Heart failure Flashcards
Definition-left?
CHF is a clinical syndrome in which the heart is unable to pump enough blood to meet the metabolic needs of the body as there is ventricular dysfunction leading to a low CO.
Left /forward heart failure relates to left ventricular dysfunction
Risk factors left?
- CAD
- HT
- DM
ddx LHF?
- Ageing
- COPD-cough and wheeze, smoker
- Pneumonia-infection and consolidation
- PE-chest pain, dyspnoea and haemoptysis
- PPCM-same as PE but in preg
- Cirrhosis-jaundice, N and V, peripheral oedema,
- Nephrotic syndrome-p oedema, fatigue, dyspnoea and lack of appetite
- Pericardial disease-left sternal rub, pain worse when lying
- Venous stasis-dark varicose veins and ulceration
- DVT–pain and swelling of calf, unilateral, warm and red.
aetiology LHF?
- IHD
- HT
- Aortic/mitral valve disease
- Myocardial disease
CP LHF?
- Nocturia
- Fatigue
- Tachycardia
- Arrhythmias
- S8/S4 gallop
- Pulsus alternans
- Dyspnoea/orthopnoea
- Pulomnary oedema
- Bilateral rales
- PND
- Cardiac asthma
- Laterally displaced apical heart beat
- Cool extremities, cerebral/renal dysfunction sweating
pathophysiology general LHF?
• Systolic-cant pump hard enough-reduced ejection fraction-systolic heart failure-<40%
• Diastolic-not filling enough-abnormal filling/less preload but same ejection fraction
Starlings law-preload
pathophysiology LHF?
- LHS is mainly Systolic
- Damage to myocardium cant contract as much
- IHD-coronary AS-less oxygen and blood-ischaemia or scar tissue not contracting after MI
- HT-as pressure increases-harder to pump against gradient-so hypertrophy occurs-more oxygen demand and coronary arteries squeezed
- Weaker contractions
- Dilated cardiomyopathy-preload-increases contraction strength-thin and weak-systolic failure
• Diastolic-HT-concentric hypertrophy-less room for filling
• Aortic stenosis
• HT cardiomyopathy-genetic
• Rest cardiomyopathy-stiffer-cant stretch and fill
• Less blood-RAAS preload-contractile strength increases-leakage and fluid build up as preload plateaus after a while.
• Backflow from pulmonary veins can increase pressure in the pulomnary arteries and cause pulmonary oedema-longer diffusion distance causes dyspnoea and orthopnoea as greater venous pressure when lying down
Can get heamosiderin-laden macrophages as blood leakage cleared up by thes
Investigations LHF/RHF first line?
CVS and Resp exam
Investigations LHF/RHF second line?
- Elevated BNP or pro-BNP
- Elevatedatrial natriuretic peptide(ANP):
- Complete blood count: may showanemia
- Serum electrolyte levels:hyponatremia→ indicates a poor prognosis
- Kidney function tests:↑creatinine,↓ sodium
- Urine analysis: rule out concurrent renal impairment
- Fastingglucose: to screen fordiabetes mellitus, which is a common comorbidity
- Fastinglipid profile: to detectdyslipidemiaassociated with a higher cardiovascular risk
- LFT-abdominal distension
- TFT-cause
- Ferritin/transferrin-iron linked cardiomyopathy
Investigations LHF/RHF third line?
- ECG
- Signs of LV Ht-high QRS complex and long QRS duration and left axis deviation, assess previous heart conditions(irritation causes arrhythmias)
- CXR-
- Excludes pulomnary disease
- Cardiomegaly
- Boot-shaped heart
- Pulmonary congestion
Investigations LHF/RHF fourth line?
- Transthoracic echo (gold standard)
* Hypertrophy, EF and diastolic function and etiology
management LHF/RHF first line?
Lifestyle and ACEi, Beta-blocker, diuretic, statins
management LHF/RHF second line?
Aldosterone antagonist (A and B don’t work) , ARB, digoxin(low LVEF), ivabradine (still symptomatic), Vasopressin antagonist(severe hyponatremia)
management LHF/RHF third line?
Hydrasalazine (ACEi and ARB intolerant)
management LHF/RHF fourth line?
ICD/biventricular pacemaker, and cardiac transplant
