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cardiovascular > heart failure > Flashcards

heart failure Flashcards

1
Q

what is it

A

any disorder that impairs the ability of the heart to function as a pump

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2
Q

what is most common cause of heart failure in western countries

A

coronary artery disease

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3
Q

causes

A
  • ischaemic heart disease
  • cardiomyopathy
  • hypertension
  • valvular heart disease
  • alcohol and drugs
  • right heart failure
  • arrhythmias
  • infections
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4
Q

factors involved

A
  • venous return
  • outflow resistance
  • contractility of the myocardium
  • salt and water retention
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5
Q

what does heart failure to do blood volume

A

reduces volume of blood ejected with each heart beat

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6
Q

what does the increased diastolic volume do

A

stretches the myocardial fibres

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7
Q

what is reduced early in heart failure

A

the ejection fraction

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8
Q

how is cardiac output maintained during heart failure

A

sinus tachycardia

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9
Q

what symptoms does increased venous pressure contribute to

A
  • dyspnoea
  • accumulation of interstitial fluid
  • ascites
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10
Q

what is outflow resistance

A

the load or resistance against which the ventricle contracts

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11
Q

what is outflow resistance formed by

A
  • pulmonary and systemic resistance
  • characteristics of the vessel walls
  • volume of blood that is ejected
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12
Q

what does an increase in afterload do to cardiac output

A

decrease it

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13
Q

what autonomic innervation is activated during heart failure

A

sympathetic

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14
Q

what do myocardial depressants do

A

decrease myocardial contractility

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15
Q

what does excitation of myocyte membrane cause

A

rapid entry of calcium into myocytes from the extracellular space

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16
Q

how is relaxation of heart mediated

A

by uptake and storage of calcium by sarcoplasmic reticulum

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17
Q

what is apoptosis

A

programmed cell death

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18
Q

is apoptosis associated with heart failure

A

yes

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19
Q

where is atrial natriuretic peptide released from

A

atrial myocytes

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20
Q

when is ANP released

A

in response to stretch.

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21
Q

what does ANP induce

A
  • vasodilatation

- suppresses RAAS

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22
Q

can BNP levels be used for heart failure

A

yes

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23
Q

where is brain natriuretic peptide secreted by

A

ventricles

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24
Q

what does pro-BNP release

A

BNP.

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25
Q

where is C-type peptide

A

vascular endothelium and central venous system

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26
Q

what does endothelium have a central role in

A

regulation of vasomotor tone

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27
Q

nitric oxide vasodilator or vasoconstrictor

A

vasodilator

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28
Q

is endothelin increased or decreased in heart failure

A

increased

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29
Q

what is major source of endothelin

A

pulmonary vascular bed

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30
Q

what pathophysiology of heart failure does endothelin contribute to

A
  • vasoconstriction
  • sympathetic stimulation
  • RAAS
  • LVH
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31
Q

causes

A
  • left ventricular systolic dysfunction
  • diastolic heart failure
  • right ventricular systolic dysfunction
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32
Q

symptoms

A
  • dyspnoea
  • orthopnoea
  • paroxysmal nocturnal dyspnoea
  • fatigue
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33
Q

signs

A
  • tachycardia
  • elevated JVP
  • cardiomegaly
  • S3 and S4
  • bi-basal crackles
  • pleural effusion
  • peripheral ankle oedema
  • ascites
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34
Q

how is it classified

A

new york heart association

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35
Q

diagnosis

A
  • FBC
  • CXR
  • electrocardiogram
  • echocardiography
  • cardiac MRI
  • cardiac biopsy
  • exercise testing
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36
Q

what is seen in CXR

A
  • cardiomegaly
  • Kerley B lines
  • pulmonary oedeam
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37
Q

what is seen in electrocardiogram

A
  • ischaemia
  • hypertension
  • arrhythmia
38
Q

what is used for diagnosis

A

cardiac biopsy

39
Q

what lifestyle changes should be made to prevent heart failure

A
  • cessation of smoking
  • no alcohol
  • no illicit drugs
  • weight monitoring
  • weight reduction
  • salt restrictions
40
Q

what should all be controlled to prevent heart failure

A
  • effective treatment of hypertension
  • treat diabetes
  • therapy following MI
41
Q

what effect does alcohol have on the heart

A

negative inotropic

42
Q

list of all drugs used for heart failure

A
  • ramipril
  • enalapril
  • candesartan
  • valsartan
  • losartan
  • bisoprolol
  • carvedilol
  • furosemide
  • bendroflumethiazide
  • spironolactone
  • eplerenone
  • digoxin
  • isosorbide dinitrate
  • ivabradine
43
Q

what should be monitored when using ramipril

A

renal function

44
Q

what should be monitored when using furosemide

A

renal function

45
Q

what diuretic should be used in severe heart failure

A

metolazone

46
Q

what should be checked for when using sprionolactone

A
  • renal funcitoin

- gynaecomastia

47
Q

what should be done once heart failure is diagnosed

A

check underlying cause and treat it

48
Q

what is a flow chart for treatment

A
  1. reduce risk factors
  2. treat hypertension, diabetes
  3. ACE inhibitor or ARB in all patients
  4. dietary sodium restrictions
  5. revascularisation
  6. aldosterone antagonist
  7. VAD, transplantation
49
Q

how do diuretics work

A

by promoting renal excretion of salt and water by blocking tubular reabsorption of sodium and chloride

50
Q

example of loop diuretic

A

furosemide

51
Q

example of thiazide diuretic

A

bendroflumethiazide

52
Q

what do diuretics provide symptomatic relief for

A
  • dyspnoea

- improve exercise tolerance

53
Q

what must be monitored whilst on diuretics

A
  • serum electrolytes

- renal function

54
Q

ACE inhibitors are proven to improve symptoms and significantly reduce mortality

TRUE or FALSE

A

true

55
Q

side effects of ACE inhibitor

A
  • cough
  • hypotension
  • hyperkalaemia
  • renal dysfunction
56
Q

when are ACE inhibitors contraindicated

A
  • renal artery stenosis
  • pregnancy
  • previous angio-oedema.
57
Q

example of angiotensin II receptor antagonist

A

valsartan

58
Q

ARB affect bradykinin metabolism

TRUE or FALSE

A

false

ACE inhibitors affect it

59
Q

what affect do beta blockers have on patients with heart failure

A
  • improve functional status

- reduce cardiovascular morbidity

60
Q

example of aldosterone antagonist

A

spironolactone

61
Q

what occurred in men taking spironolactone

A
  • gynaecomastia

- breast pain

62
Q

example of cardiac glycoside

A

digoxin

63
Q

when is digoxin given

A

in patients in atrial fibrillation with heart failure

64
Q

how is digoxin given

A

as add therapy with ACE inhibitor and beta blockers

65
Q

what does heart failure increase risk of

A

stroke

66
Q

what drug decreases hear rate without affecting blood pressure

A

ivabradine

67
Q

what is hibernating myocardium

A

reversible left ventricular dysfunction

due to chronic coronary artery disease

68
Q

what does hibernating myocardium respond to

A

coronary revascaularisation

69
Q

what is cardiac resynchronisation therapy

A

simultaneous pacing of both ventricles using a lead placed in right ventricle and another in the coronary sinus (to pace the left)

70
Q

what is treatment of choice for young patients with heart failure

A

cardiac transplantation

71
Q

complications of cardiac transplantation

A
  • infection
  • allograft vascular disease
  • hypertension
  • hypercholesterolaemia
  • malignancy
72
Q

symptoms acute heart failure

A
  • severe dyspnoea
  • fluid accumulates in interstitium
  • pulmonary oedema
73
Q

causes of acute heart failure

A
  • ischaemic heart disease
  • valvular heart disease
  • hypertension
  • kidney disease
  • AF
74
Q

what is activated in acute heart failure

A

RAAS

sympathetic nervous system

75
Q

what does prolonged ischaemia result in

A

myocardial stunning

76
Q

what investigations should be done for acute heart failure

A
  • ECG
  • CXR
  • FBC
  • plasma BNP
  • echocardiography
77
Q

what does ECG show

A
  • LVH
  • atrial fibrillation
  • valvular heart diseaes
78
Q

what does CXR show

A
  • cardiomegaly
  • pulmonary oedema
  • pleural effusion
  • non-cardiac disease
79
Q

what does raised BNP suggestive of

A

heart failure

80
Q

what should be done to confirm heart failure

A

echo

81
Q

what should be checked regularly in hospital for AHF

A
  • temperature
  • heart rate
  • blood pressure
  • cardiac monitoring
82
Q

what is given to all patients with AHF

A

prophylactic anticoagulation with LWMH

83
Q

initial therapy for AHF

A

oxygen and diuretics (furosemide)

84
Q

what else should be given for treatment for AHF

A

vasodilator

85
Q

what do patients with profound hypotension require

A

inotropes and vasopressors

to improve haemodynamic status

86
Q

what is better CPAP or oxygen via mask

A

CPAP

87
Q

what are ventricular assist devices

A

mechanical devices that replace or help the failing ventricles in delivering blood around the body

88
Q

what does a left ventricular assist device do (LVAD)

A

receive blood from left ventricle and deliver it to the aorta

89
Q

what does right ventricular assist device do (RVAD)

A

receives blood from right ventricle and delivers it to the pulmonary artery

90
Q

what are side effects of VADs

A
  • thromboembolism
  • bleeding
  • infection
  • device malfunction

cardiovascular (36 decks)

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