Heart failure Flashcards
What is HF
Inability of cardiac output to meet the physiological demands of the body
Different classifications of HF
Left ventricular failure
Right ventricular failure
Low output and high output heart failure
Symptoms of Left ventricular failure
Paroxysmal nocturnal dyspnoea
Wheeze
Nocturnal cough with pink sputum due to pulmonary oedema
What causes the pink sputum in Left Ventricular Failure
Pulmonary oedema
Symptoms of Right ventricular failure
Usually caused by LVF or: Lung disease Peripheral oedema Ascites Raised JVP (Kussmaul sign)
Cause of low output and high output heart failure
Excessive afterload, excessive preload or pump failure
Causes of HF
Anything that causes myocardial damage may lead to heart failure: Coronary artery disease Hypertension Atrial fibrillation Valve disease Cardiomyopathies Infective endocarditis Anaemia Endocrine disorders Cor pulmonale
What is cor pulmonale
Right ventricular failure secondary to pulmonary disease
Causes of left-sided HF
Coronary artery disease Hypertension Aortic valve disease Mitral valve disease Myocardial disease
Causes of right-sided HF
Left-sided HF
Tricuspid valve disease
Pulmonary valve disease
Pulmonary vascular disease
Pathophysiology of congestive HF (CHF)
Left or Right-sided heart failure leads to Ischaemic Injury and thus reduced myocardial efficiency:
-Increased workload of heart muscles
-Decreased cardiac output
-Decreased contractility
Activates compensatory mechanisms
Chronic activation of these compensatory mechanisms worsens HF and leads to increased cardiac damage
Decrease compensatory mechanisms after ischaemic injury leads to increased workload and decreased CO and contractility
- Activation of Renin Angiotensin Aldosterone system (RAAS) causes Na+ ion and H2O retention and peripheral vasoconstriction. This increases preload
- Activation of the sympathetic NS increases heart rate and causes peripheral vasoconstriction. This increases afterload.
- Increased myocyte size
What can result from chronic activation of these compensatory mechanisms to HF
Worsens HF ad leads to increased cardiac damage
What causes cardiac dilation
Increased End-Diastolic volume
What is raised Jugular venous pressure (JVP) related to?
Right-sided heart failure
Fluid overload
What causes hepatomegaly
Congestion of the hepatic portal circulation
Complications
Renal failure
Valve dysfunction
Stroke
Classifications of HF
Framingham Criteria for Congestive Heart Failure
New York Heart Association Classification for Heart Failure
Describe the Framingham Criteria for Congestive Heart Failure
2 major criteria or 1 major and 2 minor criteria: Major criteria: PAINS Paroxysmal nocturnal dyspnoea Acute pulmonary oedema Increased heart size; Increased central venous pressure Neck vein dilation S3 gallop Minor criteria: PAIN Pleural effusion Ankle oedema (bilateral) Increased heart rate (>120 beats/min) Nocturnal cough
Describe the New York Heart Association Classification for Heart Failure
I: No limitation of physical activity
II: Slight limitation of physical activity
III:Marked limitation of physical activity
IV: Inability to carry out physical activity
Investigations
Bloods
CXR
ECHO - aims to identify cause and assess function of the heart
ECG
Blood investigations
FBC, U and Es, LFTs, TFTs, Lipid profile
BNP (Brain Natriuretic Peptide)
Why is BNP important to test for
It suggests how much the myocytes are stretched.
BNP is arguable cardio-protective as it causes Na+ ion and H2O excretion in addition to vasodilation.
What BNP concentrations are suggestive of HF
> 400pg/mL (>116 pmol/L)
Describe CXR of HF
ABCDE: Alveolar oedema kerley B lines Cardiomegaly Dilated upper lobe vessels pleural Effusion
Conservative treatment
Smoking cessation advice
Weight loss
Promotion of healthy diet
Exercise
Surgical treatment
Heart transplant
Medical treatment
ABCDDS
Angiotensin converting enzyme inhibitors
Beta-blockers
Candersartan (Angiotensin Receptor Blocker)
Digoxin
Diuretics (Furosemide)
Spironolactone (Aldosterone receptor antagonist)
Legal Beta-blockers in UK
Bisoprolol
Carvedilol
What is digoxin
cardiac glycoside
