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Year 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Cause of Heart Failure

A
  1. Hypertension
  2. IHD
  3. Alcohol
  4. Cardiomyopathy
  5. Valvular
  6. Pericardial causes
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2
Q

How does HF effect Venous return

A
  1. Myocardial failure leads to reduction of blood ejected with each beat + increase in volume remaining after systole
  2. Increased diastolic volume stretches myocardial fibres (increased force of contraction) - compensation mechanism
  3. Myocardium eventually fails and can’t be compensated for
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3
Q

How does HF effect Afterload

A

After load - resistance against which LV contracts (increase decreases CO)

As volume of blood ejected increases, after load increases which exacerbates problem

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4
Q

How does HF effect Myocardial contractility

A
  1. HF activates sympathetic NS via baroreceptors - maintains CO
  2. Chronic sympathetic activation causes myocyte apoptosis even if there is temporary increase in contractility
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5
Q

Acute Decompensated CHF vs AHF

A

Generally effects <70 vs 71-76

Male vs Female dominance

LVEF < 40% vs LVEF> 40%

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6
Q

How is LVSD commonly caused

A

IHD, VHD and hypertension

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7
Q

What is diastolic heart failure

A

Heart Failure where stiffness in Lv increases and compliance decreases - impaired LV diastolic filling so decreased CO

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8
Q

Symptoms of HF

A
  1. Dyspnoea
  2. Fatigue
  3. Tachycardia
  4. Cardiomegaly
  5. Pleural effusion
  6. Fourth heart sounds
  7. Ascites
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9
Q

How is HF investigated in blood tests

A
  1. Full blood count, thyroid function, cardiac enzymes
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10
Q

How is Hf diagnosed

A

Echocardiography

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11
Q

How does an electrocardiogram help with AF

A

Identifies Ischaemia, hypertension

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12
Q

CXR in HF diagnosis

A

Looks for pulmonary congestion

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13
Q

What two systems are involved in the heart failure syndrome

A
  1. Sympathetic system
  2. RAAS
  3. Inflammation
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14
Q

How does the sympathetic system lead to HF

A
  1. Increased NE released from cardiac cells
  2. SHort-term increase of CO
  3. B-receptor transduction is altered
  4. Progressive myocardial dysfunction
  5. HF
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15
Q

How does the RAAS system cause HF

A
  1. Increase in venous pressure occurs when ventricles fail cause retention of Na and water and accumulation in interstitium
  2. Reduced CO causes reduced renal perfusion
  3. RAAS activated
  4. RAAS causes more salt and water retention
  5. Increased ANP to antagonise salt retention
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16
Q

How is RAAS system treated in patients with HF

A
  1. Given Neprilysin inhibitor (sacubitril) which stops angiotensin II -> AT-II (1) - NO VASOCONSTRICTION OR RETENTION
  2. Causes production of AT-II (2) which is vasodilatory
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17
Q

Non-specific symptoms of HF

A
  1. SOB
  2. Fatigue
  3. Ankle swelling
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18
Q

Specific signs of HF

A
  1. JVP
  2. S3
  3. Displaced apex beat
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19
Q

What is the NYHA classification

A

Class I: No Limitation (asymptomatic)
Class II: Slight Limitation (mild HF)
Class III: Marked Limitation (moderate HF)
Class IV: Inability to carry out any physical activity without discomfort (sever HF)

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20
Q

Stages of HF

A

1, High risk

  1. Asymptomatic
  2. Symptomatic HF
  3. End-stage HF
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21
Q

Causes of acute decompensation of CHF

A
  1. NSAIDS
  2. treatment noncompliance
  3. Excess alcohol
  4. Obesity
  5. Uncorrected high BP
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22
Q

Complications of ADCHF

A
  1. Renal dysfunction
  2. Rhythm disturbances
  3. Hepatic dysfunction
  4. DVT
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23
Q

Why are diuretics (thiazides) given in AF

A

Promotes renal excretion of Na and water by blocking Na/Cl co-transporters (will cure oedema and dyspnoea)

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24
Q

How does ACEI (angiotensin-converting enzyme inhibitors) help with AF

A

1, Reduce mortality

2. Less Effective in blacks

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25
Q

Name an aldosterone antagonist

A

Spironolactone

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26
Q

side-effects of aldosterone antagonists

A

Hyperkalaemia

Renal impairment

27
Q

What beta-blocker should be given to AFs

A

Bisoprolol - increases heart function

28
Q

When should ARBs (angiotensin receptor blockers) be given

A

If a patient is experiencing side-effects and intolerance to ACEI

29
Q

What arterial and venous dilators should be given

A

Hydralazine and Nitrates as a combo

30
Q

When is Hydrazine and nitrates given

A

Patient tolerant to ACEI

31
Q

What do we do with HF that has preserved left ventricular ejection fraction

A

Diuretics to deal with congestion

Aldosterone antagonists possibly (don’t write in exams)

32
Q

Consequence of Ankylosing spondylitis and AF

A

Surgery needs to done

33
Q

What is Hibernating Myocardium

A

Reversible Left ventricular dysfunction that responds positively to inotropic stress

Revascularisation could cause it to recover.

34
Q

how is Hibernating Myocardium caused

A

Decreased myocardial perfusion allows viability of heart muscles to be maintained

35
Q

Name four common surgeries involved with HF

A
  1. Mitral valve repair
  2. Aortic valve replacement
  3. Mitral valve replacement
  4. Lv re-modelling
36
Q

When should re-synchronisation and defibrillators be used

A
  1. Defibrillator reduces arythmie mortality

2. Multi-site pacing

37
Q

What is Left-sided heart failure

A

The left side of the heart is responsible for receiving oxygenated blood from lungs.

Inability of LV to pump blood through aorta causes blood to move back into the lungs = congestion

Increased pressure in pulmonary circuit = pulmonary oedema

Decreased oxygenated blood travelling around the body = cyanosis, dyspnoea, difficulty breathing due to oedema causing pericardium to thicken, increased rate of breathing

38
Q

Heart sounds in left-sided heart failure

A
  1. Laterally displaced apex beat (due to enlarged heart)

2. S3 gallop due to increased blood flow from atria to ventricles

39
Q

What is right-sided heart failure

A

COR PULMONALE:
Venous system dilates causing oedema in the lower legs
Liver can’t move blood through hepatic vein back to heart = liver enlargement
Jugular venous pressure raised
Nocturne
Ascites

40
Q

Why does right-sided heart failure cause nocturia

A

From fluid returning back to blood stream when lying down at night

41
Q

Define acute decompensated heart failure

A

Sudden worsening of symptoms of heart failure

42
Q

Signs and symptoms of decompensated heart failure

A
  1. Difficullty breathing
  2. Epsides of waking up from sleep gasping
  3. Pulmonary oedema
43
Q

What causes acute decompensated heart failure

A

MI
Pneumonia
AFs

Recurrent infections basically

44
Q

Clinical signs of acute decompensated heart failure

A

Jugular venous distention (most probable sign)

45
Q

Systolic vs diastolic heart failure

A

Systolic: Reduced ejection fraction
Diastolic: Preserved ejection fraction

46
Q

What can causes systolic heart failure

A

Restrictive pericarditis

47
Q

What can cause diastolic heart failure

A

Cardiac tamponade and pericarditis

48
Q

Clinical presentation of an aortic dissection

A
  1. Vomiting
  2. Sweating
  3. SEVERE CHEST OR BACK PAIN (tearing feeling)
  4. MI
  5. Pleural effusions
49
Q

Risk factors for aortic dissection

A
  1. High BP
  2. Ehlers Danlos syndrome (effects connective tissue of blood vessels)
  3. Bicuspid aortic valve
50
Q

Pathophysiology of aortic dissection

A
  1. Blood penetrates intimate and enters the media

2. High pressure rips media tissue apart, forming a false lumen through which blood flows through

51
Q

How is aortic dissection diagnosed

A
  1. D-dimer test
  2. Chest X-Ray to see widening mediastinum + Pleural effusions
  3. CT angiography
  4. MRI
  5. Transoesophageal Echocardiogram
52
Q

How is aortic dissection treated

A
  1. Propranolol
  2. Nitrates

If propranolol is contraindicated, then verapamil or dilitiazem (calcium channel blockers)

Open aortic surgery

53
Q

Definition of hypertension

A

<140/90 mmHG

54
Q

What is primary essential hypertension

A

Hypertension with no identifiable cause

55
Q

What causes primary essential hypertension

A
  1. Genetic factors

2. Diet (increased Na, insulin resistance, endothelial dysfunction etc)

56
Q

What is the classic symptoms of peripheral vascular disease

A
  1. Leg pain when walking that resolves with rest - INTERMITTENT CLAUDICATION
57
Q

Clinical presentation of peripheral vascular disease

A
  1. Intermittent claudication (because during exercise, leg needs more oxygen and nutrients)
  2. Critical limb ischaemia
  3. Gangrene
58
Q

What is critical limb ischaemia

A
  1. Obstruction to blood flow is so bad that the leg can’t be oxygenated at rest either
59
Q

Clinical presentation of critical limb ischaemia

A
  1. Pain at rest
  2. Cold
  3. Numbness
  4. Gangrene and ulcers
60
Q

Risk factors for PVD

A
  1. Smoking
  2. Diabetes Mellitus (high blood sugar)
  3. Hyperlipidaemia
  4. Hypertension
  5. Black Men
61
Q

Diagnosis of PVD

A
  1. Decreased or absent pulses
  2. Muscle wasting
  3. Cyanosis
  4. Coolness of the limb
  5. Thickened nails
  6. Hair loss on skin
  7. Buerger’s test for pallor
62
Q

How is PVD treated

A
  1. SMOKING CESSATION
  2. REGULAR EXCERCISE

Manage diabetes, hypertension and hyperlipidaemia

e.g. simvastatin, warfarin, aspirin and clopidogrel

Third line: REVASCULARISATION (angioplasty)
Thrombolysis
Atherectomy

63
Q

Diagnosis of PVD

A
  1. Ankle, Branchial Index (less than 0.9 is PVD)
  2. Then lower limb doppler ultrasound
  3. X-ray
  4. CT
  5. Magnetic Resonance Angiography

Year 2 (155 decks)

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