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heart failure Flashcards

1
Q

what causes heart failure?

A

impaired cardiac function

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2
Q

what are the types of heart failure?

A

left ventricular systolic dysfunction (LVSD) and heart failure with preserved ejection fraction (HFPEF)

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3
Q

what is the most common cause of heart failure?

A

coronary artery disease

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4
Q

how many patients die within a year of diagnosis?

A

30-40%

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5
Q

what are the causes of heart failure?

A
  • Coronary artery disease
  • Hypertension
  • Cardiomyopathy
  • Valvular heart disease
  • Other causes
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6
Q

what are aggravating factors of heart failure?

A
  • Cardiac arrhythmias (AF)
  • Hypertension
  • Anaemia
  • Infections
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7
Q

how does heart failure present?

A

non-specific signs and symptoms

  • shortness of breath
  • ankle oedema
  • fatigue
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8
Q

what causes shortness of breath?

A 
o	Anaemia
o	COPD
o	Obesity
o	Rheumatics
o	Deconditioning
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9
Q

what causes ankle oedema?

A 
o	Drainage problems
	VVs
	Vein harvesting
	DVT
	Lymphoedema
o	Postural effects
o	Drugs
	amlodipine
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10
Q

what can cause fatigue?

A 
o	Anaemia
o	Sleep disorders
o	Stress
o	Ageing
o	Childcare etc.
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11
Q

how does heart failure present on an ecg and what causes these signs?

A
  • Inferior Q waves – may present bc of previous MI
  • Anterior T wave + ectopics – pulmonary embolism, stenosis of coronary artery
  • Left bundle branch block – shows left ventricular disease
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12
Q

how does congestive heart failure look on a CXR?

A

will have progressive pulmonary congestion (X-ray more sharp)

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13
Q

how does acute heart failure look on a CXR?

A

in acute HF the lungs will be flooded with fluid (oedema).

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14
Q

why is m-mode echocardiography useful?

A

• Provides monodimensional view of the heart.

o Allows for fine measurements of changes.

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15
Q

how does an m-mode echocardiography look in global LV dysfunction?

A

interventricular septum and posterior wall will hardly be moving

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16
Q

how does an m-mode echocardiography look in regional LV dysfunction?

A

posterior wall is contracting normall but the IVS is hardly moving

17
Q

what secretes brain natriuretic peptide and when?

A

Secreted by myocardial cells in response to increased left atrial pressure

18
Q

what does BNP do?

A

• Promotes natriuesis (excretion of sodium and therefore water) and vasodilation.
o Inhibits ADH and aldosterone release.

19
Q

how do you diagnose a patiet who hasnt had a previous MI?

A
  • measure BNP
  • if it’s less than 100pg/ml –> heart failure is unlikely
  • abve 100pg/ml 00 –> special assessment and doppler echo
  • normal echo = no heart failure
  • abnormal ech - systolic/diastolic dysfunction
20
Q

what can an abnormal echo imply?

A

systolic or diastolic dysfunction

21
Q

why is increasing contractile function through sympatho-adrenal-activation and renin-angiotensin bad?

A

o Heart requires more oxygen and nutrients (which it doesn’t receive)
o Heart gets thicker and won’t relax properly (increases metabolic requirements as well as decreasing its efficacy to pump.

22
Q

what is diastolic failure and what does it lead to?

A

Diastolic failure is when ventricle is not able to fill properly –> causes concentric hypertrophy

23
Q

what is heart failure with normal ejection fraction?

A

Impaired LV filling due to stiffness

24
Q

who is HeFNEF more common in ?

A

women and old people

25
Q

what can cause the ventricular walls to become stiffer?

A

o Long standing hypertension
o Aortic stenosis
o Age (stiffened ventricles)

26
Q

what is systolic failure and what does it lead to?

A

when the heart cannot contract properly = eccentric hypertrophy

27
Q

what causes systolic failure?

A
  • Mitral regurgitation
  • Coronary artery disease
  • Cardiomyopathy
28
Q

how would systolic and diastolic be treated together?

A
  • Treat causes and aggravating factors.

* Treat fluid retention with diuretics.

29
Q

what medication can be used to treat systolic failure?

A

• ACE Inhibitors
o ARBs (if ACE’s not tolerated)
• Beta-Blockers (all grades of failure)
• Spironolactone (potassium sparing drug)

30
Q

what devices can be used to treat systolic failure?

A
  • cardiac resynchronisation therapy

- ICD (implantable cardioverter-defibrillator)

31
Q

who is given cardiac resynchronisation therapy?

A

o Only works in patients with normal (sinus) rhythm
o In HF patients in New York Heart Association Category III/IV.
 Also, must have QRS prolongation.

32
Q

who is an ICD given to?

A

o AMI >4 weeks previously

o LV ejection fraction <30% and QRS >120msec

33
Q

who is a heart transplant given to?

A

If congestive cardiac failure is resistant, heart transplant can be given if there is:
• NO organ failure, NO co-morbidity
• NO psychological disability
• NO severe pulmonary hypertension.

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