Heart Failure Flashcards
What are the symptoms of heart failure?
Fatigue/exhaustion Breathlessness Lack of exercise capacity orthopnoea paroxysmal nocturnal dyspnoea
What are the signs of heart failure?
Oedema Tachycardia Raised JVP Crepitations Pleural effusions Bi basal crackles 3rd heart sound Displaced or abnormal apex beat Cardiomegaly Tender hepatomegaly
What do you need for the diagnosis of heart failure?
Symptoms or signs of heart failure And Objective evidence of cardiac dysfunction And Response to therapy (diuretics)
What investigations can be carried out to help diagnose heart failure?
Blood test Chest Xray ECG ECHO Stress cardiography radionucleotide scan Left ventriculogram Cardiac MRI Cardiac catheterisation Cardiac biopsy
BNP is a highly sensitive test for heart failure
However you have to be cautious because BNP can be elevated due to what?
atrial fibrillation
Old age (in the elderly)
Valve disease
When taking a history, what might you ask to rule out any causes?
Hillwakers? (Lyme disease) HIV? post partum? Alcohol? High blood pressure? Previous MI? Familial dilated cardiomyopathy?
Why can the ejection fraction be difficult to quantify accuratly and reproducibly by echo?
Quality of images Experience of operator Calculation method Use of contrast agents Time consuming to perform accuratly
What are values for severity of ejection fraction?
Normal 50-80%
Mild 40-50%
Moderate 30-40%
Severe <30%
Why is ejection fraction not the best indicator of heart failure?
Becauze someone with LV systolic dysfunction causing heart failure can still have a normal ejection fraction
Describe the bilane modified simpsons rule for measurement of ejection fraction.
Divides Left ventricle into multiple slices of known thickness and diamter
Volune of each slice is equal to the area x thickness
What makes the simpsons rule for measurement of ejection fracture more accurate?
Thinner cut slices of the ventricle
What is the disadvantage of MUGA?
Ionising radiation
No additional structural information
What are the benefits of MRI for left ventricular ejection fraction?
Gold standard for assesment of LVEF
greater reproducability
Added information about aetiology such as fibrosis, infiltration and oedema
Information about valves
What are the disadvantages about MRI for LVEF?
Time consuming- approx 1 hour
Patient compliance - breath holds, claustrophobic, ability to lie flat
Specialist centers
Long waiting lists
What is thr modern pharmacological treatment of heart failure due to LV systolic dysfunction?
Diuretics ACE inhibitors Beta blockers Aldosterone receptor blockers ARNI’s
What are the 2 possible screening tests for heart failure?
12 lead ECG
BNP
Name causes of left ventricular systolic dysfunction.
Ischaemic heart disease Secere attioventricular AV disease or mitral regurgitation Dilated cardiomyopathy DCM Inherited Toxins Viral Systemic diseases i.e sarcoidosis Peri partum cardiomyopathy Hypertension End stage hypertrophic cardiomyopathy End stage arrythmigenic RV cardiomyopathy RV pacing induced cardiomyopathy
By taking a blood test for diagnosis what do you want to exclude?
Anaemia
Renal failure
Hypo or hyperthyroidism
When is a coronary angiography required in the diagnosis for the cause of heart failure?
If the patient has heart pain
Why is an ECHO an essential investigation in the diagnosis ?
An ECHO identifys and quanitfys; LV systolic dysfunction Valvular dysfunction Pericardial effusion/ tamponade Diastolic dysfunction Left ventricular hypertrophy Atrial/ventricular shunts/ complex congenital heart Pulmonary hypertension Right heart dysfunction
Diagnosis of heart failure with LV diastolic dysfunction requires what conditions to be satisfied?
symptoms typical of HF
signs typical of HF
reduced left ventricular ejection fraction
Describe the algorithm for the diagnosis of heart failure.
signs and symptoms of heart failure then get an ECG and chest-Xray
If its abnormal then do ECHO
If abnormal then assess aetiology, degree of HF and type of cardiac dysfunction with other tests as appropriate.
Then choose treatment
What are the risk factors for heart failure?
Hypertension Coronary artery disease Valvular heart disease Alcoholism Infection (viral) Diabetes Congenital heart defects Other: age, obesity, smoking, high/low hematocrit levels, obstructive sleep apnoea
What is the no.1 risk factor for heart failure and how does this vary with sex?
Hypertension is the no.1 risk factor
It is even more so in women compared to men
(Men have almost equal risk with previous MI whereas women show a much greater risk with having hypertension compared to a previous MI)
Myocardial injury causes ……….. stimulation?
Neurohormonal
What is frank-starling law?
If the muscle of a healthy heart is stretched it will contract with greater force and pump out more blood.
Therefore C0 is proportional to the initial stretch of the muscle
Sustained hypertension usually causes what type of dysfunction to the heart?
And what type of heart failure is this termed?
Diastolic dysfunction
Preserved ejection fraction heart failure
How does Heart failure result in oedema?
Failure in the heart to pump efficiently results in a decrease in CO.
The body registers this a reduction in blood volume which stimulates the RAAS system and release of ASH.
This triggers progressive vasodilation and salt and water retention resulting in oedema and pulmonary oedema.
The failure of the heart to pump also causes blood to back up in the atria and then subsequently into the pulmonary and systemic circulations.
What causes the myocyte hypertrophy?
Sympathetic stimulation
What are the 2 main aims of treatment for heart failure?
To improve symptoms
To improve survival
Which drugs improve survival?
Beta blockers Ivabradine ACE inhibitors ARB’s Spironolatone Vallarta’s-sacubitril
What is the action of spironolactone?
Blocks aldosterone
What type of drug is digoxin?
Possitive ionotrope
What is the function of the loop diuretic furosemide?
Removes excess salt and water by inducing profound dieresis
Inhibits the Na-K-Cl transporter in the loop of Henle
