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Cardiorespiratory 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

what are the two types of heart failure

A

left ventricular systolic dysfunction (LVSD)

heart failure with preserved ejection fraction (HFPEF – heart contracts okay but doesn’t pump effectively, the heart wont relax properly therefore it cannot fill)

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2
Q

what is the most common cause of heart failure

A

coronary artery disease

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3
Q

how many patients die within a year diagnosis of heart failure

A

30-40% of patients

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4
Q

what are the causes of heart failure

A
  • Coronary artery disease
  • Hypertension
  • Cardiomyopathy
  • Valvular heart disease
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5
Q

what are aggravating factors of heart failure that are more treatable

A
  • Cardiac arrhythmias such as AF
  • Hypertension
  • Anaemia
  • Infections
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6
Q

what is the presentation of heart failure in terms of symptoms

A
  • Very non specific symptoms and signs
  • Shortness of breath
  • Ankle oedema
  • Fatigue
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7
Q

what can shortness of breath symptom of heart failure be caused by

A
  • Anaemia
  • COPD
  • OBESITY
  • Rheumatic joints
  • Deconiditioning
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8
Q

what can the ankle oedema symptom of heart failure be caused by

A 
•	Drainage problems
–	VVs
–	Vein harvesting
–	Lymphoedema
–	DVT
•	Postural effects
•	Drugs
–	amlodipine
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9
Q

what can the fatigue symptom of heart failure be caused by

A
  • Anemia
  • Sleep disorders
  • Stress
  • Ageing
  • Childcare etc
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10
Q

what does the ECG of heart failure look like

A
  • Inferior(pathological) Q waves
  • Anterior T waves and ectopics
  • Left bundle branch block
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11
Q

what does the chest x ray of heart failure look like

A
  • Pulmonary congestion
  • Pulmonary oedema
  • Enlarged heart
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12
Q

what can an echocardiogram show you

A
  • interested in heart valves
  • dimensions of the left ventricle and how well it is contracting
  • how well the septum is moving
  • how the posterior and anterior walls are moving
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13
Q

how would a GP diagnose heart failure

A
  • raised BNP
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14
Q

what is BNP secreted by

A

• Secreted by myocardial cells in response to raised left atrial pressure

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15
Q

what does BNP do

A

Promotes natriuresis, vasodilatation

• Inhibits ADH and aldosterone release

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16
Q

what levels of BNP can cause heart failure

A

Levels >100pg/ml (NT PRO-BNP >400 pg/ml) indicate heart disease as likely cause of dyspnoea and fluid retention

17
Q

describe the NICE guideline of treatment for heart failure

A
  1. detailed examination and history

if previous MI

  • specialist assessment and doppler echo
  • normal echo - heart failure is unlikely
  • abnormal echo - systolic dysfunction or diastolic dysfunction

no previous MI

  • measure BNP
  • less than 100pg/ml then heart failure is unlikely
  • greater then 100pg/ml heart failure is likely refer to specialist assessment and doppler echo and so on
18
Q

what is the most common heart failure systolic or diastolic

A

systolic

19
Q

describe how the body toys to prevent and treat heart failure itself

A
  • either via the sympatho-adrenal activation or by renin-angiotensin activation
20
Q

how does the sympho-adrenal system compensate

A
  • increases inotropic state of the heart
  • increases contractile function
  • it also can cause redistribution of venous flow
  • this leads to ventricular dilation which increases contractile function
21
Q

what blocks the sympho-adrenal system

A

beta blockers

22
Q

how does the renin angiotensin activation work

A
  • it increases myocardial mass
  • this increases contractile function
  • all can cause salt and water retention, this increases ventricular dilation which increases contractile function
23
Q

what blocks the renin angiontestine system

A
  • ACE
  • ARB
  • spironolactone
24
Q

what are the overlying treatments for systolic and diastolic failure

A

Treat aetiological and aggravating factors

• Treat fluid retention with diuretics

25
Q

how do you treat systolic heart failure

A

ACE-Is (all grades of heart failure)
• ARBs (if ACE-Is cannot be tolerated)
• beta-blockers (all grades of heart failure)
• spironolactone (NYHA grade III and IV only)
• devices
– cardiac resynchronization therapy (CRT)
– ± ICD
• angiotensin receptor neprilysin inhibitor.

26
Q

what is the only thing from systolic heart failure that can work in diastolic heart failure treatments

A

diuretics

27
Q

what is cardiac resynchronisation therapy

A

if you have prolonged QRS complex and bad left ventricle which is symptomatic despite therapy in that situation a pacemaker will be implanted and getting the stimulation delay between left and right, this will improve patietns,

28
Q

what is the criteria for a pacemaker

A
  • have to be in sinus rhythm for it to work
  • LV ejection fraction has to be less than 35%
  • Sympatomatic
  • And QRS complex
29
Q

what do you have to have in order to get heart transplant

A 
resistant ccf without:
–	 major organ failure
–	 major co-morbidity
–	 psychological disability
–	 severe pulmonary hypertension (heart lung transplant needed)
30
Q

what is the prognosis for heart failure

A

• Prognosis

– 80% 1 year survival

31
Q

describe diastolic heart failure

A
  • Impaired LV filling due to increased chamber stiffness and/or decreased relaxation
  • More common in women and older people
  • Responsible for about 50% of heart failure in adults
  • Prognosis similar to systolic dysfunction
  • Most patients have elements of systolic and diastolic dysfunction
32
Q

what are the treatments of diastolic heart failure

A
  • Treat underlying cause: esp hypertension
  • Treat systolic components if picture is mixed
  • Treat fluid retention
  • RAS Inhibition, B-blockers: no proven value

Cardiorespiratory 2 (43 decks)

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