Heart Failure Flashcards
What is heart failure?
Cardiac output is insufficient to meet the demands of the body
What are the causes of heart failure?
Pump failure
Excessive preload
Chronic excessive afterload
What causes pump failure?
Heart muscle disease
- IHD
- cardiomyopathy
Restricted filling
- constrictive pericarditis
- tamponade
Inadequate heart rate
- heart block
- post MI
What causes excessive preload?
Mitral regurg
Fluid overload
What causes chronic excessive afterload?
Aortic stenosis
Hypertension
What happens to the ejection fraction in systolic HF?
Reduced
What happens to the ejection fraction in diastolic HF?
Preserved
What happens to EDV in systolic HF?
Increased
What happens to EDV in diastolic HF?
Normal
Why does systolic HF occur?
Reduced contractility
Why does diastolic HF occur?
Low compliance
What causes systolic HF?
MI
Cardiomyopathy
What caused diastolic HF?
Hypertension
Aortic stenosis
What are the symptoms of left HF?
Fatigue Dyspnoea Nocturnal cough +/- pink frothy sputum PND Orthopnoea
What are the symptoms of right HF?
Peripheral oedema
Nausea
Raised JVP
Hepatomegaly (nutmeg liver)
What is nutmeg liver?
Appearance of liver as a result of hepatic venous congestion
What are the signs of HF?
Cold peripheries Peripheral cyanosis Narrow pulse pressure Raised JVP Displaced apex Murmur Basal crackles - pulmonary oedema
What is the NYHA HF classification
Class I - Heart disease present but no dyspnoea from ordinary activity
Class II - Comfortable at rest, dyspnoea on normal activities
Class III - less than ordinary activity causes dyspnoea
Class IV - dyspnoea present at rest
What are investigations for suspected HF?
Bloods
- FBS
- U+Es
- LFTs
- Troponin
- BNP
CXR
ECG
What is BNP?
Brain natruiretic peptide
- produced in LV in response to stretch
What are the effects of BNP?
Vasodilation
Diuresis
Naturesis
What is high BNP?
Raised = 100-400
- Echo in 6 weeks
High = >400
- Echo in 2 weeks
What are the CXR changes in HF?
Alveolar bat wings
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Pleural effusion
What is conservative HF management?
Stop smoking
Salt reduction
Weight loss
What is the management of acute HF?
IV furosemide
B-blocker
ACEi
What is the management of chronic HF?
ACEi
B-blocker
Hydralazine + nitrates
Spironolactone
