Heart Failure Flashcards
What is the mechanism behind systolic HF?
Ventricles enlarged
Unable to contract fully
↓CO + ejection fraction < 40%
What are the causes of systolic HF?
IHD
MI
Cardiomyopathy
What is the mechanism behind diastolic HF?
Stiff ventricles cannot relax fully
↑filling pressure
Ejection fraction > 50%
What are the causes of diastolic HF?
Constrictive pericarditis
HTN
Cardiomyopathy
How are HF causes divided?
LOW OUTPUT = reduced heart function
HIGH OUTPUT = Heart working at normal/inc rate but body has greater demand
What are the causes of low output HF?
Inc pre-load: MR, fluid overload
Pump failure: IHD, MI, (restrictive) Cardiomyopathy, AF, tamponade
Chronic excessive overload: AS, HTN
What are the causes of high output HF?
Hyperthyroid
Anaemia
Paget’s
AV malformation
What are the Sx of LVF?
Dyspnoea → Orthopnoea → PND Nocturnal cough- pink frothy sputum ↓weight Muscle wasting Fatigue/lethargy Cyanosis Basal creps Displaced Apex beat Pulsus alternans
What are the Sx of RVF?
Peripheral oedema (calfs & ascites) N&V (pressure on stomach) Dyspnoea ↑JVP ↑Weight Poor exercise tolerance Confusion
How is HF investigated?
ECG BNP CXR Bloods: FBC, U&E, LFT, TFT, Lipids, Glucose Urine dip: Check for proteins
What is seen on an ECG in HF?
Exaggerated R waves V1-6 = LVH
Inverted R waves V1-6 = RVH
Axis deviation
What do the different BNP levels correlate to?
> 400/Prev MI: 2w referral for doppler ECHO
100-400: 6w referral for doppler ECHO
<100: likely not HF
How is acute HF treated?
LMNOP's: L: Loop diuretics 40-80mg Slow IV M: Morphine & Metoclopramide N: Nitrates- 2sprays GTN O: O2 15L/min P: Position- sit up S: SHIT!- CPAP
What needs to be monitored in acute HF in someone on loop diuretics?
U&E eGFR ACR Weight Urine output
How is stable HF initially managed?
1) ACEi: Ramipril → ARB if not tolerated
2) BB: Bisoprolol
FOLLOW-UP in 2w w/HF team
Why are beta-blockers given in HF?
Prevent cardiac remodelling
What surgery can be offered in HF?
AV replacement: Due to severe AS
Implantable cardioverter defibrillator: Prev VT/VF, familial CV condition, surgical repair of congenital HD
What is the NYHA classification of HF?
1: No limitation, normal activity
2: Slight limitation, ordinary activity
3: Marked limitation, less than ordinary activity
4: Unable to carry out activity w/o discomfort, Sx of HF at rest
What additional medications can be given to those of NYHA stage 3-4?
Aldosterone antagonist (Spironolactone)
Hydralazine +/- Nitrate
Valsartan
3rd line: Digoxin
How is cardiomyopathy categorised?
Dilated- MOST COMMON
Hypertrophic- MAIN CAUSE OF DEATH IN YOUNG PTS
Restrictive
What are the causes of dilated cardiomyopathy?
Idiopathic DMD Infection (Coxsackie, Chaga) OH- Drugs (Chemo-Doxorubicin, Cocaine) Peri-partum
What happens in dilated cardiomyopathy?
Dilatation of all 4 chambers Mostly LV = thin walls = weak contractile strength ↓SV (less blood pumped) → systolic HF
What complications can arise from dilated cardiomyopathy?
Arrhythmia: Stretching → pacemaker cell dysfunction
Murmur: Dilated ventricle → Tricuspid & mitral valve fail to close properly = Regurg
What are the causes of hypertrophic cardiomyopathy?
GENETIC: Autosomal Dominant mutation of B-myosin heavy chain or myosin binding protein C
