Heart Failure Flashcards
What is the background of Heart Failure?
Complex syndrome that results from structural or functional cardiac disorder impairing the ability of heart to function as a pump to support physiological circulation.
What are the pathophysiological changes of Heart Failure?
- Ventricular dilatation
- Myocyte Hypertrophy
- Increased collagen synthesis
- Increase ANP/BNP and C-type peptide
- Salt and Water retention through activation of RAAS
- Sympathetic Stimulation and Peripheral Vasoconstriction
- High ADH
What happens to preload in Heart failure?
- Preload increases due to requirement of the heart to have increase pressure in order for the myocardium to eject a sufficient amount of blood.
- In moderate to severe heart failure this leads to increase backflow leading to fluid in alveoli, hepatic enlargement and ascites.
What happens to afterload in Heart failure?
- Increase in afterload decreases cardiac output.
- Results in further increase of end-diastolic volume
- Leads to dilation of ventricles which further exacerbates problem of afterload.
- Expressed by Laplace’s law
What are clinical syndromes of Heart Failure?
- Left ventricular systolic dysfunction (LVSD) or heart failure and reduced ejection fraction.
- Diastolic heart failure is a syndrome of symptoms and signs of heart failure with preserved (P) left ventricular ejection fraction.
- Right ventricular systolic dysfunction.
What are causes of Heart Failure?
- Ischaemic heart disease
- Cardiomyopathy (dilated)
- Hypertension
- Others:
- Other Cardiomyopathies
- Valvular heart disease
- Congenital heart disease
- Alcohol and drugs
- Hyperdynamic circulation
- Right heart failure
- Tricuspid incompetence
What is the pathophysiology Diastolic Heart?
- Increase stiffness in ventricular wall and decrease left ventricular compliance
- Leads to impairment of diastolic ventricular filling and hence decrease cardiac output.
What are the echocardiographic changes that may be seen in Diastolic Heart Failure?
- Increase left ventricular wall thickness
- Increase atrial size and abnormal left ventricular relaxation with normal or near-normal left ventricular volume.
Which patients are affected by Diastolic Heart Failure commonly?
Diastolic failure more common in elderly hypertensive patients but may occur in primary cardiomyopathies (hypertrophic, restrictive, infiltrative)
What can cause Right Ventricular Systolic dysfunction?
It may be second to chronic LVSD but can occur with primary and secondary hypertension, right ventricular infarction, arrhythmogenic right ventricular cardiomyopathy and adult congenital heart disease
What is a common cause of Left ventricular systolic dysfunction?
It is commonly cause by ischaemic heart disease but also valvular heart disease and hypertension
What are symptoms of Heart Failure?
- Exertional dyspnoea
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Fatigue
What signs are seen on examination in patient with heart failure?
- Tachycardia
- Elevated jugular venous pressure
- Cardiomegaly signified by displaced apex beat
- Third and fourth heart sounds
- Bi-basal crackles
- Pleural effusion
- Peripheral ankle oedema
- Ascites
- Tender hepatomegaly
What are classifications of Heart Failure?
NYHA Class I
- no symptoms
- no limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitation
NYHA Class II
- mild symptoms
- slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea
NYHA Class III
- moderate symptoms
- marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms NYHA
NYHA Class IV
- severe symptoms
- unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity
What are investigations for Heart Failure?
- Blood Test: (U&E’s, TFTs, LFTs, Lipid Profile, Glycosylated Haemoglobin)
- BNP or NT-proBNP
- Chest X-ray
- ECG (ischaemia, hypertension or arrythmia)
- Echocardiography
- Cardiac MRI (assess structure, function and viability of dysfunction myocardium)
- Cardiac Catheterisation (for diagnosis of IHD, measure of PA pressure, LA pressure and Left ventricular end-diastolic pressure)
- Cardiac Biopsy (amyloid)
- Cardiopulmonary Exercise testing
