heart failure Flashcards
what is it
any disorder that impairs the ability of the heart to function as a pump
what is most common cause of heart failure in western countries
coronary artery disease
causes
- ischaemic heart disease
- cardiomyopathy
- hypertension
- valvular heart disease
- alcohol and drugs
- right heart failure
- arrhythmias
- infections
factors involved
- venous return
- outflow resistance
- contractility of the myocardium
- salt and water retention
what does heart failure to do blood volume
reduces volume of blood ejected with each heart beat
what does the increased diastolic volume do
stretches the myocardial fibres
what is reduced early in heart failure
the ejection fraction
how is cardiac output maintained during heart failure
sinus tachycardia
what symptoms does increased venous pressure contribute to
- dyspnoea
- accumulation of interstitial fluid
- ascites
what is outflow resistance
the load or resistance against which the ventricle contracts
what is outflow resistance formed by
- pulmonary and systemic resistance
- characteristics of the vessel walls
- volume of blood that is ejected
what does an increase in afterload do to cardiac output
decrease it
what autonomic innervation is activated during heart failure
sympathetic
what do myocardial depressants do
decrease myocardial contractility
what does excitation of myocyte membrane cause
rapid entry of calcium into myocytes from the extracellular space
how is relaxation of heart mediated
by uptake and storage of calcium by sarcoplasmic reticulum
what is apoptosis
programmed cell death
is apoptosis associated with heart failure
yes
where is atrial natriuretic peptide released from
atrial myocytes
when is ANP released
in response to stretch.
what does ANP induce
- vasodilatation
- suppresses RAAS
can BNP levels be used for heart failure
yes
where is brain natriuretic peptide secreted by
ventricles
what does pro-BNP release
BNP.
where is C-type peptide
vascular endothelium and central venous system
what does endothelium have a central role in
regulation of vasomotor tone
nitric oxide vasodilator or vasoconstrictor
vasodilator
is endothelin increased or decreased in heart failure
increased
what is major source of endothelin
pulmonary vascular bed
what pathophysiology of heart failure does endothelin contribute to
- vasoconstriction
- sympathetic stimulation
- RAAS
- LVH
causes
- left ventricular systolic dysfunction
- diastolic heart failure
- right ventricular systolic dysfunction
symptoms
- dyspnoea
- orthopnoea
- paroxysmal nocturnal dyspnoea
- fatigue
signs
- tachycardia
- elevated JVP
- cardiomegaly
- S3 and S4
- bi-basal crackles
- pleural effusion
- peripheral ankle oedema
- ascites
how is it classified
new york heart association
diagnosis
- FBC
- CXR
- electrocardiogram
- echocardiography
- cardiac MRI
- cardiac biopsy
- exercise testing
what is seen in CXR
- cardiomegaly
- Kerley B lines
- pulmonary oedeam
what is seen in electrocardiogram
- ischaemia
- hypertension
- arrhythmia
what is used for diagnosis
cardiac biopsy
what lifestyle changes should be made to prevent heart failure
- cessation of smoking
- no alcohol
- no illicit drugs
- weight monitoring
- weight reduction
- salt restrictions
what should all be controlled to prevent heart failure
- effective treatment of hypertension
- treat diabetes
- therapy following MI
what effect does alcohol have on the heart
negative inotropic
list of all drugs used for heart failure
- ramipril
- enalapril
- candesartan
- valsartan
- losartan
- bisoprolol
- carvedilol
- furosemide
- bendroflumethiazide
- spironolactone
- eplerenone
- digoxin
- isosorbide dinitrate
- ivabradine
what should be monitored when using ramipril
renal function
what should be monitored when using furosemide
renal function
what diuretic should be used in severe heart failure
metolazone
what should be checked for when using sprionolactone
- renal funcitoin
- gynaecomastia
what should be done once heart failure is diagnosed
check underlying cause and treat it
what is a flow chart for treatment
- reduce risk factors
- treat hypertension, diabetes
- ACE inhibitor or ARB in all patients
- dietary sodium restrictions
- revascularisation
- aldosterone antagonist
- VAD, transplantation
how do diuretics work
by promoting renal excretion of salt and water by blocking tubular reabsorption of sodium and chloride
example of loop diuretic
furosemide
example of thiazide diuretic
bendroflumethiazide
what do diuretics provide symptomatic relief for
- dyspnoea
- improve exercise tolerance
what must be monitored whilst on diuretics
- serum electrolytes
- renal function
ACE inhibitors are proven to improve symptoms and significantly reduce mortality
TRUE or FALSE
true
side effects of ACE inhibitor
- cough
- hypotension
- hyperkalaemia
- renal dysfunction
when are ACE inhibitors contraindicated
- renal artery stenosis
- pregnancy
- previous angio-oedema.
example of angiotensin II receptor antagonist
valsartan
ARB affect bradykinin metabolism
TRUE or FALSE
false
ACE inhibitors affect it
what affect do beta blockers have on patients with heart failure
- improve functional status
- reduce cardiovascular morbidity
example of aldosterone antagonist
spironolactone
what occurred in men taking spironolactone
- gynaecomastia
- breast pain
example of cardiac glycoside
digoxin
when is digoxin given
in patients in atrial fibrillation with heart failure
how is digoxin given
as add therapy with ACE inhibitor and beta blockers
what does heart failure increase risk of
stroke
what drug decreases hear rate without affecting blood pressure
ivabradine
what is hibernating myocardium
reversible left ventricular dysfunction
due to chronic coronary artery disease
what does hibernating myocardium respond to
coronary revascaularisation
what is cardiac resynchronisation therapy
simultaneous pacing of both ventricles using a lead placed in right ventricle and another in the coronary sinus (to pace the left)
what is treatment of choice for young patients with heart failure
cardiac transplantation
complications of cardiac transplantation
- infection
- allograft vascular disease
- hypertension
- hypercholesterolaemia
- malignancy
symptoms acute heart failure
- severe dyspnoea
- fluid accumulates in interstitium
- pulmonary oedema
causes of acute heart failure
- ischaemic heart disease
- valvular heart disease
- hypertension
- kidney disease
- AF
what is activated in acute heart failure
RAAS
sympathetic nervous system
what does prolonged ischaemia result in
myocardial stunning
what investigations should be done for acute heart failure
- ECG
- CXR
- FBC
- plasma BNP
- echocardiography
what does ECG show
- LVH
- atrial fibrillation
- valvular heart diseaes
what does CXR show
- cardiomegaly
- pulmonary oedema
- pleural effusion
- non-cardiac disease
what does raised BNP suggestive of
heart failure
what should be done to confirm heart failure
echo
what should be checked regularly in hospital for AHF
- temperature
- heart rate
- blood pressure
- cardiac monitoring
what is given to all patients with AHF
prophylactic anticoagulation with LWMH
initial therapy for AHF
oxygen and diuretics (furosemide)
what else should be given for treatment for AHF
vasodilator
what do patients with profound hypotension require
inotropes and vasopressors
to improve haemodynamic status
what is better CPAP or oxygen via mask
CPAP
what are ventricular assist devices
mechanical devices that replace or help the failing ventricles in delivering blood around the body
what does a left ventricular assist device do (LVAD)
receive blood from left ventricle and deliver it to the aorta
what does right ventricular assist device do (RVAD)
receives blood from right ventricle and delivers it to the pulmonary artery
what are side effects of VADs
- thromboembolism
- bleeding
- infection
- device malfunction
