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CVS > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Define Heart Failure

A

State in which the heart fails to maintain an adequate circulation for the needs of the body despite an adequate filling pressure

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2
Q

Conditions that affect/ impair which 3 things can lead to impaired cardiac function

A
  • Functioning muscle
  • Chamber size
  • One way valves
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3
Q

List 7 possible causes of Heart failure

A
  • Coronary artery disease (Most common)
  • Hypertension (Increased afterload on ventricle)
  • Aortic stenosis (Increased afterload on ventricle)
  • Cardiomyopathies (Hypertrophy)
  • Pericardial disease
  • Arrhythmia
  • Elevated demand on Cardiac output (Rare)
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4
Q

What is the Ejection Fraction, EF?

How much is normal?

A

Percentage of EDV of blood pumped out of heart per beat (SV/EDV *100)

50%-70%

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5
Q

What are 4 things that influence the Cardiac Output

A

Pre load (EDV)
After load (Total peripheral resistance)
Myocardial Contractility
Heart rate

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6
Q

What are 2 causes of Heart failure

A

Inability of heart to fill properly (HFpEF/ diastolic dysfunction)

Inability of heart muscle to contract properly (HFrEF systolic dysfunction)

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7
Q

In reference to HFpEF, explain why a normal Ejection Fraction does not rule out Heart Failure

A
  • Less filling of heart, so less blood pumped out

- Fraction of SV/ EDV is normal, but CO is still lower than normal

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8
Q

What are 2 mechanisms of HFpEF

A
  • Ventricle chambers too stiff
  • Ventricle walls thickened

(Reduced capacity of ventricle for blood)

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9
Q

What are 3 mechanisms of HFrEF

A
  • Ventricle muscle walls thin/ fibrosed
  • Ventricle chambers enlarged
  • Abnormal/ uncoordinated myocardial contraction

(Can’t pump with enough force for a given EDV)

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10
Q

What is the most common type of heart failure

A

HFrEF

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11
Q

Heart failure can affect both sides of heart. Which side is most commonly affected?

A

Left side (Often leads to right side failure as well)

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12
Q

How can left sided heart failure cause right sided heart failure

What do you call hear failure in both sides

A

Raised pulmonary arterial pressure leading to additional right sided heart failure

Congestive heart failure

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13
Q

What’s the most common cause of Right sided heart failure

A

Left sided heart failure

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14
Q

Name 3 physiological mechanisms used to try and correct a falling cardiac output in heart failure

What is the outcome of these?

A

(Neurohormonal effects);

  • SNS (increased contractility, vasoconstriction, tachycardia)
  • RAAS
  • Increased ADH secretion

Cause a failing heart to work harder, further reducing cardiac output)

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15
Q

Other than oedema, list 6 symptoms of LV Heart Failure

A
  • Fatigue/ lethargy
  • Breathlessness on exertion
  • Orthopnea (Shortness of breath when lying flat)
  • Paroxysmal nocturnal dyspnoea (Severe SOB and coughing at night)
  • Basal pulmonary crackles
  • Cardiomegaly (Displaced apex beat indicated enlarged LV)
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16
Q

Other than oedema, list 4 symptoms of RV Heart Failure

A
  • Fatigue/ lethargy
  • Breathlessness
  • Raised jugular venous pressure
  • (Possible) Tender, smooth enlarged liver (liver congestion)
17
Q

Compare the types of Oedma caused by RV and LV heart failure

A

RV: Peripheral oedema
LV: Pulmonary oedema

18
Q

Impaired ventricle contractility leads to Atria stretching. What 2 molecules are released as this happens?

What are 3 of their effects?

A

Natriuretic peptides, ANP and BNP

Oppose the opposite neurohormonal effects;

  • Vasodilation
  • Inhibit renin secretion
  • Natriuresis (los of Na and H2O at kidneys)

(Beneficial effects are not usually sufficient to overcome the deteriorating neurohormonal effects)

19
Q

Which Natriuretic Peptide is used to assess likelihood of Heart failure?

What other heart condition raises those substance’s blood concentration?

A

BNP (Normal varies with age/ gender)

Atrial fibrillation (Can triple BNP)

20
Q

Identify 1 symptomatic treatment for Heart failure, and 5 prognostic treatments

A
  • Furosemide (Immediate Venodilator)
  • Beta blockers
  • Spironolactone
  • ACE inhibitors/ Angiotensin II receptor blockers
  • Biventricular pacemaker
  • Diuretics
21
Q

Name 4 investigations used to diagnose heart failure

A
  • ECG
  • CXR
  • Transthoracic Echocardiogram
  • Blood tests (FBC, BNP, NTpro-BNP, U&Es)
22
Q

Other than BNP and NTpro-BNP, describe 3 blood tests used to investigate heart failure

A
  1. FBC;
    - Often anaemic in heart failure
  2. U&Es;
    - Renal function deteriorates in heart failure
  3. LFTs;
    - May be elevated due to hepatic congestion

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