Heart Failure Flashcards
what are the two types of heart failure
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)
what is the most common cause of heart failure
coronary artery disease
how many patients die within a year diagnosis of heart failure
30-40% of patients
what are the causes of heart failure
- Coronary artery disease
- Hypertension
- Cardiomyopathy
- Valvular heart disease
what are aggravating factors of heart failure that are more treatable
- Cardiac arrhythmias such as AF
- Hypertension
- Anaemia
- Infections
what is the presentation of heart failure in terms of symptoms
- Very non specific symptoms and signs
- Shortness of breath
- Ankle oedema
- Fatigue
what can shortness of breath symptom of heart failure be caused by
- Anaemia
- COPD
- OBESITY
- Rheumatic joints
- Deconiditioning
what can the ankle oedema symptom of heart failure be caused by
• Drainage problems – VVs – Vein harvesting – Lymphoedema – DVT • Postural effects • Drugs – amlodipine
what can the fatigue symptom of heart failure be caused by
- Anemia
- Sleep disorders
- Stress
- Ageing
- Childcare etc
what does the ECG of heart failure look like
- Inferior(pathological) Q waves
- Anterior T waves and ectopics
- Left bundle branch block
what does the chest x ray of heart failure look like
- Pulmonary congestion
- Pulmonary oedema
- Enlarged heart
what can an echocardiogram show you
- 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
how would a GP diagnose heart failure
- raised BNP
what is BNP secreted by
• Secreted by myocardial cells in response to raised left atrial pressure
what does BNP do
Promotes natriuresis, vasodilatation
• Inhibits ADH and aldosterone release
what levels of BNP can cause heart failure
Levels >100pg/ml (NT PRO-BNP >400 pg/ml) indicate heart disease as likely cause of dyspnoea and fluid retention
describe the NICE guideline of treatment for heart failure
- 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
what is the most common heart failure systolic or diastolic
systolic
describe how the body toys to prevent and treat heart failure itself
- either via the sympatho-adrenal activation or by renin-angiotensin activation
how does the sympho-adrenal system compensate
- 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
what blocks the sympho-adrenal system
beta blockers
how does the renin angiotensin activation work
- it increases myocardial mass
- this increases contractile function
- all can cause salt and water retention, this increases ventricular dilation which increases contractile function
what blocks the renin angiontestine system
- ACE
- ARB
- spironolactone
what are the overlying treatments for systolic and diastolic failure
Treat aetiological and aggravating factors
• Treat fluid retention with diuretics
how do you treat systolic heart failure
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.
what is the only thing from systolic heart failure that can work in diastolic heart failure treatments
diuretics
what is cardiac resynchronisation therapy
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,
what is the criteria for a pacemaker
- have to be in sinus rhythm for it to work
- LV ejection fraction has to be less than 35%
- Sympatomatic
- And QRS complex
what do you have to have in order to get heart transplant
resistant ccf without: – major organ failure – major co-morbidity – psychological disability – severe pulmonary hypertension (heart lung transplant needed)
what is the prognosis for heart failure
• Prognosis
– 80% 1 year survival
describe diastolic heart failure
- 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
what are the treatments of diastolic heart failure
- Treat underlying cause: esp hypertension
- Treat systolic components if picture is mixed
- Treat fluid retention
- RAS Inhibition, B-blockers: no proven value
