heart failure Flashcards
1
Q
what is it
A
any disorder that impairs the ability of the heart to function as a pump
2
Q
what is most common cause of heart failure in western countries
A
coronary artery disease
3
Q
causes
A
- ischaemic heart disease
- cardiomyopathy
- hypertension
- valvular heart disease
- alcohol and drugs
- right heart failure
- arrhythmias
- infections
4
Q
factors involved
A
- venous return
- outflow resistance
- contractility of the myocardium
- salt and water retention
5
Q
what does heart failure to do blood volume
A
reduces volume of blood ejected with each heart beat
6
Q
what does the increased diastolic volume do
A
stretches the myocardial fibres
7
Q
what is reduced early in heart failure
A
the ejection fraction
8
Q
how is cardiac output maintained during heart failure
A
sinus tachycardia
9
Q
what symptoms does increased venous pressure contribute to
A
- dyspnoea
- accumulation of interstitial fluid
- ascites
10
Q
what is outflow resistance
A
the load or resistance against which the ventricle contracts
11
Q
what is outflow resistance formed by
A
- pulmonary and systemic resistance
- characteristics of the vessel walls
- volume of blood that is ejected
12
Q
what does an increase in afterload do to cardiac output
A
decrease it
13
Q
what autonomic innervation is activated during heart failure
A
sympathetic
14
Q
what do myocardial depressants do
A
decrease myocardial contractility
15
Q
what does excitation of myocyte membrane cause
A
rapid entry of calcium into myocytes from the extracellular space
16
Q
how is relaxation of heart mediated
A
by uptake and storage of calcium by sarcoplasmic reticulum
17
Q
what is apoptosis
A
programmed cell death
18
Q
is apoptosis associated with heart failure
A
yes
19
Q
where is atrial natriuretic peptide released from
A
atrial myocytes
20
Q
when is ANP released
A
in response to stretch.
21
Q
what does ANP induce
A
- vasodilatation
- suppresses RAAS
22
Q
can BNP levels be used for heart failure
A
yes
23
Q
where is brain natriuretic peptide secreted by
A
ventricles
24
Q
what does pro-BNP release
A
BNP.
25
where is C-type peptide
vascular endothelium and central venous system
26
what does endothelium have a central role in
regulation of vasomotor tone
27
nitric oxide vasodilator or vasoconstrictor
vasodilator
28
is endothelin increased or decreased in heart failure
increased
29
what is major source of endothelin
pulmonary vascular bed
30
what pathophysiology of heart failure does endothelin contribute to
- vasoconstriction
- sympathetic stimulation
- RAAS
- LVH
31
causes
- left ventricular systolic dysfunction
- diastolic heart failure
- right ventricular systolic dysfunction
32
symptoms
- dyspnoea
- orthopnoea
- paroxysmal nocturnal dyspnoea
- fatigue
33
signs
- tachycardia
- elevated JVP
- cardiomegaly
- S3 and S4
- bi-basal crackles
- pleural effusion
- peripheral ankle oedema
- ascites
34
how is it classified
new york heart association
35
diagnosis
- FBC
- CXR
- electrocardiogram
- echocardiography
- cardiac MRI
- cardiac biopsy
- exercise testing
36
what is seen in CXR
- cardiomegaly
- Kerley B lines
- pulmonary oedeam
37
what is seen in electrocardiogram
- ischaemia
- hypertension
- arrhythmia
38
what is used for diagnosis
cardiac biopsy
39
what lifestyle changes should be made to prevent heart failure
- cessation of smoking
- no alcohol
- no illicit drugs
- weight monitoring
- weight reduction
- salt restrictions
40
what should all be controlled to prevent heart failure
- effective treatment of hypertension
- treat diabetes
- therapy following MI
41
what effect does alcohol have on the heart
negative inotropic
42
list of all drugs used for heart failure
- ramipril
- enalapril
- candesartan
- valsartan
- losartan
- bisoprolol
- carvedilol
- furosemide
- bendroflumethiazide
- spironolactone
- eplerenone
- digoxin
- isosorbide dinitrate
- ivabradine
43
what should be monitored when using ramipril
renal function
44
what should be monitored when using furosemide
renal function
45
what diuretic should be used in severe heart failure
metolazone
46
what should be checked for when using sprionolactone
- renal funcitoin
| - gynaecomastia
47
what should be done once heart failure is diagnosed
check underlying cause and treat it
48
what is a flow chart for treatment
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
how do diuretics work
by promoting renal excretion of salt and water by blocking tubular reabsorption of sodium and chloride
50
example of loop diuretic
furosemide
51
example of thiazide diuretic
bendroflumethiazide
52
what do diuretics provide symptomatic relief for
- dyspnoea
| - improve exercise tolerance
53
what must be monitored whilst on diuretics
- serum electrolytes
| - renal function
54
ACE inhibitors are proven to improve symptoms and significantly reduce mortality
TRUE or FALSE
true
55
side effects of ACE inhibitor
- cough
- hypotension
- hyperkalaemia
- renal dysfunction
56
when are ACE inhibitors contraindicated
- renal artery stenosis
- pregnancy
- previous angio-oedema.
57
example of angiotensin II receptor antagonist
valsartan
58
ARB affect bradykinin metabolism
TRUE or FALSE
false
ACE inhibitors affect it
59
what affect do beta blockers have on patients with heart failure
- improve functional status
| - reduce cardiovascular morbidity
60
example of aldosterone antagonist
spironolactone
61
what occurred in men taking spironolactone
- gynaecomastia
| - breast pain
62
example of cardiac glycoside
digoxin
63
when is digoxin given
in patients in atrial fibrillation with heart failure
64
how is digoxin given
as add therapy with ACE inhibitor and beta blockers
65
what does heart failure increase risk of
stroke
66
what drug decreases hear rate without affecting blood pressure
ivabradine
67
what is hibernating myocardium
reversible left ventricular dysfunction
due to chronic coronary artery disease
68
what does hibernating myocardium respond to
coronary revascaularisation
69
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)
70
what is treatment of choice for young patients with heart failure
cardiac transplantation
71
complications of cardiac transplantation
- infection
- allograft vascular disease
- hypertension
- hypercholesterolaemia
- malignancy
72
symptoms acute heart failure
- severe dyspnoea
- fluid accumulates in interstitium
- pulmonary oedema
73
causes of acute heart failure
- ischaemic heart disease
- valvular heart disease
- hypertension
- kidney disease
- AF
74
what is activated in acute heart failure
RAAS
| sympathetic nervous system
75
what does prolonged ischaemia result in
myocardial stunning
76
what investigations should be done for acute heart failure
- ECG
- CXR
- FBC
- plasma BNP
- echocardiography
77
what does ECG show
- LVH
- atrial fibrillation
- valvular heart diseaes
78
what does CXR show
- cardiomegaly
- pulmonary oedema
- pleural effusion
- non-cardiac disease
79
what does raised BNP suggestive of
heart failure
80
what should be done to confirm heart failure
echo
81
what should be checked regularly in hospital for AHF
- temperature
- heart rate
- blood pressure
- cardiac monitoring
82
what is given to all patients with AHF
prophylactic anticoagulation with LWMH
83
initial therapy for AHF
oxygen and diuretics (furosemide)
84
what else should be given for treatment for AHF
vasodilator
85
what do patients with profound hypotension require
inotropes and vasopressors
to improve haemodynamic status
86
what is better CPAP or oxygen via mask
CPAP
87
what are ventricular assist devices
mechanical devices that replace or help the failing ventricles in delivering blood around the body
88
what does a left ventricular assist device do (LVAD)
receive blood from left ventricle and deliver it to the aorta
89
what does right ventricular assist device do (RVAD)
receives blood from right ventricle and delivers it to the pulmonary artery
90
what are side effects of VADs
- thromboembolism
- bleeding
- infection
- device malfunction
