Heart Failure + Cardiomyopathy Flashcards
what is the definition of heart failure
cardiac output doesn’t meet the body’s requirements
what’s the prognosis of HF
25-50% within 5 years
what is systolic failure?
ventricle can’t contract normally so decreased cardiac output
what is diastolic failure?
ventricle can’t relax and fill properly causing increased filling pressures
what is the ejection fraction in diastolic
50%
causes of systolic failure
IHD (ischaemic heart disease), MI, cardiomyopathy
causes of diastolic failure
constrictive pericarditis, tamponade, restrictive cardiomyopathy, hypertension
what are the symptoms of left ventricular failure
dyspnoea, PND, orthopnoea, poor exercise tolerance, wheeze, nocturia, cold peripheries, weight loss, muscle wasting
what are the symptoms of right ventricular failure
peripheral oedema, ascites, nausea, anorexia, facial engorgement, pulsation in neck and face (tricuspid regurg), epistaxis
causes of RVF
LVF, pulmonary stenosis, lung disease
what is acute heart failure
new onset acute or decompensation of chronic HF; pulm and or peripheral oedema with or without signs of peripheral hypoperfusion
what is chronic heart failure
develops/progresses slowly. venous congestion common but arterial pressure well maintained until very late
what is low output HF
cardiac output low and fails to increase with exertion
causes of low output HF
pump failure (low HR, systolic and or diastolic failure, -vely inotropic drugs), excessive preload (mitral regurg, fluid overload- NSAIDS causing retention), chronic excessive afterload (aortic stenosis, hypertension)
what is congestive heart failure
LVF and RVF
what is high output HF
rare. output normal or increase to meet needs, but fails.
causes of high output HF
anaemia, pregnancy, hyperthyroidism, Pagets, beri beri, arteriovenous malformation
what is the initial presentation of high output HF
RVF, then later signs of LVF
what criteria is made to diagnose
Framingham
Framingham criteria requires 2 maj and 1 minor criteria or 1 maj and 2 min. what are the major criteria?
PND, creps, S3 gallop, neck vein distention, acute pulm oedema, increased hepatojugular reflex, cardiomegaly, weight loss, increased central venous pressure
what are the minor criteria
bilat ankle oedema, dyspnoea, nocturnal cough, tachycardia, decr vital capacity, hepatomegaly, pleural effusion
other signs HF
exhaustion, cool peripheries, cyanosis, decr BP, narrow pulse pressure, displaced apex, rv heave, murmurs, wheeze
if what 2 tests are normal makes HF unlikely
ECG, BNP. if one abnormal do echo
what is the ABCDE of ECG showing LVF
Alveolar oedema (bats wings), Kerley B lines (interstitial oedema), Cardiomegaly, Dilated prominent upper lobe vessels, pleural Effusion
what may ECG show
cause- ischaemia, LVH, MI
what may echo show
cause- valvular disease, MI, LV dysfunction
what is the management in chronic heart failure
treat the cause, treat exacerbating factors, avoid exacerbating factors eg NSAIDs, verapamil, drugs
what are the drugs used in chronic heart failure
diuretics, ACE-I, B blockers, spironolactone, digoxin, vasodilators
what is the New York classification of heart failure
I- heart disease present, no dyspnoea. II- comfortable at rest, dyspnoea ordinary activities. III- less than ordinary activities cause dyspnoea which is limiting. IV- dyspnoea present at rest, all activity causes discomfort.
what is dilated cardiomyopathy
dilated, flabby heart of unknown cause
what are the associations with dilated cardiomyo
alcohol, incr BP, haemochromatosis, viral infection, autoimmune, peri or post partum, thyrotoxicosis, congenital
presentation of dilated cardiomyo
fatigue, pulm oedema, RVF, emboli, AF, VT.
signs of dilated cardiomyo
incr pulse, decr BP, incr JVP, displaced diffuse apex, S3 gallop, mitral or tricuspid regurg, pleural effusion, oedema, jaundice, hepatomegaly, ascites
tests for dilated cardiomyo
BNP, decr Na; CXR- cardiomegaly and pulm oedema; ECG- tachycardia, T wave changed, poorR wave progression. Echo- dilated hypokinetic heart, low ejection fraction (MR, TR,LV mural thrombus)
treatment dilated cardiomyo
diuretics, digoxin, ACE-I, anticoag, pacing, ICDs, transplant
mortality of dilated cardiomyo
40% in 2 years
what is hypertrophic cardiomyo
LV outflow tract obstruction from asymmetrical septal hypertrophy
what are the genetics involved in HCM
autosomal dominant but 50% sporadic. 70% mutations in genes encoding B myosin, alpha tropomyosin, troponin T. presents at any age
symptoms and signs HCM
VF, angina, dyspnoea, palpitation, syncope, CCF, jerky pulse, alpha wave in JVP, double apex beat, systolic thrill
what can the ECG show for HCM
LVH, T wave inversion, deep Q waves, AF, WPW, ventricular ectopics, VT
what would the echo show for HCM
asymmetrical septal hypertrophy, small LV cavity, midsystolic closure of aortic valve
treatment for HCM
B blockers, verapamil- reduce ventricular contractility. amiodarone for arrhythmias. anticoagulate for paroxysmal AF or systemic emboli
what is the mortality HCM
5.9% per year if 14 years
what are the causes of restrictive cardiomyopathy
idiopathic, amyloidosis, haemochromatosis, sarcoidosis, scleroderma, Lofflers eosinophilic endocarditis, endomyocardial fibrosis
what are the types of cardiomyopathy
dilated, hypertrophic, restrictive
what is the presentation of restrictive cardiomyo
like constrictive pericarditis. features RVF- incr JVP, hepatomegaly, oedema, ascites
diagnosis of restrictive cardiomyo
cardiac catheterisation
what is acute myocarditis
inflammation of the myocardium
causes of myocarditis
viral (flu, hep, mumps, coxsackie, polio, HIV), bacterial (clostridia, diphtheria, TB, meningococcus, mycoplasma), spirochetes (lyme, syphilis), toxins, vasculitis
what drugs can lead to acute myocarditis
cyclophosphamide, Herceptin, penicillin, chloramphenicol, sulphonamides, methyldopa, spironolactone, phenytoin, carbamazepine
symptoms and signs acute myocarditis
fatigue, dyspnoea, chest pain, fever, palps, tachy, soft S1, s4 gallop
what does the ECG show in acute myocarditis
ST elevation or depression, t wave inversion, atrial arrhythmias, transient AV block,
what confirms diagnosis acute myocarditis
positive troponin.
what excludes active myocarditis
negative antimyosin scintigraphy
