Heart Failure and Structural Defects

Question 1

Define heart failure and state the most common cause of it

Answer 1

D: Complex clinical syndrome of S/S showing efficiency of heart as pump impaired
CC: Ischaemic Heart Disease/ Myocardial Dysfunction

Question 2

What hormones are produced by the heart and what metabolises these?

Answer 2

ANP and BNP

Metabolised by NEP

Question 3

How do NEP inhibitors act as a treatment for heart failure?

Answer 3

Prevents NEP to metabolise ANP/BNP, increasing levels of these in the serum

Question 4

How do nitrates help to treat heart failure?

Answer 4

Venodilators, reducing preload and BP (GTN spray and isosorbide mononitrate)

Question 5

What are the 3 main side effects of nitrate usage?

Answer 5

Syncope, Headaches and Tolerance

Question 6

What is heart failure?

Answer 6

Inability of heart to deliver blood/o2 with requirements of metabolising tissue (Despite increased/normal cardiac filling pressures)

Question 7

What are the S/S of HF?

Answer 7

Sy: Breathlessness, Tiredness, cold peripheries, leg swelling, ^ weight
Si: Tachycardia, displaced apex beat, ^ JVP, added heart sounds, ascites, oedemas

Question 8

What are the compensatory mechanisms in HF?

Answer 8

1) RAAS 2) Sympathetic NS 3) Natriuretic peptides 4) Ventricular dilation 5) Ventricular hypertrophy

Question 9

How does the RAAS work in compensatory fashion?

Answer 9

Reduced CO sees V renal perfusion, causing activation of RAAS. Increased fluid retention with ^ BP so increased preload
(However arteriolar constriction increasing after load and myocardial work)

Question 10

How does Sympathetic NS work in compensatory fashion for heart failure?

Answer 10

Sympathetic NS improves ventricular function by increasing HR and contractility, maintaining CO
(Arteriolar constriction so afterload and myocardial work -> Strain are caused)

Question 11

What is the first line of treatment for heart failure?

Answer 11

Vasodilator therapy (ACEi, beta blocker) via neurohumoral blockade

Question 12

What are the 3 main signs of Left heart failure?

Answer 12

1) Pulmonary crackles
2) Added heart sounds (3rd and 4th HS)
3) Displaced apex beat
4) Tachycardia

Question 13

What are 3 non-cyanotic heart defects?

Answer 13

1) Atrial Septal Defect
2) Ventral Septal Defect
3) PDA
(Seen as left to right shunt, insufficiency high and chance of Eisenmenger’s syndrome)

Question 14

What is a cyanotic heart defect?

Answer 14

Tetralogy of Fallot

Right to Left shunt

Question 15

What are the 4 main features of TOF?

Answer 15

1) Ventricular septal defect
2) over-riding aorta
3) Right Ventricle Hypertrophy
4) Pulmonary stenosis
(Baby born with it cyanotic as ^ Pa in RV so shunted across)

Question 16

What is VSD, including clinical signs and risk?

Answer 16

Abnormal connection between 2 ventricles
(Not cyanotic baby as L->R)
1) ^ Pulmonary BF 2) ^ Resp rate 3) Tachycardia 4) Surgical repair required 5) breathless –> poor feeding, can’t thrive
Risk: Eisenmenger’s syndrome

Question 17

What is Eisenmenger’s syndrome and the associated risks?

Answer 17

^ Pa Pulmonary BF damages pulmonary vasculature –> ^ resistance to BF -> ^ RV Pa, shunt change direction and cyanosis
Risks: Death, Endocarditis and Stroke

Question 18

What is ASD, including clinical signs and risk

Answer 18

Abnormal connection between 2 atria (common)
[Baby not cyanotic as ^ LA Pa so L->R shunt]
1) ^ BF through R Heart/Lungs 2) Enlarged pulmonary arteries 3) Right Heart dilatation 4) SOBOE 5) ^Chest infection

Question 19

What is AVSD and clinical signs?

Answer 19

Atrio-Ventricular septal defect (Centre of heart)

- Breathless, poor feeding and poor weight gain

Question 20

What is PDA?

Answer 20

Patent Ductus Arteriosus
1) Endocarditis risk 2) Poor feeding 3) Breathless 4) Torrential flow from aorta to pulmonary arteries lead to pulmonary HT and RHF

Question 21

What is coarctation of the aorta?

Answer 21

Excessive sclerosis that would close DA< extends into aortic wall leading to narrowing