Heart Failure Flashcards
Give 5 clinical pieces of evidence that someone may have a heart structural/functional abnormality
- ECG
- Echocardiogram
- Cardiac murmur
- Raised natriuretic peptide
- Cardiomegaly
What are the 3 ways Heart failure can be classified?
- Acute vs Chronic
- L side vs R side (or congestive = both)
- Reduced vs Preserved ejection fraction (or both)
What’s the difference between a reduced and preserved ejection fraction?
A reduced EF: Heart cannot pump properly
Therefore there is an issue in systole and the EF becomes less than 40%
A preserved EF: Heart cannot fill properly
Therefore it’s an issue in diastole and the EF remains above 40%
Name 3 things that could cause the body to demand a higher output from the heart, what could cause a lowered output?
Demanding a higher output:
- Pregnancy
- Anaemia
- Hyperthryoidism
Heart is producing a lowered outout: any cardiovascular problem
LName 3 other things that could cause this
Main causes: Coronary heart disease, hypertension
Others: cardiomyopathy, AV valvular disease, arrythmias
What is the main cause of R sided Heart failure?
Try to name 5 other things that could cause this
Main cause: Left sided Heart failure eventually backs up and affects the Right side
- Pulmonary embolus
- Chronic lung disease
- RV infarction
- Shunts: Atrial or ventricular septal defect
- Pulmonary and tricuspid regurgitation
What is the latin term for what occurs in the R side of the heart during R sided heart failure
Cor pulmonale: R sided hypertrophy due to disease in the pulmonary vessels or lungs
What 3 factors help to increase the stroke volume?
- Decreased afterload
- Increased preload
- Increased contractility
What are 3 pathologies that could increase the preload and 2 things that could increase an afterload?
Increasing the preload
- Hypervolemia
- Valve regurgitation
- Heart failure
Increasing the afterload:
- Hypertension
- vasoconstriction
How does the ventricular output change from excercise to heart failure?
Excercise: Dilation of blood vessels (metabolic vasodilators) decreases the afterload and makes ventricular output more efficient in pumping out their end-diastolic volume
Heart failure: The more severe it becomes the more contractility decreases, decreasing ventricular output
What is an ejection fraction, how is it calculated and what should it be normally?
Ejection Fraction: the % of blood that gets pumped out of the heart after each diastolic filling
Calculated:
Amount pumped out/Total ventricular volume at end of diastole
Normal: 55-75%
Where would an oedema occur in L and R sided Heart Failure?
L sided: pulmonary oedema
R sided: peripheral oedema
What are 4 things that could cause a preserved ejection fraction?
Problems with ventricular filling…
- L ventricular hypertrophy
- Restrictive cardiomyopathy
- Coronary heart disease
- Tamponade: fluid accumulation in the pericardial space compressing on the heart
What are the 2 main causes of a reduced ejection fracion? Name 2 ways you could acquire each
Issues pumping blood…
1. Impaired contractility: coronary heart disease, chronic volume overload, and bonus: dilated cardiomyopathy
- Increased Afterload: severe hypertension, aortic stenosis
Give 5 symptoms of LEFT Ventricular failure
- Orthopnea
- Paroxysmal nocturnal dyspnoea
- Nocturnal cough is pink and frothy
- Breathless on exertion
- Weight loss, muscle wasting and fatigue!
Give 5 symptoms of RIGHT ventricular failure
- swollen ankles
- fatigue
- Dysopnea
- Anorexia: gut or liver congestion
- Nausea
Name 4 signs of R ventricular failure
- Pitting oedema
- Raised JVP
- Hepatomegaly (liver may also be pulsating)
- Ascites: fluid accumulation in the peritoneal cavity/abdomen
What is the basic mechanism that forms an oedema?
Hydrostatic
How is staging classified for heart failure? List the stages and their brief characteristics
Heart failure is staged depending on how functional the heart still is
Class 1: no symptomatic limitation of physical activity
Class 2: Mild physical limitation, symptoms when doing ordinary physical activity, i.e; running, weights, etc
Class 3: Marked physical limitation, symptoms when doing ordinary daily activity, i.e; walking, chores
Class 4: severe discomfort and inability to carry out any physical activity without symptoms, symptoms at rest
How is the prognosis for Heart failure?
Generally poor as it can be treated but not cured, class 4 has an 80% mortality rate after 3 years
What are the 3 compensatory mechanisms the body tries to bring the CO back to normal?
- Ventricular remodelling
- Starling law mechanism
- Neurohormonal alterations
Describe the starling law mechanism
Since HF decreases CO and stroke volume:
This decreases the amount of blood being pumped out of the ventricle - which causes an accumulation of blood within the ventricle
This stretches the cardiac myocytes, helps them contract harder and brings the SV and CO back up
When are neurohormonal alterations activated and what are their 2 overall goals?
Activated in response to a low CO
Aim to:
1. Increase systemic vascular resistance as this brings up the BP (BP = CO X TPR) which (through somewhat unknown mechanisms) brings up the CO (involves increasing peripheral venous pressure and decreasing central venous pressure)
- Increase the preload by retaining salt and water
What does the sympathetic nervous system do as a neurohormonal alteration?
Baroreceptors located in the aortic arch and carotid sinus sense a low CO and increase the sympathetic activity:
- Vasoconstriction
- Increased HR
- Increased contractility via adrenaline