Heart Failure Flashcards
What is heart failure
When the output of the heart is incapable of meeting the demands of the tissues
What are the main types of heart failure
High output failure
Low output failure
Describe high output failure and give examples
Demands of the system have increased beyond the capacity of the pump
eg - anaemia, thyrotoxicosis
Describe low output failure and give examples
Pump is failing and not strong enough to force liquid around the body
eg - cardiac defects such as MI or valve disease
Which type of heart failure is most common
Low output failure
What other terms can be used to describe heart failure
Left heart failure
Right heart failure
Congestive heart failure - both sides
Describe systolic dysfunction
During diastole the enlarged ventricles fill with blood
During systole the ventricles pump out less than 40-50% of the blood
Describe diastolic dysfunction
During diastole the stiff ventricles fill with less blood than normal
During systole the ventricles pump out about 60% of the blood, but the amount may be lower than normal
Describe diastole and systole in a normal, healthy heart
During diastole, the ventricles fill normally with blood
During systole, the ventricles pump out about 60% of the blood
What causes systolic dysfunction
Muscle loss or stiffness of ventricle walls
What are common causes of low output failure
Heart muscle disease Pressure overload Volume overload Arrhythmias Drugs
Which drugs can cause low output heart failure
Beta blockers
Corticosteroids
Anti cancer drugs
What are the compensation mechanisms of heart failure and what effect does this have
Body increases circulating blood volume if blood is lost
Has a negative effect and makes heart failure worse
What are the signs of left heart failure
Dyspnoea
Tachycardia
Low blood pressure
Low blood volume and pulse
What are the signs of right heart failure
Elevated venous pressure Swollen ankles Ascites Raised JVP Tender, enlarged liver Poor GI absorption
What is the problem in left heart failure
Blood being pumped by right side towards left side isn’t pumped out of left side into circulation so lungs have a build up of blood so increased blood pressure
What is the problem in right heart failure
Systemic veins will be filling as blood isn’t taken away and carried around the body and therefore the venous pressure will increase leading to fluid transudating from the veins into the body tissues
What is ascites
Fluid within the abdominal cavity
What are the symptoms of heart failure
Shortness of breath Swelling of feet and legs Chronic lack of energy Difficulty sleeping due to breathing problems Swollen or tender abdomen with loss of appetite Cough with frothy sputum Increased urination at night Confusion and/or impaired memory
How can heart failure cause ankle swelling
Fluid accumulates in peripheral tissues from right sided failure
What is pitting oedema and what does its position indicate
Fluid accumulation in superficial tissues that can be squeezed out of the way by pressure
Higher up the leg it appears, the more severe the heart failure is
How is acute heart failure treated
Emergency hospital management
Oxygen, morphine and frusemide
How does acute heart failure present
Left side has sudden loss of function
Fluid accumulates in the lungs
Patient is short of breath
How is chronic heart failure treated
Community based
Improve myocardial function
Reduce compensation effects
Where possible treat the cause
What are possible underlying causes of heart failure that can be treated
Hypertension Valve disease Heart arrhythmias Anaemia Thyroid disease
Which drugs work against heart failure and should be stopped
Negative inotropes - Beta blockers
What drugs can be used to treat heart failure
Diuretics to increase salt and water loss
ACE inhibitors to reduce salt and water retention
Nitrates to reduce venous filling pressure
Inotropes such as digoxin
What can be done when treating heart failure to improve cardiac function
Assist pumps which work with the heart to pump blood around the body
Heart transplant where it has been damaged and there is no prospect of improvement
