Heart Failure Flashcards
describe heart failure
the state in which the heart is unable to pump blood at a rate commensurate with the requirements of the tissues or can only do so at high pressures
describe impairment of left ventricular filling
without proper LV relaxation during diastole, the volume of blood filling the cavity is reduced, thus;
reducing the stroke volume
reducing the volume of blood ejected with each contraction
describe impaired ejection of blood
due to LV wall damage, the LV may have reduced ability to pump or eject
what is heart failure a result of
results from structural or functional impairment of ventricular filling or ejection of blood. Can be due to disorders of;
pericardium
myocardium (left ventricular myocardium dysfunction)
endocardium
heart valves
great vessels
metabolic abnormalities
describe diagnostic evaluation of new onset heart failure
determine type of cardiac dysfunction (systolic or diastolic)
determine aetiology and treat potentially reversible causes
define prognosis
guide therapy
describe aetiology of heart failure
coronary heart disease+/- MI hypertension dilated cardiomyopathy valve disease tachycardic arrhythmia heart failure with preserved ejection fraction
tests for heart failure
ECG - identify arrhythmia, MI, left ventricular hypertrophy
echocardiogram - chamber size, right and left ventricular function, regional wall motion abnormalities, evidence of impaired filling, valvular heart disease, diseases of pericardium, ejection fraction
transthoracic echocardiography - preferred method for documentation of cardiac dysfunction at rest
CXR - size and shape of cardiac silhouette, evidence of fluid accumulation in lungs
BNP levels
symptoms of heart failure
shortness of breath difficulty breathing at night when recumbent - orthopnoea, paroxysmal nocturnal dyspnoea reduced exercise tolerance fatigue tiredness ankle swelling pulmonary and/or splanchnic congestion peripheral oedema
describe volume overload in heart failure
neck exam - elevated JVP
auscultation of lungs - rales or crackles
auscultation of heart - 3rd or 4th heart sound sometimes called gallop rhythm, murmur
oedema in dependant areas - sacrum, feet, ankles, lower leg
describe ejection fraction (EF)
percentage of blood that is pumped out of heart during each beat
normal - >50%
heart failure with EF <40% => heart failure with reduced ejection fraction
heart failure in the setting of a normal EF => heart failure with preserved ejection fraction
describe the difference between heart failure with EF (HErEF) and heart failure in the setting of a normal EF (HFpEF)
HRrEF - LV is unable to eject an adequate amount of blood during systole
HFpEF - less blood is able to fill the LV in diastole, due to myocardial stiffness. Thus the LV has less blood to eject during systole
describe BNP
ventricular hormone
increases with heart failure - can rule out primary care patients with normal BNP levels
measuring BNP is the most sensitive and specific test for diagnosing heart failure
describe signs in heart failure
signs of volume overload
evidence of secondary causes
elevated BNP
describe lifestyle advice treatment in heart failure
exercise therapy;
rehabilitation
salt reduction in diet
up to date vaccination
manage health - treat depression, care for the carers
describe drug treatment for heart failure
prolong surivial
RAS inhibition;
ACE inhibitors and ARII antagonisits - titrate up
beta blockers - titrate up
aldosterone antagonists- spironolactone and eplerenone
vasodilators;
hydralazine and nitrates combined (for those who do not tolerate ACEI/ARB)
sinus node blocker - ivabradine
improve symptoms
digoxin
frusemide
