heart failure Flashcards
what causes heart failure?
impaired cardiac function
what are the types of heart failure?
left ventricular systolic dysfunction (LVSD) and heart failure with preserved ejection fraction (HFPEF)
what is the most common cause of heart failure?
coronary artery disease
how many patients die within a year of diagnosis?
30-40%
what are the causes of heart failure?
- Coronary artery disease
- Hypertension
- Cardiomyopathy
- Valvular heart disease
- Other causes
what are aggravating factors of heart failure?
- Cardiac arrhythmias (AF)
- Hypertension
- Anaemia
- Infections
how does heart failure present?
non-specific signs and symptoms
- shortness of breath
- ankle oedema
- fatigue
what causes shortness of breath?
o Anaemia o COPD o Obesity o Rheumatics o Deconditioning
what causes ankle oedema?
o Drainage problems VVs Vein harvesting DVT Lymphoedema o Postural effects o Drugs amlodipine
what can cause fatigue?
o Anaemia o Sleep disorders o Stress o Ageing o Childcare etc.
how does heart failure present on an ecg and what causes these signs?
- 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
how does congestive heart failure look on a CXR?
will have progressive pulmonary congestion (X-ray more sharp)
how does acute heart failure look on a CXR?
in acute HF the lungs will be flooded with fluid (oedema).
why is m-mode echocardiography useful?
• Provides monodimensional view of the heart.
o Allows for fine measurements of changes.
how does an m-mode echocardiography look in global LV dysfunction?
interventricular septum and posterior wall will hardly be moving
how does an m-mode echocardiography look in regional LV dysfunction?
posterior wall is contracting normall but the IVS is hardly moving
what secretes brain natriuretic peptide and when?
Secreted by myocardial cells in response to increased left atrial pressure
what does BNP do?
• Promotes natriuesis (excretion of sodium and therefore water) and vasodilation.
o Inhibits ADH and aldosterone release.
how do you diagnose a patiet who hasnt had a previous MI?
- 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
what can an abnormal echo imply?
systolic or diastolic dysfunction
why is increasing contractile function through sympatho-adrenal-activation and renin-angiotensin bad?
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.
what is diastolic failure and what does it lead to?
Diastolic failure is when ventricle is not able to fill properly –> causes concentric hypertrophy
what is heart failure with normal ejection fraction?
Impaired LV filling due to stiffness
who is HeFNEF more common in ?
women and old people
what can cause the ventricular walls to become stiffer?
o Long standing hypertension
o Aortic stenosis
o Age (stiffened ventricles)
what is systolic failure and what does it lead to?
when the heart cannot contract properly = eccentric hypertrophy
what causes systolic failure?
- Mitral regurgitation
- Coronary artery disease
- Cardiomyopathy
how would systolic and diastolic be treated together?
- Treat causes and aggravating factors.
* Treat fluid retention with diuretics.
what medication can be used to treat systolic failure?
• ACE Inhibitors
o ARBs (if ACE’s not tolerated)
• Beta-Blockers (all grades of failure)
• Spironolactone (potassium sparing drug)
what devices can be used to treat systolic failure?
- cardiac resynchronisation therapy
- ICD (implantable cardioverter-defibrillator)
who is given cardiac resynchronisation therapy?
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.
who is an ICD given to?
o AMI >4 weeks previously
o LV ejection fraction <30% and QRS >120msec
who is a heart transplant given to?
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.
