Heart Failure Flashcards
What is Heat Failure?
When the heart is unable to generate sufficient CO to meet the demands of the body
How is heart faliure categorised?
- Acute or Chronic
- Left or Right
- Systolic or Diastolic
What is Acute right Sided Heart Failure and what are its causes?
Sudden deterioration of the right side of the heart diagnosed through the absence of left sided heart failure
Causes:
- Massive Pulmonary Embolism = results in pulmonary hypertension
- Myocardial Infarction = affecting RV but sparing LV
What are the clinical features of Right Sided Heart Failure?
- Raised JVP
- Parasternal Heave
- Ascites
- Hepatomegaly
- Tenderness
- Peripheral oedema
What is pulmonary hypertension?
Pressure at or above 22 mmHg in the pulmonary artery
What is Acute Left Sided Heart Failure?
- Sudden major insult to the left ventricle
- No time for compensatory mechanisms
- Results in congestion in pulmonary venous system and rapid fluid accumulation, presenting as:
=> pulmonary oedema
=> severe breathlessness
What are the causes of Acute Left Sided Heart Failure?
=> Complications of MI:
- Extensive MI rendering LV non-functional
- Rupture papillary muscle of mitral valve
- Arrhythmias
What is Chronic Right Sided Heart Failure and what are its causes?
Slow damage over a long period of time
Causes:
- COPD
- Pulmonary Fibrosis
- Recurrent small pulmonary emboli
What is Cor Pulmoanle?
- Lung diseases cause damage to the right ventricle through their affects on the lung
- The affects on the lung result in pulmonary hypertension
- Cor pulmonale is right sided heart failure as a result of lung disease
- In its early stages, compensatory changes occur resulting in RV hypertrophy
- Heart eventually decompensates
Cor Pulmonale can be acute or chronic. What are the causes of acute and chronic Cor Pulmonale?
ACUTE:
- Massive PE
CHRONIC:
- COPD
- Recurrent small pulmonary emboli
- Pulmonary Fibrosis
What are the causes of Chronic Left Sided Heart Failure?
- Coronary Artery Atherosclerosis
- Systemic Hypertension
- Valvular Heart Disease
Chronic means that the heart will under compensatory LV hypertrophy but will eventually decompensate
The poor CO leads to activation of sympathetic drive and RAAS. This leads to an increase in BP, putting more pressure on an already failing heart
What are the clinical features of Chronic Left Sided Heart Failure?
- Crackles
- Cardiomegaly
- Added Heart Sounds
- Cyanosis
What are the 2 categories of chronic heart failure?
- Systolic
- Diastolic
What is systolic and disatolic heart failure?
Systolic Heart Failure is when there is a problem with the pumping action of the heart, leading to a reduction in the ejection fraction.
Diastolic Heart Failure is when there is a problem in the filling of the ventricle due to increased wall stiffness. Also known as Heart Failure with Preserved Ejection Fraction (HFPEF)
What are the investigations for suspected Heart Failure?
=> Echo
- if BNP > 400, then trans-thoracic Echo within 6 weeks
- If BNP > 2000, then trans-thoracic Echo within 2 weeks
=> CXR A - Alveolar Bat Wings B - Kerby B Lines C - Cardiomegaly D - Dilated prominent Upper Lobe Veins E - Pleural Effusion
=> Blood tests
BNP - Gold Standard
What is the management of Heart Failure?
Categorised conservative, medical or surgical
CONSERVATIVE:
- Lifestyle advice
- Smoking cessation
- Physical exercise
MEDICAL:
- First line is ACEi or B blocker
- Second line is (Aldosterone antagonist) or (Ang II blocker) or (Hydralazine + nitrate)
- If symptoms persist then cardiac resyncronisation therapy or Digoxin
- Diuretics only in fluid overload cases
- All patients should be offered an annual influenza vaccine and one off pneumococcal vaccine
=> Supported alternative to cardiac resyncronisation therapy or Digoxin is Ivabradine. Criteria for Ivabradine:
- already on suitable therapy
- HR > 75 bpm
- left ventricular fraction < 35%
SURGICAL:
- Revascularization
- Cardiac Resyncronization Therapy
- Cardiac Transplant
What is MOA of Digoxin?
- Reduces HR and increases force of contraction
- HR reduced through increases in parasympathetic innervation to AVN
- Also inhibits the Ca/Na pump such that intracellular Na levels increases, therefore decreasing Ca extrusion
- higher levels of Ca ions means stronger force of contraction
What are the contraindication of Digoxin use?
- Worsens conduction problems
- ventricular arrhythmias
- Renal failure
What are the adverse affects of Digoxin?
- Visual disturbances
- Dizziness
- Bradycardia
- GI disturbances
- Rash
What is the MOA of Warfarin?
- Inhibits vitamin K
Contraindications of Warfarin?
- Bleeding disorders
What is the contraindication of B blockers?
- Asthma
- Heart Block
What is the emergency management of acute heart failure?
Sit the patient upright and provide high flow oxygen if levels are low.
Establish IV access and perform ECG.
Carry out investigations
- If in pain, give IV Diamorphine
- IV Furosemide slowly
- GTN Spray, 2 puffs
- Nitrate infusion is systolic BP > 100 mmHg
IF PATIENT CONTINUES TO WORSEN:
- Further furosemide dose
- Consider CPAP
- Increase nitrate infusion
- consider alternate diagnosis
What are the different classes of the New York Heart Association Classification?
=> Class I
- No symptoms
- No limitation
=> Class II
- Mild symptoms
- Slight limitation: no symptoms at rest more than ordinary activity causes symptoms
=> Class III
- Moderate symptoms
- Marked limitation: no symptoms at rest but less than ordinary activity causes symptoms
=> Class IV:
- Severe symptoms
- Unable to carry out any physical activity without discomfort. Symptoms present with any form of physical activity
