Heart Failure Flashcards
HF
A cardiac disorder that prohibits delivery of sufficient output to meet the perfusion requirements of metabolising tissues
HF Causes
Coronary artery disease
Hypertension
Cardiomyopathy
Valvular heart disease
HF aggravating factors
Cardiac arrhythmias
Hypertension
Anaemia
Infections
HF effect
Decreased Cardiac Output (peripheral hypoperfusion)
Fluid retention (congestion)
Increased sympathetic NS
HF Symptoms
Fatigue
Dyspnoea
Oedema
HF Signs
Skin cold to touch Basal crackles Increased JVP Ankle oedema Ascites Tachycardia Sweating Pulsus alternans
HF Complications
Intravascular thrombosis Infection Functional valvular dysfunction Multi-organ failure Cardiac arrhythmias Sudden death
Intravascular thrombosis
PE
Systemic embolism
Infection
Chest
Ulcerated cellulitis legs
Multi-organ failure
Renal
Liver
HF Diagnosis
BNP
ECG
Chest X Rays
Echo
BNP RELEASE
Secreted by myocardial cells in response to raised left atrial pressure
BNP effect
Promotes natriuresis and vasodilation
Inhibits ADH and aldosterone release
BNP Levels
Levels >100pg/ml indicate heart disease
–> likely cause of dyspnoea and fluid retention
HF ECG
Never normal
Inferior Q waves
Ectopic firing
Left BBB
HF Chest X rays
Pulmonary congestion
Pulmonary oedema
HF Echo
LV huge
HF Treatment
Treat both systolic and diastolic failure
Systolic failure treatment
ACE inhibitors Beta Blockers Spironolactone CRT (cardiac resynchronisation therapy) Angiotensin receptor neprilysin inhibitor
Cardiac resynchronisation therapy
Patient in sinus rhythm (no AF)
LVEF <35%
QRS prolongation required (usually left BBB)– >150msec, or >120 msec + mechanical dyssynchrony
Heart transplant
80% 1 year survival
Heart transplant indications
Resistant CCF without:
- major organ failure, major co-morbidity, psychological disability, severe pulmonary hypertension
Diastolic failure
Heart failure with normal ejection fracture
Impaired LV filling due to increased chamber stiffness +/or decreased relaxation
Diastolic failure epidemiology
Women more common
Older people
50% HF in adults
Diastolic failure treatment
Treat underlying cause, especially hypertension
Treat systolic failure if mixed
Treat fluid retention
Acute HF Causes
Acute MI
Cardiac tachyarrhythmia
Valvular heat disease- mitral stenosis
Acute HF clinical presentation
Pulmonary oedema –> severe dyspnoea
Desaturation –> central cyanosis
Reduced CO –> cool skin, peripheral cyanosis
Symp. activation –> tachycardia, sweating
Other findings –> S3, pulsus alternans
Acute HF Immediate treatment
Treat aggravating factors
Correct pulmonary oedema
Correct desaturation
Support LV
Pharmacological support –> inotropes
Mechanical support–> balloon pump, LVAD
Support kidneys
ultrafiltration/dialysis
HF Aggravating factors
Cardiac arrhythmias- AF
Hypertension
Anaemia
Chest infection
Implantable Defibrillator
AMI > 4 weeks previously
LV ejection fraction >30% and QRS <120msec
