Heart Failure Flashcards
Define Heart Failure
Heart failure is defined as a condition where there is an abnormality of the structure and function of the heart to deliver oxygen to meet the metabolic demands of metabolizing tissue despite normal filling pressures.
Describe the two types of dysfunction associated with heart failure and compare what occurs here with normal heart function
Normal function: ventricles fill with blood and pump out 60% of blood
Systolic dysfunction: the enlarged ventricles fill with blood but pump out between 40 -50% of the blood from the ventricles.
Diastolic dysfunction: the ventricles are stiff, and as a result fill with less blood. They still pump out 60% of however much blood fills the ventricles
What is the Frank-Starling Law?
Cardiac Output= Heart Rate * Stroke Volume
What is Left Ventricular Systolic Dysfunction?
This is heart failure with a reduced ejection fraction
Which of these is not associated with heart failure?
a. Dyspnoea
b. Fatigue
c. Bradypnoea
d. Peripheral oedema
e. Orthopnoea
c. Bradypnoea - Bradypnoea is defined as having fewer breaths per minute, a heart failure would have more breaths per minute.
Which of these is not associated with heart failure?
a. Elevated venous jugular pressure
b. Paroxysmal nocturnal dyspnoea
c. Increased exercise tolerance
d. Irregular pulse
c. Increased exercise tolerance - should be decreased exercise tolerance
What are the 4 classes associated with the New York Heart Association (NYHA) classification of
symptoms of heart failure and the symptoms associated with each class?
Class 1- No limitations with ordinary physical activity
Class 2- Slight limitation with dyspnoea on moderate to severe exertion
Class 3- Marked limitation- less than severe activity causes dyspnoea
Class 4- Severe disability dyspnoea at rest
7 common causes of heart failure include:
- Coronary artery disease
- Valvular disease
- Arrhythmia
- Cardiomyopathy (familial or acquired)
- Congenital heart disease
- Non-cardiac causes e.g. anaemia, pregnancy
- Hypertension
Name 4 ways in which heart failure can be diagnosed
Chest X-Ray
Echocardiogram
Electrocardiogram
NT-proBNP
List 5 goals of heart failure treatment
Relieve or reduce symptoms Prevent hospital admission Improve quality of life Improve survival Slow disease progression
Treatment algorithm for Heart Failure:
ACE/ARB
B-blocker
Spironalactone
Add diuretics for symptomatic relief
Add digoxin in AF and symptomatic with 1st/2nd line
Add Ivabradine in SR and when HR >75 bpm and
symptomatic with 1st/2nd line
Which diuretics are preferred more for symptomatic relief: loop or thiazide and why?
Loop because they produce a more intense and shorter diuresis
Name the 4 types of diuretics and how they act
Carbonic anhydrase inhibitors - these inhibitors inhibit carbonic anhydrase (CA) situated in the PCT- less H+ is generated so less Na+ exchanged with H+ from the Na+/H+ exchanger so more Na+ in the nephron -> more excreted
Loop Diuretic - Loop diuretics work by inhibiting a Na+/K+/Cl- cotransporter found in the thick ascending limb of the loop of Henle
Thiazide Diuretic - Inhibits a Na+/CL- transporter in the DCT
Aldosterone Antagonist - Inhibits Na+ reabsorption by inhibiting aldosterone binding to the collecting duct and some parts of the DCT
Name three instances where ACEi are contraindicated
Angiodema, bilateral renal artery stenosis and chronic aortic stenosis
What are side effects associated with B-blockers?
a. Bradycardia
b. Fatigue
c. Peripheral vasoconstriction
d. Erectile dysfunction
e. Bronchospasm
f. All of them
I think all of them
