heart failure Flashcards
what is the definition of heart failure ?
heart failure is the inability of the heart to maintain its demand
generally what is the cause of heart failure ?
any functional or structural impairment of blood ejection or ventricular filling
what is the most common cause of heart failure?
coronary artery disease
how is the cardiac output calculated ?
stroke volume multiplied by heart rate
what is stroke volume determined by ?
pre load
after load
myocardial contractility
what physiological measure can be used the overall function of the heart ?
ejection fraction
what is the ejection fraction ?
percentage of the blood within the chamber that is pumped out with every heartbeat
what is the normal ejection fraction ?
55 to 75 percent
what is the aetiology of heart failure ?
heart failure is a clinical consequence valvular heart disease pericardial disease high output states volume overload congenital heart disease
what is the pathophysiology of heart failure ?
an imbalance occurs in three neurohormonal systems :
the renin-aldosterone system
the sympathetic nervous system
the nariuteric peptide system
what are the classifications of heart failure ?
systolic heart failure
diastolic heart failure
mixed systolic and diastolic heart failure
what is the ejection fraction in each of the types of heart failure ?
systolic heart failure - ejection fraction is 40%
diastolic heart failure - ejection fraction is normal
mixed systolic and diastolic- ejection fraction is 35%
when do we see mixed systolic and diastolic failure ?
dilated cardiomyopathy
what are the typical symptoms of heart failure?
breathlessness orthopnea paroxysmal nocturnal dyspnoea reduced exercise tolerance ankle swelling
what are the more specific signs of heart failure ?
elevated jugular venous pressure hepato-jugular reflex third heart sound ( gallop rhythm) laterally displaced apical impulse cardiac murmur
what are the signs of left sided heart failure ?
paroxysmal nocturnal dyspnea pulmonary congestion elevated pulmonary capillary wedge pressure cyanosis exertional dyspnea
what are the signs of pulmonary congestion ?
cough crackles wheezes blood tinged sputum tachypnea
what are the signs of right sided heart failure ?
venous congestion
cor pulmonale
distended jugular veins
hepatomegaly
splenomegaly
ascites
dependent edema
increased peripheral venous pressure
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how would you asses the aetiology of HF ?
angiography
cMRI
biopsy
how would you confirm a diagnosis of HF?
natriuretic peptides
and echo
Echocardiography
what are the steps following an acute onset with heart failure ?
perform ECG , chest x-ray
then echocardiography along with BNP and NT-pro BNP
then if the ECG turns out normal NT-pro BNP is below 300 or BNP is below 100 then heart failure is unlikely
what results would make us suspect heart failure ?
if the ECG turned out abnormal
NT pro-BNP was equal to or more than 300
BNP was equal to or more than 100
what to do when the lab results are leaning towards heart failure ?
perform an echocardiogram
how do you treat heart failure ?
first with lifestyle changes to improve signs and symptoms: diuretics Calcium channel blockers management of underlying disease
what kind of lifestyle changes can be made ?
salt restriction
exercise
cessation of alcohol and smoking
decrease in body weight
what is the drug management for congestive heart failure ?
ACE inhibiots
Angiotensin II receptor blockers
beta blockers
loop diuretics furosemide
why would anticoagulants be used in heart failure pateints?
thromboembolic problems may be caused because of stasis and stagnant blood flow
what are the surgical interventions for congestive heart failure?
coronary artery bypass grafting (CABG) percutaneous coronary intervention valve replacement heart transplantation left ventricular assist device
what type of pulse , rhythm and valvular disease is seen in left sided heart failure?
pulse: pulsus alternans
rhythm : s3 gallop rhythm
valvular HDd : mitral regurgitation
how does the RAAS system hav a role in heart failure?
first it serves as a compensatory mechanism
but later on it increases preload and after load
what is the normal function of natriuretic peptides ?
they prevent cardiac. hypertrophy and remodelling
what does preload and afterload mean ?
preload is the diastolic force
afterload is the systolic force
what is high output cardiac failure and what are the causes ?
thee ejection fraction is normal but the metabolic demands have increased and they have not been met
anemia
thyrotoxicosis
sepsis
pagets disease of the bones
AV malformation
what are the features of diastolic heart failure ?
pulmonary congestion
pulmonary hypertension
ventricular hypertrophy
what are the changes seen on X ray of heart failure ?
A: alveolar oedema
B: kerley B sign
C: cardiomegaly
D: upper lobe blood diversion
E: pleural effusion
F: fluid in horizontal fissure
what is the initial management for a patient with pulmonary oedema ?
sit the patient up
give oxygen therapy
IV furosemide to reach diuresis
IV nitrates GTN infusion
if all failed CPAP
what are the types of pulmonary oedema ?
cardiogenic - due to increased in pulmonary venous pressure
noncardiogenic - increase in the capillary permeability
when can we use inotropic therapies in pulmonary oedema ?
if there is signs of shock or hypoperfusion of other organs
what type of congestion is associated with LVF and RVF ?
LVF is associated with pulmonary congestion
RVF is associated with venous congestion
what medications are used for HF with reduced EF ?
systolic HF or HFFrEF
BASH
Beta blockers
ACE inhibitors
Spironolactone
Hydrasalazine
what does s3 gallop rhythm indicate ?
volume overload usually owing to congestive heart failure
what is heard on auscultation of patient with pulmonary oedema ?
bi basal crepitations
