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Internal Med > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart failure?

A

It is when the heart cannot pump enough blood to supply the body’s demands

  • This depends on whether the right, left or both sides of the heart are involved
  • clinical syndrome of neurohormonal malaptation
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2
Q

What are the two causes of heart failure?

A
  1. systolic HF-the heart is not pumping enough
  2. Diastolic HF- heart is not filling enough
  • coronary artery disease(ischaemic heart disease)
  • valvular heart disease
  • myocardial infarction
  • pericardial disease
  • hypertension
  • renal disease
  • infiltrative disease: sarcoidosis, amyloidosis
  • diabetes mellitus
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3
Q

What is cardiac output?

A

HR multiplied by Stroke volume

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4
Q

What is the Frank Starling mechanism?

A

Loading the ventricles with blood during diastole increases the sroke volume

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5
Q

What are the causes of left sided heart failure?

A
  1. dilated cardiomyopathy
  2. Ischaemic Heart Disease
  3. Long standing hypertension
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6
Q

What are the clinical signs of pulmonary edema?

A
  1. dyspnea
  2. orthopnea
  3. rales in the lungs
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7
Q

What do ACE inhibitors do?

A

They dilate blood vessels

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8
Q

What is cor pulmonale?

A

It is when chronic lung disease causes right heart hypertrophy and failure

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9
Q

What are the causes of congestive cardiac failure?

A
  1. coronary artery disease
  2. Diabetes mellitus
  3. Hypetrension
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10
Q

How does biventricular cardiac failure present as?

A
  • Both symptoms of left and right heart failure

- and general symptoms like fatigue and tachycardia and nocturia

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11
Q

Who are the people that are affected the most with CHF?

A

> 60 years old

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12
Q

What are the risk factors that cause CHF?

A
  1. obesity
  2. smoking
  3. COPD
  4. Alcohol abuse
  5. recreational drugs
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13
Q

What does the body do to try and counteract the decreased cardiac output?

A
  1. There will be an increase in adrenergic response: increase in blood pressure, heart rate and ventricular contractility
  2. The renin angiotensin aldosterone system will be activated which will increase angiotensin II secretion which will lead to peripheral vasoconstriction leading to hypertension
  3. Increase in the brain natriuretic peptide:
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14
Q

What are the general features of congestive cardiac failure?

A
  1. Tachycardia with arrythmias
  2. pulsus alternans
  3. S3/S4 gallop
  4. Cachectic
  5. Fatigue, nocturia, dyspnea
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15
Q

What are the clinical symptoms of left sided heart failure?

A
  1. Dyspnea
  2. Orthopnea
  3. Pulmonary edema
  4. Paroxysmal nocturnal dyspnea
    - acute shortness of breath and coughing during sleep
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16
Q

What will you find on physical examination of the patient?

A

On ausculatation; bilateral basilar rales
Palpation: laterally displaced apex beat
-coolness of the peripheries and limbs

17
Q

What are the clinical symptoms of right heart failure?

A
  1. Pitting edema

2. hepatic venous congestion

18
Q

What are the physical symptoms that the patient presents with?

A
  1. Raised JVP
  2. Kussmauls sign-when on isnpiration the JVP increases
  3. hepatosplenomegaly
  4. hepatojugular reflex:
19
Q

What is the classification of NYHA?

A
  1. Class 1- no physical limitation, cofortable at rest
  2. Class 2- some physical limitation, patient out of breath after 2 flights of stairs or heavy lifting, comfortable at rest
  3. Class 3- physical limitations significant, tired after walking and dressing, comfortable only at rest
  4. Class 4- patient in bed. cannot do any physical activity, symptoms even at rest
20
Q

What are the special investigations we need to do in these patients?

A 
1. bloods: 
FBC-anaemia
Brain natriuretic peptide >400
U&E- hyponatraemia
creatinine will be increased
  1. ECG with signs of left ventricular hypertrophy
  2. chest Xray: pulmonary congestion, cardiomegaly
  3. Echo
21
Q

How do we treat CHF?

A
  1. lifestyle modifications
  2. pharmacological
    - diuretics specifically loop diuretics
    - ACE inhibitors: monitor for dry cough and start to reduce preload, afterload and cardiac output
    - add beta blocker and gradually titrate
    - add aldosterone antagonist
    - if patient develops cough change to angiotensin receptor blocker
    - if everything fails give patient digoxin
22
Q

How do we classify cardiac failure according to the presentation?

A
  1. Stable heart failure
23
Q

Why do patients decompensate in heart failure?

A
  1. non adeherence to medication
  2. over-indulgence with alcohol
  3. increased heart rate: AF, thyotoxicosis, anaemia, pregnancy, infections like UTI, URTI, LRTI
  4. myocardial infarction
  5. infective endocarditis
24
Q

When should we avoid beta blockers?

A
  1. cardiogenic shock
  2. atrial fibrillation
  3. mitral stenosis

Internal Med (15 decks)

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