Heart Failure Flashcards
4 clinical peices of evidence that someone may have a heart structural/functional abnormality
ECG, murmur, raised natriuretic peptide, cardiomegaly
How is HF classified? (3)
- Acute vs Chronic
- L side vs R side (or congestive = both)
- Reduced vs Preserved ejection fraction (or both)
What’s the difference between a reduced and preserved ejection fraction? Name examples of each
Reduced: problem with systole (impaired contractility/increased afterload)
Preserved: problem with diastole (EF stays higher)
L ventricular hypertrophy, tamponade, restrictive cardiomyopathy, etc
3 scenarios that could cause the body to demand a higher output from the heart
Pregnancy, anemia, hyperthyroidism
What are the 2 main causes of L sided Heart failure?
Coronary heart disease, hypertension
What is the main cause of R sided Heart failure?
L sided HF
What is the latin term for what occurs in the R side of the heart during R sided heart failure
Cor pulmonale
What are 3 pathologies that could increase the preload and 2 things that could increase an afterload?
Hypervolemia, valve regurg, HF
HTN, vasoconstriction
Symptoms of LEFT Ventricular failure
Pulmonary congestion: orthopnea, paroxysmal nocturnal dyspnoea, pink/frothy nocturnal cough, breathless on exertion
Lower O2: muscle wasting, fatigue
Signs of RIGHT ventricular failure
pitting edema/Swollen ankles, raised JVP, ascites, hepatomegaly (back up in hepatic veins)
+fatigue, nausea, anorexia
How is staging classified for heart failure? List the stages and their brief characteristics
Staged depending on how functional the heart still is
Class 1: no symptomatic limitation of physical activity
Class 2: Mild physical limitation, (i.e symptoms when doing ordinary physical activity)
Class 3: Marked physical limitation, (i.e symptoms when doing ordinary daily activity)
Class 4: symptoms at rest + severe discomfort/inability to do physical activity without symptoms
3 compensatory mechanisms the body tries to bring the CO back to normal
Ventricular remodelling, starling law, neurohormonal alterations
Describe the starling law mechanism in HF
Increase L ventricle force -> brings SV and CO up
*HF decreases CO and SV so blood accumulates in ventricle
When are neurohormonal alterations activated and what are their 2 overall goals?
Low CO activates..
1. Increase TPR as this brings up BP and CO
- Increase preload by retaining salt and water
What does the RAAS system lead to as a neurohormonal alteration?
Fluid retention/increase preload
Angiotensin II:
- increases thirst
- Vasoconstriction
- Produces aldosterone: retains Na+, excretes K+ and H+
How can neurohormonal alterations become an issue chronically? (4 things)
Too much
Vasoconstriction: wall stress, hypotension
HR: increases heart’s metabolic/O2 needs
TPR: high afterload that reduces SV and CO further
Volume: further pulmonary and peripheral congestion
What does ADH/Vasopressin do as a neurohormonal alteration?
Released via hypovolaemia, increases fluid retention (aquaporins)
What 2 things activate the start of RAAS?
Sympathetic NS and reduced renal blood flow
-> Renin secreted from JGA cells in kidney
Describe the two natriuretic peptides, what is their relationship with RAAS?
ANP: atrial myocytes in response to high blood volume/atrial pressure -> vasodilation and decreased Na absorption
B type natriuretic peptide (BNP): ventricular myocytes in response to high pressure
-> BALANCE RAAS: vasodilation, increase Na+ and water excretion, decrease renin and angiotensin II action
What are the 3 main components to Ventricular Remodelling and what is the eventual outcome?
Hypertrophy, fibrosis, apoptosis
Eventually overstretch of myocyte -> thin/weak -> blood backs up into L atria and pulmonary vessels
Why is BNP not always reliable?
Highly sensitive but low specificity
*many things affect it; may be decreased with certain meds, obesity, etc
What is the main goal in medical management of heart failure? List 3 things
Symptomatic improvement, delay progression
Reduce fluid: Loop diuretics, ACE inhibitors
Reduce sympathetic response: beta-blockers
Veno/vasodilation: nitrates
What are 3 main surgical interventions that can be done to manage heart failure?
Implantable defibrillator, pacemaker, surgery (transplant, valve, revascularisation, etc)
What defines acute heart failure? List 5 symptoms and 7 signs
Sudden onset of symptoms
Severe SOB, sweating, nausea, anxious, dry or productive (wet and chesty) cough
Hypotension, edema, crackles, S3, raised JVP, tachycardia, orthopnea
