Heart Failure Flashcards by Thomas Eraifej

Heart failure definition

Cardiac output inadequate for body requirements

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Systolic heart failure definition

Inability of ventricles to contract properly

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Systolic heart failure ejection fraction

< 40%

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Causes of systolic heart failure

IHD

Cardiomyopathy

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Diastolic heart failure definition

Inability of the ventricle to relax and fill properly

Increased filling pressures

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Diastolic heart failure ejection fraction

> 50%

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Causes of diastolic heart failure

Constrictive pericarditis

Tamponade

Restrictive cardiomyopathy

HTN

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Types of heart failure

Systolic heart failure

Diastolic heart failure

Usually co-exist

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Categories of heart failure

Left sided

Right sided

Congestive Cardiac Failure (L+R)

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Acute heart failure / Acute decompensation of chronic heart failure Sx

Pulmonary / peripheral oedema

+/- peripheral hypoperfusion

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Chronic heart failure

Develops slowly

Arterial pressure well mantained until late

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Low output heart failure definition

Low CO

Fails to increase on exertion

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Causes of low output heart failure

Pump failre

Excessive preload

Chronic excessive afterload

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Causes of excessive preload

Fluid overload

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Causes of chronic excessive afterload

HTN

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High output heart failure definition

Rare

Normal CO

Body requirements still not met (eg. greater demand)

Causes of high output heart failure

Anaemia

Pregnancy

Hyperthyroidism

Paget’s disease

Beri beri

Presentation of high output heart failure

Initially RVF

Later LVF

Diagnosis of heart failure

Framingham criteria:

2 major OR
1 major + 2 minor

Major Framingham criteria

PND

Crepitations

Cardiomegaly

Raised JVP

Acute pulmonary oedema

Minor Framingham criteria

Bilateral ankle oedema

SOB on normal exertion

Tachycardia > 120

Nocturnal cough

Hepatomegaly

Pleural effusion

Ix for heart failure

ECG + BNP

Echo if either are abnormal

Mx of chronic heart failure

Conservative

Medical

Conservative Mx of chronic heart failure

Stop smoking

Reduce salt intake

Weight loss

Medical Mx of chronic heart failure

Diuretics / Spironolactone ACEi / Vasodilators Beta blocker Digoxin

New York classification of heart failure

I: No SOB on normal activity II: SOB on normal activity III: SOB on minor activity IV: SOB at rest

BNP

B-type Natriuretic Peptide

BNP level to diagnose heart failure

\> 100 ng/L

BNP level to rule out heart failre

\< 50 ng/L

Causes of RVF

- LVF - Cor pulmonale - Tricuspid and pulmonary valve disease

Cor pulmonale definition

RVF due to lung disease / pulmonary HTN

Right ventricular failure signs

↑JVP Hepatomegaly Oedema Ascites Nausea

Left ventricular failure causes

IHD Idiopathic dilated cardiomyopathy Systemic HTN Mitral and aortic valve disease

Left ventricular failure Symptoms

SOB Orthopnoea + PND Nocturnal cough (± pink, frothy sputum) Cardiomegaly Bibasal creps (Pulmonary oedema)

Acute mx of heart failure / pulmonary oedema

Position pt sitting up O2 Nitrates Morphine + anti-emetic Loop diuretic