- HEART FAILURE - Flashcards
Outline the left ventricular function and how it relates to the presentation of left heart failure
- Pressure builds in the left ventricle
- The left ventricle is unable
to pump all the blood forward - This forces blood back into the pulmonary vasculature
- Increased hydrostatic pressure in the pulmonary system
- this causes fluid to be forced into the interstitium
Define heart failure
Heart unable to maintain sufficient cardiac output to meet metabolic demands of the body
List the causes of heart failure
- altered myocardial function
- ventricular remodelling (changes in the physical structure of the heart – usually additional cells being created)
- altered haemodynamics (decreased preload/afterload)
- neuro-hormonal & Cytokine activation vascular and endothelial dysfunction (plaques and fibrotic plaques forming etc.)
List the ‘types’ of heart failure
- acute heart failure or chronic heart failure
- Left of Right sided heart failure
- Systolic or diastolic
Describe the SNS compensatory mechanisms that occur in the development of diastolic heart failure
Sympathetic Nervous System (SNS) activation:
- decreased SV
- decreased CO
- increase SNS activation
- catecholamine release - adrenaline and noradrenaline secretion (+ve inotropes)
- increased afterload (alpha 1 receptor activation)
- increased HR (beta 1 receptor activation)
- increase myocardial contractility
Describe the physiological compensatory mechanisms that occur in the development of systolic heart failure
- Contractility affected by diseases reduce myocyte activity
- Results in inflammatory, immune and neuro-hormonal responses
- Activation of SNS and RAAS systems
- Results in dilation of myocardium (ventricular remodelling) and progressive myocyte dysfunction
- Decreased contractility and SV
- Increase in LVEDV and preload
List the clinical manifestations of left sided heart failure
- Additional heart failure (S3 & S4)
- Abnormal pulses
- Crackles in lungs (pulmonary oedema)
- Changes in mental state
- Increased heart rate
- Pleural effusion
- Restlessness and/or confusion
- Fatigue
- Anxiety, depression
- Dyspnoea, Tachypnoea, Orthopnoea
- Dry cough or pink frothy sputum
- Chest pain
- Nocturia
Describe the adaptive changes to the myocardial structure in chronic heart failure
Dilated – greater volume in ventricle (can increase CO in short term, but not long term because of reduced muscle)
Hypertrophic - increase in muscle to try and give increased force of contraction (can work short term, but long term not enough volume in LV)
Restrictive – least common form of HF – Fibrotic changes – decreased volume, decreased elacticity and contractility
Discuss the pharmacological management of heart failure
- Inotropic therapy
- Digoxin
- Adrenaline
- Dobutamine
- Milrinone
- Angiotensin concerting enzyme inhibitors (Enalopril, Captopril)
- Angiotensin II receptor blockers (Irbesartan)
- Vasodilator drugs (GTN)
- Beta Blockers (Bisoprolol, Carvedolol, Metoprolol)
Discuss the non-pharmacological management of heart failure
- haemodynamic monitoring and documentation
- patient education
- Potential revascularisation and surgical interventions
- Possible biventricular pacemaker
- Heart replacement strategies
Describe the Neuro-hormonal compensatory mechanisms that occur in the development of diastolic heart failure
Neuro-hormonal Response
- CO falls
- decreased flood flow to kidneys
- (decreased GFR)
- kidneys activate the RAAS
- decreased cerebral perfusion pressure
- production of entothelin
- inflammatory markers are released
In diastolic heart failure, the Neuro-hormonal (RAAS) combined with SNS response have what physiological effects?
- increase in cardiac workload
- increase myocardial demand
- myocardial dysfunction
- ventricular remodelling
Outline the right ventricular function and how it relates to the presentation of right heart failure
- Inability right ventricle to provide adequate flow to pulmonary circulation at normal CVP
- Due to LHF increasing pulmonary pressures
- RV unable to cope – dilates and fails
- Pressure builds up in the right ventricle
- The right ventricle is unable to pump the blood forwards
- This forces fluid back systemically
- This causes the signs and symptoms seen in this picture
Discuss the goals of heart failure management
- Identify cause and treat
- Decrease intravascular volume
- Decrease venous return (preload)
- Decrease afterload
- Improving gas exchange and oxygenation
- Improve cardiac function
- Reduce anxiety
List the clinical manifestations of right sided heart failure
- Murmurs
- JVP elevation
- Peripheral oedema
- weight gain
- Increased heart rate
- Ascites
- Enlarged liver
- Fatigue
- Anxiety, depression
- RUQ pain
- Nausea
- Chest pain
