Heart Failure Flashcards
How do we define heart failure?
as a complex clinical syndromethat can occur from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with, or eject blood (Hunt, Baker et al. 2001).
Is heart failure a disease or a syndrome?
it is a syndrome, not a pathological condition like myopathy - just because you have myopathy doesn’t mean you have heart failure
Is all failure caused by failure of the heart to pump?
no - could have high output cardiac failure due to anaemia, thyrotoxicosis, and arterio-venous malformations
What is systolic heart failure? what about diastolic heart failure?
systolic heart failure = trouble pumping blood
diastolic heart failure= trouble filling with blood
can you have both diastolic and systolic dysfunction?
yes - systolic dysfunction is often accompanied by a failure to fill left ventricle - therefore systolic/diastolic go hand in hand
is the depolarization or repolarization part of cardiac activity most disturbed in heart failure?
The passive part of muscle contraction is the depolarization, therefore the ’repolarization’ is the part that is generally disturbed in hart failure
is diastolic or systolic left ventricular dysfunction more common?
systolic dysfunction is more common
what is the muscle in the heart’s response to heart failure
muscle in the heart switches on the ‘fetal gene program ‘ so it goes from being nice muscle to floppy muscle
What are the symptoms of heart failure?
Dyspnoea
chest pain
oedema
fatigue
early satiety
palpitations
syncopy
what is the physiological response to heart failure?
- salt retention
- water retension
- circulatory shift
- initially these are helpful as increased circulating volume maintains adequate cardiac output = but it eventually becomes counter productive - leads to increased stretch on myocardium
Where is angiotensin made? Where is it converted?
angiotensin made in liver
converted in the renal renin
then lung ACE convertes Angiotensin 1 to angiotensin 2
what is the mortality of heart failure?
up to 50% mortality in 5 years - certain subgroups have worse prognosis than metastatic cancer!
what are some of the most important causes of heart failure?
- coronary artery disease (most common cause in developed economies)
- hypertension (particularly important cause of diastolic heart failure)
- cardiomyopathy
- toxic - alcoholic myocardopathy, cocaine, or chemotherapy drugs
- valvular heart disease
- arrhythmias
what is the term ‘remodelling’ as it relates to heart failure?
important to understand progression of left ventricular dysfunction
initial compensatory hypertrophy of the muscle follows with fibrosis, dilation and progressive dysfunction
as a rule, volume overload causes what in the heart?
causes chamber dilatation (i.e. aortic incompetence, mitral regurgitation)
what are the different types of cardiomyopathy?
dilated
hypertrophic (thickend heart)
arrhythmogenic right ventricular cardiomyopathy
restrictive cardiomyopathy
*often these are genetic/famiial
what are the major classes of cardiomyopathy?
ischaemic vs. non-ischaemic
systolic vs . diastolic
what are the symptoms of heart failure?
dyspnoea on exertion
paroxysmal noctural nyspnea
tachycardia
cough
haemoptysis
abdominal pain
anorexia
nausea
bloating
swelling
*all of these are the same wehther diastolic/systolic heart failure*
how do we determine diastolic vs. systolic heart failure?
depends on their ejection fraction
if greater than 40% = diastolic heart failure
if less than 40% = systolic heart failure
but remember that almost all systolic heart failure has a component of diastolic failure.
What are the different classes of heart failure according to the new york heart association?
Class I: No symptoms with ordinary activity
Class II: Slight limitation of physical activity. Comfortable at rest,
but ordinary physical activity results in fatigue,
palpitation, dyspnea, or angina
Class III: Marked limitation of physical activity. Comfortable at
rest, but less than ordinary physical activity results in
fatigue, palpitation, dyspnea, or anginal pain
Class IV: Unable to carry out any physical activity without
discomfort. Symptoms of cardiac insufficiency may be
present even at rest
what are the ‘signs’ of heart failure?
basilar rales
pulmonary/peripheral oedema
S3 Gallop?
pleural effusion
cheyne stokes respiration
jugular venous distention
abdominal-jugular reflux
hepatomegaly
