 main causes of left ventricular systolic dysfunction
ischaemic heart disease
severe aortic valve disease
severe mitral valve regurgitation
dilated cardiomyopathy
what is aortic valve disease
it is a condition in which the valve between the left ventricle and the aorta doesn’t work properly
what is dilated cardiomyopathy
it is a condition in which the heart’s ability to pump blood is decreased because the heart’s left ventricles is enlarged and weakened
in some cases what does dilated cardiomyopathy prevent
the heart from relaxing and filling with blood as it should
what are investigations of heart failure
ECG CXR ECHO CT coronary angiogram cardiac MRI
most patients should be assessed by a cardiologist
what is the modern pharmacological treatment of heart failure, this is heart failure due to left ventricular systolic dysfunction
diuretics (furosemide) ACE inhibitors (ramipril) ARBs beta blockers (carvedilol) aldosterone receptor blockers (spironolactone) ARNI's (entresto)
what are symptoms of NYHA class 1 heart failure
no exercise tolerance
no symptoms during usual activity
what are symptoms of NYHA class 2 heart failure
mild limitation of exercise tolerance
comfortable with rest or with mild exertion
what are symptoms of NYHA class 3 heart failure
moderate limitation of exercise tolerance
comfortable only at rest
what are symptoms of NYHA class 4 heart failure
severe limitation of exercise tolerance
any physical activity brings discomfort and symptoms occur at rest
what are the main treatments for heart failure
healthy lifestyle changes
medication
devices implanted in your chest to control your heart rhythm
surgery
what are lifestyle changes recommended
stopping smoking eating healthily moderating alcohol consumption cutting down salt intake regular exercise
how are lifestyle changes a form of treatment for heart failure
lifestyle changes can help relieve your symptoms and can reduce your risk of becoming seriously ill
what are some of the medications for heart failure
ACE inhibitors beta blockers angiotensin receptor blockers hydrazine with nitrate diuretics aldosterone antagonists sacubitril valsartan ivabradine digoxin
how are ACE inhibitors medication for heart failure
they work by relaxing and opening up your blood vessels
makes it easier for your heart to pump blood around the bod
what are side effects of ACE inhibitors as a medication for heart failure
dry cough is a common side effect
cause blood pressure to fall too low sometimes
may cause kidney problems
describe beta blockers as medication for heart failure
beta blockers work by slowing your heart rate down, they protect your heart from the effects of adrenaline and noradrenaline
beta blockers protect against fight or flight chemicals produced by the body
what are possible side effects of beta blockers as medication for heart failure
dizziness
tiredness
blurred vision
describe angiotensin receptor blockers as medication for heart failure
work in a similar way the angiotensin converting enzyme inhibitors, they relax blood vessels and reduce blood pressure
when are angiotensin receptor blockers used as medication for heart failure
they are used as an alternative for ACE inhibitors, however, they are not as effective
however angiotensin receptor blockers do not cause cough
what are possible side effects of angiotensin receptor blockers as medication for heart failure
low blood pressure and high levels of potassium in your blood are possible side effects
describe hydrazine with nitrate as medication for heart failure
hydrazine with nitrate in combination can help relax and open up the blood vessels
what are possible side effects of hydrazine with nitrate as medication for heart failure
side effects can include headaches, a fast heartbeat and palpitations
what are diuretics
they are water pills, drugs that make you pass more urine
what do diuretics help relieve
ankle swelling and breathlessness
what are possible side effects of diuretics
dehydration and reduced levels of sodium and potassium in the blood
what is heart failure caused by
many conditions that damage the heart muscle, including coronary heart disease
list conditions that can lead to heart failure
coronary heart disease high blood pressure cardiomyopathy arrhythmias damage or other problems with the heart valves congenital heart disease anaemia excessive alcohol consumption overactive thyroid pulmonary hypertension
state 3 common symptoms of heart failure
breathlessness
fatigue
swollen ankles and legs
state less common symptoms of heart failure
persistent cough wheezing bloated tummy loss of appetite weight gain weight loss confusion dizziness fainting fast heart rate palpitations
state 5 tests for heart failure
blood tests ECG ECHO breathing tests CXR
what is chronic heart failure characterised by
progressive cardiac dysfunction breathlessness tiredness neurohormonal disturbances sudden death
define heart failure
it is the state in which the heart is unable to pump blood at a rate commensurate with the requirements of the tissues or can do so only from high pressures
state 2 types of heart failure
systolic heart failure
diastolic heart failure
what is systolic heart failure
decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure
what is diastolic heart failure
it involves a thickened and stiff heart muscle - the heart does not fill with blood properly
what does diastolic heart failure result in
fluid backup in the lungs and heart failure
what does systolic heart failure result in
fluid back up in the lungs and heart failure
what are the major risk factors associated with heart failure and coronary artery disease
a history of previous myocardial infarction hypertension valvular heart disease alcoholism diabetes congenital heart defects
what are additional heart failure risk factors
obesity age reduced/falling vital capacity smoking high/low haematocrit level
describe frank starling law in relation to systolic dysfunction
the strength of the heart’s systolic contraction is directly proportional to its diastolic expansion with the result that under normal physiological conditions the heart pumps out of the right atrium all the blood returned to it without letting any back up in the veins
what does the renin angiotensin aldosterone system cause the release of
angiotensin 2 and aldosterone
what is pulmonary oedema
it is a condition caused by excess fluid in the lungs, the fluid collects in the alveoli - making it difficult to breathe
what are the 2 goals of heart failure management
improve symptoms
improve survival
what is the treatment to improve symptoms of heart failure
diuretics and digoxin
what is the treatment to improve survival of heart failure
beta blockers and ivabradine
what is the treatment to improve symptoms and survival together of heart failure
ACE inhibitors
ARBs
spironolactone
valsartan-sacubitril
what is a loop diuretic
it is a diuretic which inhibits resorption of water and sodium from the loop of Henle
state 2 adverse drug reactions with diuretics
Severe dehydration
development of gout
state 4 treatments to reduce mortality relating to heart failure
angiotensin blockade
beta receptor blockade
aldosterone blockade
atrial and brain natriuretic peptide enhancement
state 3 angiotensin converting enzyme inhibitors
ramipril
enalapril
lisinopril
what are beta blockers
any of a class of drugs which prevent the stimulation of the adrenergic receptors responsible for increased cardiac action, used to control heart rhythm, treat angina and reduce high blood pressure
what are positive inotropes
agents that
increase the strength of muscular contraction,
increase the quantity of intracellular calcium available for binding by muscle proteins,
increase the sensitivity of contractile proteins to calcium
