Heart failure Flashcards
What is the definition of heart failure?
The inability of the heart to deliver blood and oxygen at a rate meeting the requirements of metabolising tissues of the body
What is the main cause of heart failure?
Ischaemic heart disease (IHD)
What are some casues of heart failure?
- (IHD)
- Cardiomyopathy
- Valvular heart disease
- Cor pulmonale
- Hypertension
- Alcohol excess
- Any factor that increases myocardial work
Give 5 factors that increase myocardial work
- Anaemia
- Arrhythmias
- Hyperthyroidism
- Pregnancy
- Obesity
Give 5 risk factors for heart failure
- > 65yrs old
- African descent
- Being male
- Obesity
- Previous MI
Give 5 catagories of classification of heart failure
- New York Heart Association (NYHA) classification
- Systolic
- Diastolic
- Acute
- Chronic
What are the classes of the NYHA classification of heart failure?
- Class I: No limitation (asymptomatic)
- Class II Slight limitation (mild HF)
- Class III: Marked limitation (moderate HF)
- Class IV: Inability to carry out any physical activity without discomfort (severe HF)
What is systolic heart failure?
The inability of the ventricle to contract normally resulting in a decrease in cardiac output
Give 3 causes of systolic heart failure
- IHD
- MI
- Cardiomyopathy
What is diastolic heart failure?
The inability of the ventricles to relax and fill fully so SV and CO are decreased
What can cause diastolic heart failure?
Ventricular hypertrophy (from chronic hypertension) so there is less space for blood to fill so CO is decreased
What is meat by acute heart failure?
Usually means new onset or decompensation of chronic HF
What might be some characteristics of acute heart failure?
Pulmonary and/or peripheral oedema with/without signs of peripheral hypotension
Give 3 non-specific symptoms of heart failure
- Shortness of breath
- Fatigue
- Ankle swelling
Give 2 specific but insensitive symptoms of heart failure
- Orthopnoea
* Paroxysmal nocturnal dyspnoea
Give 3 non-specific signs of heart failure
- Peripheral oedema
- Pulmonary crackles (bilateral basal crackles)
- Tachycardia
Give 3 specific but insensitive signs of heart failure
- Raised jugular venous pressure (JVP)
- 3rd and 4th heart sounds
- Displaced apex beat
What would you use to diagnose heart failure?
- History and physical examination
- Chest X ray
- Blood tests
- ECG
- Echocardiogram
- Myocardial perfusion imaging
What might you seen on a chest X-ray of someone with heart failure?
- Alveolar oedema
- Cardiomegaly
- Dilated upper lobe vessels of the lungs
- Pleural effusions
What blood tests might you do in suspected heart failure?
- BNP
- FBCs
- U+Es
- Liver biochemistry
If ECGs and BNP levels are normal, what might it suggest about heart failure?
That heart failure is unlikey
What should you do if ECGs and BNP levels are both abnormal?
Do an echocardiogram
What would you look for on an echocardiogram for suspected heart failure
- Assess cardiac chamber dimension
- Look for regional wall motion abnormalities, valvular disease and cardiomyopathies
- Look for signs of MI
What are the main treaments for heart failure?
- Lifestyle chnges
- Drugs
- Revascularisatioin
- Surgery to repair
- Heart transplant in young people
- Cardiac resynchronisation
What drugs might be used to treat heart failure?
- Diuretics
- Aldosterone antagonists
- ACE inhibitors
- Hydralazine + nitrates
- Beta blockers
- ARBs
What does cardiac resynchronisation do?
Improves the coordination of the atria and ventricles
What are some complications of heart failure?
- Renal dysfunction
- Systemic thromboembolism
- LBBB and bradycardia
- Neurological and psychological complications
- Rhythm disturbances
- DVT and PEs
- Hepatic dysfunction
Give 4 rhythm disturbances that may be caused by heart failure
- Atrial fibrillation
- Atrial flutter
- Ventricular tachycardia
- Ventricular fibrillation
