Heart Failure Flashcards
What are the 2 types of heart failure
- Systolic HF - ventricles can’t pump blood hard enough during systole
- Diastolic HF - not enough blood fills ventricles during diastole
BOTH OF THESE CAUSE BLOOD TO POOL IN LUNGS - CONGESTION
What is a normal ejection fraction
50-70%
How does systolic HF affect end diastolic volume (EDV)
It increases EDV (and also increases EDP)
What can cause systolic heart failure?
- Decreased contractility due to MI ischaemia
2. Dilated cardiomyopathy - dilated and weakened ventricle
What are EDV and EDP like in diastolic HF
EDP is decreased
EDV is normal
What is a cause of diastolic HF
Ventricular hypertrophy - inability of chamber to stretch when filling
What is the main cause of right HF
Left HF
Second most common cause is pulmonary - cor pulmonale
What are the symptoms of left HF
- Pulmonary oedema (congestion)
- Dyspnea
- Orthopnea
- Paroxysmal nocturnal dyspnea - may sleep with more pillows
- Crackles on auscultation
- Fatigue
- RAAS activation causes increased pulmonary edema and pitting edema
What type of gallop is heard in systolic HF?
Ventricular gallop (i.e. S3 sound) - due to more blood in chamber
What type of gallop is heard in diastolic HF?
Atrial gallop (i.e. S4 sound) -
Aside from Left sided HF, what are other causes of Right sided HF
Lung disease e.g. PE or emphysema
In right sided HF, blood backs up into systemic circulation. What symptoms may this cause
Jugular venous distension, (congestive) hepatomegaly - eventually causing cirrhosis/liver failure, pitting edema
How is heart failure treated?
- ACEi
- ARBs
- Aldosterone receptor antagonist (spironolactone)
- Loop diuretics (/thiazides)
- Hydralazine and nitrates
- Digoxin
- B blockers (carvedilol, metoprolol, bisoprolol)
(IF in doubt, diuretic first)
AVOID NSAIDS and Diltiazem/Verapamil (non DHP CCBs)
What are the first investigations to order for HF?
Electrolytes, ECG, liver enzymes, FBC, CXR, renal function
