Heart Failure

Question 1

What are the ranges for reductions of Ejection fraction?

Answer 1

> 55% normal, 45-54% mildly reduced, 30-44% moderately reduced, <30% severely reduced

Question 2

How is EF measured?

Answer 2

Echocardiography

Question 3

What is Heart Failure?

Answer 3

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

Question 4

What is dilated cardiomyopathy?

Answer 4

Walls thinner, so less pressure generated

Question 5

What is Left Heart Failure?

Answer 5

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

Question 6

What can left heart failure lead to?

Answer 6

Pulmonary hypertension and oedema) and respiratory symptoms (SOB, coughing, wheezing) alongside dizziness/cyanosis

Question 7

What is Right Heart Failure?

Answer 7

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)

Question 8

What is Chronic heart failure?

Answer 8

Slow-onset due to infection, PE, MI or surgery

Question 9

What is Acute Heart Failure?

Answer 9

Rapid onset with Sx similar to chronic except rapid onset and worsening

Question 10

What is Heart Failure with reduced EF?

Answer 10

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

Question 11

What is Heart failure with preserved EF?

Answer 11

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

Question 12

Name the 6 main causes of Heart Failure:

Answer 12

Valve Disease
Ischaemic Heart Disease
MI
Hypertension
Dilated Cardiomyopathy
Hypertrophic cardiomyopathy

Question 13

What is Valve disease?

Answer 13

Mitral/tricuspid problems mean ventricles cannot fill with blood, pulmonary/aortic valve means cannot expel blood (systolic issue)

Question 14

How does ischaemic heart disease cause HF?

Answer 14

Less oxygen gets to cardiomyocytes when coronary arteries narrow (ischaemia)

Question 15

How does Hpt cause HF?

Answer 15

Increases afterload to much work harder (need more oxygen which not supplied so die), so muscle grows inward (reducing space for filling)

Question 16

How does Dilated cardiomyopathy cause HF?

Answer 16

Wall of ventricle shrinks to dilate LV, reducing pressures - cannot eject

Question 17

How does Hypertrophic cardiomyopathy cause HF?

Answer 17

Increased LV thickness leads to reduced internal volume, impeding filling

Question 18

What are the symptoms of HF?

Answer 18

Orthopnoea (shortness of breath lying flat)
Exertional breathlessness
Fatigue
Anorexia
Weight loss

Question 19

What are the Clinical signs of Heart failure?

Answer 19

Ascites (abdominal swelling caused by build up of fluid in peritoneum)
Hepatomegaly
Increased jugular venous pressure
Reduced pulse volume
Tachycardia

Question 20

What investigations can be done to diagnose HF?

Answer 20

X-ray
ECG
Ambulatory ECG
Exercise test
Angiogram
BNP - Brain Natriuretic Peptide

Question 21

Why does HF lead to an increased Jugular venous pressure?

Answer 21

Increased pressure in right side of heart leads to pressure backing up into systemic veins - visible in jugular vein

Question 22

Why does HF lead to pitting oedema?

Answer 22

Accumulation in tissue leads to pitting effect on depression - increased hydrostatic pressure leads to fluid leaking into legs

Question 23

What is B-Type Natriuretic Peptide?

Answer 23

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

Question 24

What are the lifestyle treatments of HF?

Answer 24

Weight loss, exercise, smoking cessation and alcohol limitation

Question 25

What are the pharmacological treatments of HF?

Answer 25

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

Question 26

What are the non-pharmacological treatments of HF?

Answer 26

Haemofiltration/dialysis, VAD, CABG or transplantation

Question 27

What is compensatory hypertrophy?

Answer 27

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

Question 28

Name 5 types of Cardiomyopathy:

Answer 28

Dilated
Hypertrophic
Restrictive
ARVC
Takotsubo

Question 29

What does ARVC stand for, and what is it?

Answer 29

Arrhythmogenic right ventricular dysplasia

Proteins holding together myocytes abnormal, leading to death and replacement with fat/fibrous tissue

Question 30

What is hypertrophic cardiomyopathy?

Answer 30

Walls become enlarged so chambers reduced in size; walls cannot properly relax

Question 31

What is restrictive cardiomyopathy?

Answer 31

Ventricle walls stiffened and cannot relax, so filling impaired - causes HF

Question 32

What is Takotsubo?

Answer 32

“broken heart syndrome” - emotional stress can stun left ventricle, so cannot contract effectively

Question 33

What are the treatments for Cardiomyopathy?

Answer 33

No cure, but lifestyle changes advised (smoking, alcohol, diet, stress, etc.) and can use diuretics, beta blockers and anticoagulants