Heart Failure (including congestive) Flashcards
Define Heart Failure
Whats the prognosis?
Cardiac output is inadequate for the body’s requirements.
Prognosis is poor with ~25-50% of patients dying within 5yrs of diagnosis.
Define systolic failure
Whats the ejection fraction?
What are causes of systolic failure?
Inability of the ventricle to contract norally, resulting in lowCO.
Ejection fraction = <40%
Causes; IHD, MI, cardiomyopathy
Define diastolic failure
Whats the ejection fraction?
What are causes of diastolic failure?
Inability of the ventricle to relax and fill normally, causing inc filling pressures.
EF = >50%
Causes; constrictive pericarditis, tamponade, restrictive cardiomyopathy, hypertension
NB: systolic & diastolic normally co-exist..
Define congestive heart failure
Left ventricular failure (LVF) and right ventricular failure (RVF) coexist.
CCF causes ‘congestion’ as blood isn’t being pumped through - ie causing ankle oedema AND pulmonary oedema.
Define Left Ventricular Failure (LVF)
What are the symptoms?
Failure of the left ventricle only.
Symptoms;
- Respiratory
- Dyspnoea, orthopnea, paroxysmal nocturnal dyspnoea
- Chest crepitations (pulmonary oedema)
- Cardiac asthma/ wheezing/ nocturnal cough
- Pleural effusion
- ↓vital capacity by 1/3
- Cardiac
- Gallop rhythm (S3/ S4)
- Cardiomegaly
- Tachycardia
- Displaced apex beat (LV dilatation)
- Heart murmurs (cause; aortic stenosis or result; mitril regurg)
- Arterial
- Cyanosis, cold peripheries
- Nocturia (low renal perfusion during ambulation, inc when sleeping)
- Hyper/ hypotension
Define Right Ventricular Failure (RVF)
What are the causes?
What are the symptoms?
Failure of the right ventrivle.
Causes;
- LVF
- Pulmonary stenosis
- Lung disease
Symptoms;
- Venous congestion
- Inc central venous pressure (>16cmH20 at RA)
- Neck vein distention, inc JVP
- Hepatojugular reflex
- Peripheral oedema (ankles, up to thighs, sacrum, abdo wall)
- Hepatomegaly, ascites
- Pulsation in neck & face (tricuspic regurg)
- RV heave
- Nausea & anorexia
What is the difference between Acute & Chronic heart failure?
Acute;
- New onset or decompensation of chronic heart failure
- Characterised by pulmonary and/or peripheral oedema
- +/- signs of peripheral hypoperfusion
Chronic;
- Develops slowly
- Venous congestion is common
- Arterial pressure is well maintained until very late
What is low-output heart failure?
What are its causes?
Low cardiac output and failed to incr normally with exertion. Causes;
- Pump failure
- Systolid and/or diastolic HF
- Low heart rate (eg B-blockers, heart block, post MI)
- Negatively inotropic drugs (eg most antiarrhythmic agents)
- Excessive preload
- Mitril regurgitation
- Fluid overload (eg NSAIDs)
- May cause LVF in kidney failure/ large overload normally, but most commonly theres simultaneous compromise of heart/ elderly
- Chronic excessive afterload
- Aortic stenosis
- Hypertension
What is high-output heart failure?
What are its causes?
What are the consequences?
CO is normal or increased with need. Failure occurs when output fails to meet these needs.
Occurs in normal heart, but even earlier in heart disease, causes;
- Anaemia
- Pregnancy
- Hyperthyroidism
- Paget’s disease
- Arteriovenous malformation
- Beri beri
Initially theres features of RVF, later LVF becomes evident.
What happens to the Frank-Starling mechanism during Heart Failure?
Blunted.
Contractile force does not increase at the same proportion as a normal heart during inc filling pressure
Outline the effects of the RAA system in Heart Failure
Low CO causes activation of RAA.
- Angiotensin 2
- Peripheral vasoconstriction
- Increases afterload of heart
- Decreasing CO
- Aldosterone
- Inc NaK in the DT & collecting duct
- Inc filling pressure of heart
- Due to blunted Starling effect there is a further decrease in CO
Outline the effects of the Sympathetic system in Heart Failure
Low cardiac output causes inc sympathetic output via aortic arch & carotid sinus baroreceptors.
- Vasoconstriction
- Renin release by JXT
- ADH secretion by Post Pituitary
- Increase HR
Outline the cytokines & hormones released in Heart Failure
- ANP [atria] & BNP [ventricles] in responce to stretch
- TNFa from macrophages
- Endothelin - from endothelium in responce to hypoxia, angiotensin & catecholamines
What histological changes may you find in Heart Failure?
- Myocyte hypertrophy + enlarged nuclei
- Interstitial fibrosis
What are the symptoms and signs of cardiac failure?
Symptoms;
- Respiratory
- Dyspnoea, orthopnea, paroxysmal nocturnal dyspnoea
- Chest crepitations (pulmonary oedema)
- Cardiac asthma/ wheezing/ nocturnal cough
- Pleural effusion
- ↓vital capacity by 1/3
- Cardiac
- Gallop rhythm (S3/ S4)
- Cardiomegaly
- Tachycardia
- Displaced apex beart (LV dilatation)
- Heart murmurs (cause; aortic stenosis or result; mitril regurg)
- Arterial
- Cyanosis, cold peripheries
- Nocturia
- Hyper/ hypotension
- Venous congestion
- Inc central venous pressure (>16cmH20 at RA)
- Neck vein distention, inc JVP
- Hepatojugular reflex
- Peripheral oedema (ankles, up to thighs, sacrum, abdo wall)
- Hepatomegaly, ascites
- Pulsation in neck & face (tricuspic regurg)
- RV heave
- Weight loss >4.5kg in 5 days in responce to treatment
- Nausea & anorexia
