Heart Failure Flashcards
Define HF
What is the ejection fraction?
Heart fails to provide adequate blood flow to meet body’s need
A measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. An ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle is pushed out with each heartbeat.
Causes of left side HF with reduced ejection fraction:
- Cardiac disease
- BP
- Glucose
- Heart muscle
- ‘mitral’
- rhythm
- lifestyle
What is this also known as?
IHD/MI HTN DM via IHD Dilated cardiomyopathy Valve disease Arrhythmias Drugs or alcohol
Systolic dysfunction or heart failure
Causes of left side HF with preserved ejection fraction:
- HTN and DM are both causes!
- What would cause less blood to come into the heart but wouldn’t affect the percentage of blood in leaving? - 2
- What type of cardiomyopathy would they have that wouldn’t affect the percentage of blood in leaving the heart?
It is also known as ______ dysfunction. Fill the blank?
Constructive pericarditis
Cardiac tamponade
Restrictive cardiomyopathy
Diastolic dysfunction
Right sided heart failure:
How do cor pulmonale, LVF cause RVF?
Primary lung disease leads to vasoconstriction in poorly ventilated lung tissue to correct V/Q mismatch.
Leads to pulmonary HTN
Therefore, RVF as needs extra force to get blood through lungs
Pulmonary HTN – RVF
Symptoms LVF
Resp symptoms:
SOB is the main symptom!
- What are 2 other respiratory symptoms?
- What colour sputum do they get and why?
- Why do they get wheezing?
- What other symptom may they have that can contribute to their feelings of dizziness?
HF patients can get body wasting:
- What is the technical name for this?
- Why does this happen?
Orthopnoea
PND
Pink frothy sputum due to the pulmonary oedema
Heart failure can cause fluid to build up in your lungs (pulmonary oedema) and in and around your airways. The latter causes signs and symptoms — such as shortness of breath, coughing and wheezing — that may mimic asthma.
Palpitations
Cachexia:
- Heart failure may cause blood to back up into the liver and intestines, and they may swell. This swelling can lead to nausea and decreased appetite.
- Swelling of the intestines may not allow for adequate absorption of nutrients from the food you eat.
- Heart failure may force you to work harder to breathe and cause your body temperature to increase. Both of these conditions burn calories.
- In people with severe heart failure, tumor necrosis factor (TNF) and other signaling molecules in the bloodstream called cytokines can increase the metabolic rate of the tissues, thus burning more calories.
Signs - LVF:
- What is heard on auscultation?
- What extra heart sounds do you hear? - 2
- What is cachexia?
Crackles - you may also hear murmurs which indicate heart pathology
S3 and S4
Weight loss
Symptoms - RVF
Liver congestion is a common symptom of RVF.
Why is nausea one of the main symptoms of this?
Why do they get early satiety and anorexia and abdo pain as well as the loss of appetite?
Why do they get nosebleeds?
Why do they get nocturia?
Liver congestion leading:
Nausea and upset stomach are common early symptoms of liver disease, but as your liver’s ability to eliminate toxins decreases, your digestive distress will likely increase. Ongoing nausea is a reaction to excess waste products in the body, and unexplained vomiting is often linked to liver problems.
Due to poor abdominal organ perfusion or oedema
Because blood is being moved away from your digestive system, your appetite may not be as big as it usually is. You might also feel sick to your stomach.
There is an increase in systemic venous pressure and, as a consequence, also in systemic capillary pressure; this condition raises the risk of capillary ruptures
Nocturia on lying flat, fluid backs up from legs to kidneys producing more urine.
Signs - RVF
What signs do you see in the:
- Neck
- Legs
- Lower back
- Abdomen
What may be felt on examination?
Raised JVP
Peripheral oedema
Ascites
Hepatomegaly
A heave
Investigations:
Bloods:
Why do FBC, U+E, LFT’S, TFT’s?
What else can be investigated in the blood that could show signs of disease that could contribute to cardiac failure?
Anaemia can mimic or exacerbate symptoms
Liver and kidney function can be affected in HF
They are a differential for fluid retention
Thyrotoxicosis can cause high output failure
Hypo could cause fatigue and oedema as well as reduced CO.
===
Cholesterol, glucose
Investigations:
Signs on CXR can be remembered using ABCDE.
What are they?
A - alveolar oedema (bat wing opacities) B - Kerley B lines C - cardiomegaly D - dilated upper lobe vessels E - pleural effusion
Investigations:
CXR:
- Why do they get bat wing opacities?
- What causes Kerley B lines?
- Why do they get dilated pulmonary veins?
- Why does pleural effusion occur?
What may be seen on an ECG? - 2
What will LV strain leading to ischaemia show? - 2
Because of pulmonary oedema.
They represent oedema of the interlobular septa and though not specific, they frequently imply left ventricular failure.
Pulmonary HTN is possibly the most common contributing factor to a dilated PA.
Pleural effusion in heart failure results from increased interstitial fluid in the lung due to elevated pulmonary capillary pressure.
Axis deviation
AF
LV strain will show some ST depression and T inversion
Investigations - imaging:
What protein is screened for which is released by the heart when it is failing? - not troponin
What imaging is done if the above chemical is elevated?
What if the diagnosis is not clear after above is done?
What score can be used to look at the heart failure severity?
BNP - b-type natriuretic peptide
Test for BNP first and do trans thoracic echo if elevated
Ultrasound provides an evaluation of the heart chamber dimensions, valvular function, ejection fraction, pericardial effusions and left ventricular hypertrophy.
Other tests such as cardiac MRI, transoesophageal echo
NYHA - New York Heart Association (NYHA)
Diagnosis Pathway:
Why is this peptide used?
What else can increase the levels?
Pro-BNP is synthesised in the ventricular wall when it is stressed and circulates as BNP (B-type natriuretic peptide)
IHD AF PE Kidney failure Cirrhosis Sepsis Number also rises with age
Management for LVF:
What does cardiac rehab involve?
What lifestyle changes can be made?
What vaccines should be given?
What should be monitored?
Cardiac rehab involves adopting heart-healthy lifestyle changes to address risk factors for cardiovascular disease. To help you adopt lifestyle changes, this program includes exercise training, education on heart-healthy living, and counselling to reduce stress and help you return to an active life.
Smoking cessation
Flu and pneumococcal vaccination
Monitor weight and fluid balance, advising moderate fluid restriction
Management for LVF:
Pharmacological:
A range of drugs can be used to support the heart! - read the list
When should mineralocorticoid receptor antagonists be added?
ACEi - enalapril most common
Beta-blockers - bisoprolol, metoprolol etc.
Diuretics - loop (furosemide, bumetanide) or thiazides
If patient still symptomatic
Spironolactone or eplerenone
