Heart Failure and Structural Defects Flashcards
Define heart failure and state the most common cause of it
D: Complex clinical syndrome of S/S showing efficiency of heart as pump impaired
CC: Ischaemic Heart Disease/ Myocardial Dysfunction
What hormones are produced by the heart and what metabolises these?
ANP and BNP
Metabolised by NEP
How do NEP inhibitors act as a treatment for heart failure?
Prevents NEP to metabolise ANP/BNP, increasing levels of these in the serum
How do nitrates help to treat heart failure?
Venodilators, reducing preload and BP (GTN spray and isosorbide mononitrate)
What are the 3 main side effects of nitrate usage?
Syncope, Headaches and Tolerance
What is heart failure?
Inability of heart to deliver blood/o2 with requirements of metabolising tissue (Despite increased/normal cardiac filling pressures)
What are the S/S of HF?
Sy: Breathlessness, Tiredness, cold peripheries, leg swelling, ^ weight
Si: Tachycardia, displaced apex beat, ^ JVP, added heart sounds, ascites, oedemas
What are the compensatory mechanisms in HF?
1) RAAS 2) Sympathetic NS 3) Natriuretic peptides 4) Ventricular dilation 5) Ventricular hypertrophy
How does the RAAS work in compensatory fashion?
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)
How does Sympathetic NS work in compensatory fashion for heart failure?
Sympathetic NS improves ventricular function by increasing HR and contractility, maintaining CO
(Arteriolar constriction so afterload and myocardial work -> Strain are caused)
What is the first line of treatment for heart failure?
Vasodilator therapy (ACEi, beta blocker) via neurohumoral blockade
What are the 3 main signs of Left heart failure?
1) Pulmonary crackles
2) Added heart sounds (3rd and 4th HS)
3) Displaced apex beat
4) Tachycardia
What are 3 non-cyanotic heart defects?
1) Atrial Septal Defect
2) Ventral Septal Defect
3) PDA
(Seen as left to right shunt, insufficiency high and chance of Eisenmenger’s syndrome)
What is a cyanotic heart defect?
Tetralogy of Fallot
Right to Left shunt
What are the 4 main features of TOF?
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)
What is VSD, including clinical signs and risk?
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
What is Eisenmenger’s syndrome and the associated risks?
^ Pa Pulmonary BF damages pulmonary vasculature –> ^ resistance to BF -> ^ RV Pa, shunt change direction and cyanosis
Risks: Death, Endocarditis and Stroke
What is ASD, including clinical signs and risk
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
What is AVSD and clinical signs?
Atrio-Ventricular septal defect (Centre of heart)
- Breathless, poor feeding and poor weight gain
What is PDA?
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
What is coarctation of the aorta?
Excessive sclerosis that would close DA< extends into aortic wall leading to narrowing
