Heart Failure Flashcards
What is HF?
HF is a clinical condition characterized by an inability of the heart to pump sufficient blood to maintain tissue metabolism despite adequate atrial filling diastole
What is Shock?
Inability of the heart to pump enough blood to meet the metabolic needs of the tissues without adequate arterial filling
Causes of HF
Causes of heart failure • Hypertension • Ischemic heart disease • Diliated cardiomyopathy • Restrictive cardiomyopathy • Valvular heart disease • Hypertrophic/obstructive cardiomyopathy • Congestive heart disease • Alcohol and drugs • pericardial disease • infection (chagas disease)
Mechanisms of HF
Mechanisms of heart failure.
Hyper dynamic state I.e cardiac output is normal but there is increased metabolism eg thyrotoxicosis
Intrinsic cardiogenic ie cardia output decrease but metabolism is normal eg constrictive pericarditis, cardiac tamponade, ischemic heart disease, aortic or mitral regurgitation
Cardiac output increase metabolism is normal or increased but lower oxygen concentration eg anemia pregnancy.
Features of right HF
Right heart failure
- early satiety due to hepatomegaly
- anorexia
- upper abdominal pain
- abdominal swelling
- leg swelling
- parotid fullness
Features of Left HF
Left heart failure
- cough( productive of frothy sputum)
- dyspnonea on exertion
- paroxysmal nocturnal dyspnea
- orthopnea
- easy fatigability
- cyclical breathing
- nocturia
- oliguria
- confusion
- delirium
On physical examination what can you see on someone with heart failure?
O/E • Respiratory distress • Anxious • Diaphoretic • Pale • Cyanosed • Icteric • Fever • Cold extremities • Digital clubbing • Pedal edema
What do you notice on the cardiovascular system?
Cardiovascular
• BP : hypotension or hypertension
• Pulse: tachycardia, irregular rate rhythm-thyrotoxicosis, sepsis
• Raised JVP due to increased venous return
• Hyper-dynamic pericardium due to difficulty in breathing
• Displaced apex beat (systolic heart failure).
• S3 gallop(tachycardia +3rd heart sound)
• S4 due to atrial contraction
• Murmur:
What can u see in respiratory system with some one with heart failure?
Respiratory
• intercostal retraction: due to difficulty in breathing
• Dullness to percussion: due to pleural effusion
• Stridor, wheezing, crackles,
• Rhonchi: all due to pleural effusion and compressing on the airway.
What can we see in the abdomen with some one with heart failure?
Abdomen
•Ascities due to cardiac cirrhosis
• Hepatomegaly due to liver congestion
• Liver tenderness due to liver congestion
What are the specific investigation of heart failure?
1 : chest x Ray
2 : Echocardiography
• Demonstrates structural abnormalities
• Fall in ejection fraction less than 50%
• Chamber dilation and ventricular hypertrophy
• Valvular regurgitation
3 : Electrocardiogram which May reveal ventricular dysfunction
• Valvular abnormalities
• ischemic infarction
4 : Natuirectic peptide b
X-ray features of HF?
A - Alveolar oedema (bat wing opacities) B - Kerley B lines C - Cardiomegaly D - Dilated upper lobe vessels E - Pleural effusion
What causes the release of natuirectic peptide B?
• This is released by stretched atrial myocardium and specific for making diagnosis of heart failure.
Non specific investigations for HF?
General investigation
1: CBC: to indicate anemia or infection as potential cause
2: raised ASO TITRE IN RHEUMATIC FEVER
3: raised platelets in Kawasaki disease
4: coronary arteriograph: coronary artery syndrome.
Framingham’s criteria
Major criteria include
- paroxysmal nocturnal dyspnea
- weight loss of 4.5kg in 5days in response to treatment
- neck vein distention
- rales
- acute pulmonary edema
- hepatojugular reflux
- S3 gallop
- central venous pressure >16cm of H20
- pulmonary edema
Minor criteria
- Nocturnal cough
- dyspnea on ordinary exertion,
- pleural effusion
- tachycardia (rate >120bpm)
- bilateral ankle edema
New York heart association classification of HF?
The New York heart association classification system categories heart failure on the scale of I-IV as follows
A: Class I: no limitation of physical activity
B : class II: slight of physical activity
C: III : marked limitation to physical activity
D: class IV : symptoms occur when at rest, discomfort with any physical activity.
America heart association classification
The American college of college of cardiology/ American heart association (ACC/AHA). Staging system is defined by the following stages
Stage A highly risk of heart failure but no structural heart disease or symptoms of heart failure
Stage B structural heart disease but no symptoms of heart failure
Stage C structural heart disease but there symptoms of heart failure
Stage D refractory heart failure requiring specialized intervention
Pharmacological tx of HF
Reduce preload 1V frusemide 40-120mg daily + spironolactone in severe cases
Reduce after load eg tabs captopril 6.25mg- 24mg BD or TDS
Tabs Digoxin 0.125-25mg daily.
Non pharmacological tx
Non pharmacologic management
1) positioning : managed in cardiac position (45 degrees) this is to ensure
- respiratory decongestion
- prevent aggravating peripheral edema
- facilitate diuresis with increased blood supply to the kidney
2) oxygen especially in patient in a decompensated state which increase oxygen gradient in the alveoli
3) meticulous attention of fluid and electrolytes . This is maintained with in a narrow range ie 1/3 to 2/3 of maintenance dose
4) restrict salt intake to prevent increase in intravascular volume.
E/ bed rest to ensure that available myocardial function is preserved for essential organs
Features of digoxin toxicity
MY EX BAND
Excessive salivation, yellow vision (xanthopsia), diarrhea, malaise, anorexia, nausea, bradycardia or arrhythmia
What is the management of digoxin toxicity
1)Stop digoxin
2)Iv fluid containing potassium
3)Give anti digoxin antibiotics (digibind)
4)Dialysis maybe required
6)Surgery
Heart transplantation
