Heart Failure Flashcards
What are the ranges for reductions of Ejection fraction?
> 55% normal, 45-54% mildly reduced, 30-44% moderately reduced, <30% severely reduced
How is EF measured?
Echocardiography
What is Heart Failure?
Clinical syndrome caused by inability of heart to supply blood to tissues sufficient to meet metabolic needs, or achieved at expense of filling pressures; causes inadequate organ perfusion and congestion in lungs/legs; often compensate with tachycardia
What is dilated cardiomyopathy?
Walls thinner, so less pressure generated
What is Left Heart Failure?
Dysfunction with left ventricle (ejection or filling issue), blood backs up to lungs causing congestion (blood does not move through heart, so backs up into pulmonary veins
What can left heart failure lead to?
Pulmonary hypertension and oedema) and respiratory symptoms (SOB, coughing, wheezing) alongside dizziness/cyanosis
What is Right Heart Failure?
Right ventricle dysfunction (ejection/filling) due to increased afterload of pulmonary circulation (pulmonary hypertension - often 2/2 left heart failure; need more O2 but not supplied, leading to ischaemic death)
What is Chronic heart failure?
Slow-onset due to infection, PE, MI or surgery
What is Acute Heart Failure?
Rapid onset with Sx similar to chronic except rapid onset and worsening
What is Heart Failure with reduced EF?
Abnormal systolic function; impaired ventricle contraction despite increased HR, resulting in decreased CO - caused by damage/destruction of ventricular myocytes or valve abnormalities [decreased SV with normal/increased EDV] - weaker ejection leads to higher diastolic pressures - CANT EXPEL BLOOD
What is Heart failure with preserved EF?
Abnormal diastolic function, with normal ventricle contraction but increased stiffness/impaired relaxation or filling leading to reduced EDV AND SV leading to normal EF; hypertrophy occurs inwards, so smaller space for blood - CANT GAIN BLOOD
Name the 6 main causes of Heart Failure:
Valve Disease Ischaemic Heart Disease MI Hypertension Dilated Cardiomyopathy Hypertrophic cardiomyopathy
What is Valve disease?
Mitral/tricuspid problems mean ventricles cannot fill with blood, pulmonary/aortic valve means cannot expel blood (systolic issue)
How does ischaemic heart disease cause HF?
Less oxygen gets to cardiomyocytes when coronary arteries narrow (ischaemia)
How does Hpt cause HF?
Increases afterload to much work harder (need more oxygen which not supplied so die), so muscle grows inward (reducing space for filling)
How does Dilated cardiomyopathy cause HF?
Wall of ventricle shrinks to dilate LV, reducing pressures - cannot eject
How does Hypertrophic cardiomyopathy cause HF?
Increased LV thickness leads to reduced internal volume, impeding filling
What are the symptoms of HF?
Orthopnoea (shortness of breath lying flat) Exertional breathlessness Fatigue Anorexia Weight loss
What are the Clinical signs of Heart failure?
Ascites (abdominal swelling caused by build up of fluid in peritoneum) Hepatomegaly Increased jugular venous pressure Reduced pulse volume Tachycardia
What investigations can be done to diagnose HF?
X-ray ECG Ambulatory ECG Exercise test Angiogram BNP - Brain Natriuretic Peptide
Why does HF lead to an increased Jugular venous pressure?
Increased pressure in right side of heart leads to pressure backing up into systemic veins - visible in jugular vein
Why does HF lead to pitting oedema?
Accumulation in tissue leads to pitting effect on depression - increased hydrostatic pressure leads to fluid leaking into legs
What is B-Type Natriuretic Peptide?
Released from ventricular myocytes in response to stretch - leads to microvessel vasodilation, reduced aldosterone secretion, reduced sodium reabsorption and inhibited renin secretion to reduce ECF and pressure (sodium in blood leads to osmosis into blood, increasing pressure/volume; can be used as a clinical marker of heart failure
What are the lifestyle treatments of HF?
Weight loss, exercise, smoking cessation and alcohol limitation
What are the pharmacological treatments of HF?
1st Line: ACE inhibitors to reduce afterload or beta blockers (e.g. Bisoprolol) to reduce HR (diuretics can also cause fluid loss to reduce BP)
2nd Line: ivabradine to cause vasodilation and valsartan to stop aldosterone production
What are the non-pharmacological treatments of HF?
Haemofiltration/dialysis, VAD, CABG or transplantation
What is compensatory hypertrophy?
Reduces wall stress in response to acute load, but then leads to dilated cardiomyopathy as ventricle volume has reduced - increasing wall stress; thin wall can no longer contract with enough force to eject blood
Name 5 types of Cardiomyopathy:
Dilated Hypertrophic Restrictive ARVC Takotsubo
What does ARVC stand for, and what is it?
Arrhythmogenic right ventricular dysplasia
Proteins holding together myocytes abnormal, leading to death and replacement with fat/fibrous tissue
What is hypertrophic cardiomyopathy?
Walls become enlarged so chambers reduced in size; walls cannot properly relax
What is restrictive cardiomyopathy?
Ventricle walls stiffened and cannot relax, so filling impaired - causes HF
What is Takotsubo?
“broken heart syndrome” - emotional stress can stun left ventricle, so cannot contract effectively
What are the treatments for Cardiomyopathy?
No cure, but lifestyle changes advised (smoking, alcohol, diet, stress, etc.) and can use diuretics, beta blockers and anticoagulants
