Heart Failure Flashcards
what is the pathophysiology of decompensated heart failure ?
Progressive dilatation → impaired contractility +
functional valve regurgitation
Hypertrophy → relative myocardial ischaemia
RAS activation → Na+ and fluid retention → ↑ venous
pressure → oedema
Sympathetic excess → ↑ afterload → ↓ CO
what are the three causes of low output heart failure?
pump failure
excessive preload
excessive after load
what are some causes of excessive preload?
AR, MR, fluid overload
what are some causes of excessive after load?
aortic stenosis
HTN
HOCM
what are some causes of pump failure
systolic failure (impaired contraction) - MI, dilated cardiomyopathy, HTN, myocarditis
diastolic failure (impaired filling) - pericardial effusion, restrictive cardiomyopathy
arrhythmias
what are some causes of high output heart failure?
anaemia AVM (arteriovenous malformation) thyrotoxicosis thiamine deficiency (beri beri) pregnancy pagets
what is beri beri ?
chronic thiamine deficiency
- wet beri beri (affects CVS)
- dry beri beri (affects CNS)
what are the symptoms of RVF?
anorexia and nausea
what are the symptoms of LVF?
Fatigue
Exertional dyspnoea
Orthopnoea + PND (paroxysmal nocturnal dysnoea- wake up during night catching breath)
Nocturnal cough (± pink, frothy sputum) Wt. loss and muscle wasting
what are signs seen in LVF ?
Cold peripheries ± cyanosis
Often in AF
Cardiomegaly ̄c displaced apex S3 + tachycardia = gallop rhythm Wheeze (cardiac asthma)
Bibasal creps
what criteria is used for chronic heart failure?
Framingham Criteria
2 major criteria or 1 major + 2 minor
what are the major criteria for chronic heart failure?
PND \+ve abdominojugular reflux Neck vein distension S3 Basal creps Cardiomegaly Acute pulmonary oedema ↑ CVP (>16cmH2O) Wt. loss >4.5kg in 5d 2O to Rx
what hormone is a biomarker for heart failure?
B-type Natriuretic Peptide: BNP
what is Pulsus paradoxus?
(pulse fades on inspiration)
what is Kussmaul’s sign:?
↑JVP on inspiration
