Heart Failure & Oedema Flashcards
Heart Failure
Unable to pump in sufficient manner to meet the requirements of tissues
Causes of HF
Coronary heart disease/MI Hypertension Diabetes Valve disease- rheumatic Poorly controlled AF Idiopathic dilated cardiomyopathy
Symptoms of HF
SOB, Orthopnea, Paroxysmal Nocturnal dyspnoea, fatigue, tiredness, ankle swelling, reduced exercise tolerance
Clinical signs of HF
Raised JVP, crackles in lower lung fields, 3rd or 4th heart sound, murmur, sacral oedema
CXR in HF
Kerley B lines, Perihilar congestion, enlarged heart, pleural effusion
ECG
Arrythmias or signs of past MI
Echocardiogram
Shows the size of the heart, allows calculation of the ejection fraction
BNP levels
ventricular hormone released when damaged so high levels of BNP indicate damage to the ventricle
Highly sensitive
Lifestyle modifications
Increase exercise, water salt restriction, vaccination, mental health care
Drugs to prolong survival
ACE and ARB inhibitors, Beta Blockers Aldosterone antagonists Vasodilators Ivabradine
Drugs to improve symptoms
Digoxin, Frusemide
New drug that replaces ACE and ARB for heart failure
Entresto - angiotensin receptor neprylisin inhibitor
Which vessels remove excess interstitial fluid?
Lymph vessels
What two forces are in opposition at either end of the cappiliary?
Hydrostatic and Plasma Osmotic pressure
Why does pulmonary oedema lead to SOb
Increases diffusion distance- decreases diffusion rate
reduced lung compliance
What does Left ventricular failure cause?
Pulmonary oedema, as backlog of hydrostatic pressure up pulmonary veins into pulmonary capillaries
What does right ventricular failure cause?
Systemic oedema, as hydrostatic pressure backlog into systemic veins
Two other reasons for raised capillary pressure leading to oedema
Arteriolar dilation
Prolonged standing - ankle oedema
How can a reduced plasma osmotic pressure occur?
Malnutrition, protein malabsorption, excessive renal excretion, hepatic failure
How can a lymphatic insufficiency occur?
Lymph node damage
Filariasis elephantiasis
Difference in the oedema when its due to lymphatic insufficiency?
The oedema is not pitting
How can changes in capillary permeability occur?
Inflammation- swelling
Histamine increases leakage of proteins
