Heart Failure Flashcards
What is heart failure?
Heart failure is the inability of cardiac output to meet the physiological demands of the body. Left ventricular failure (LVF) Right ventricular failure (RVF) Low output and high output heart failure.
What are the signs of LVF?
The signs of LVF include:
- Increased RR
- Decreased SpO2
- Bibasal crackles
- Tachycardia
- 3rd heart sound (S3)
What are the causes of heart failure?
The causes of heart failure may include anything that causes myocardial damage including:
- Coronary artery disease
- HTN
- AF
- Valve disease
- Cardiomyopathies
- Infective endocarditis
- Anaemia
- Endocrine disorders
- Cor pulmonale (RVF secondary to pulmonary disease)
- Iatrogenic (agressive fluid resuscitation causing LVF)
How would you investigate heart failure?
Heart failure can be investigated by:
- Bloods
- CXR
- ECHO
- ECG
How would you treat heart failure?
Conservative:
- Smoking cessation advice, weight loss, promotion of healthy diet and exercise
Medical:
- ACE inhibitors
- Beta-blockers: bisoprolol or carvedilol
- Digoxin: a cardiac glycoside
- Diuretics, e.g. furosemide
- Spironolactone: an aldosterone receptor antagonist
Surgical:
- Heart transplant
What are the complications of heart failure?
The complications of heart failure include:
- Pulmonary oedema
- Renal failure
- Valve dysfunction
- Stroke
What are the classifications of heart failure?
The classifications of her failure include:
- Framingham Criteria for Congestive Heart Failure
- New York Heart Association Classification for Heart Failure
What is the Framingham Criteria for Congestive Heart Failure?
(you don’t need to memorise this but it may help you think about the signs and symptoms of heart failure)
Framingham Criteria for Congestive Heart Failure:
2 major criteria or 1 major criteria and 2 minor criteria:
Major criteria:
- Paroxysmal nocturnal dyspnea
- Neck vein distention
- Rales
- Radiographic cardiomegaly
- Acute pulmonary edema
- S3 gallop
- Increased CVP >16 cmH2O
- Hepatojugular reflux
- Weight loss >4.5 kg in 5 days in response to treatment
Minor criteria (not explained by other conditions)
- Bilateral ankle edema
- Nocturnal cough
- Dyspnea on ordinary exertion
- Hepatomegaly
- Pleural effusion
- Decrease in vital capacity by one third from maximum recorded
- Tachycardia (>120)
What is the New York Heart Association Classification for Heart Failure?
New York Heart Association Classification for Heart Failure
I: No limitation of physical activity
II: Slight limitation of physical activity
III: Marked limitation of physical activity
IV: Inability to carry out physical activity
What is the pathophysiology of heart failure?
↑ Workload ↓ Cardiac output ↓ Contractility Activates compensatory mechanisms
Activation of the renin angiotensin aldosterone system (RAAS) causes Na+ ion and H2O retention & peripheral vasoconstriction → increases preload
Activation of the sympathetic nervous system increases heart rate and causes peripheral vasoconstriction → increases afterload
↑ Myocyte size Chronic activation of these compensatory mechanisms worsens heart failure and leads to increased cardiac damage.
What are the symptoms of LVF?
The symptoms of LVF include:
Paroxysmal nocturnal dyspnoea
Nocturnal cough with white/pink frothy sputum (caused by pulmonary oedema)
Wheeze
Dyspnea on ordinary exertion
What bloods would you do to investigate heart failure?
Bloods in here failure should include: FBC U and Es LFTs TFTs lipid profile. BNP (brain natriuretic peptide).
What signs might you see on a CXR if a patient was in heart failure?
Signs of heart failure on a CXR include: Pulmonary oedema Kerley B lines Cardiomegaly Dilated upper lobe vessels pleural effusion
