Heart failure patho and investigation Flashcards
Define Heart failure
A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction either at rest, on exertion and with accompanying neurohormonal activation
What percentage of hospital admissions are H.F
5%
Why is Heart failure increasing in prevalence
1) Increasing age of population
2) More people are surviving M.I and have cardiac damage
What diseases can cause Heart Failure
- Any structural damage that causes myocardial damage if they are severe enough
-Coronary artery disease
-Hypertension
-Atrial fibrillation
-Valve disease
-Anemia
etc
What are the presenting symptoms of Heart failure
- Breathless
- Fatigue
- Oedema
- Reduced exercise capacity
What are clinical signs of Heart failure
Oedema Tachycardia Raised JVP Chest crepitations 3rd heart sound Displaced apex beat
What initial investigations should you do for suspected heart failure
12 Lead ECG (90-95% sensitive)
Brain natriuretic peptide (BNP)
What is Brain natriuretic peptide (BNP) test
It measures the amino peptide, a hormone secreted by cardiomyocytes in the heart ventricles in response to stretching caused by increased ventricular blood volume. It is elevated in heart failure.
If BNP and ECG suggest heart failure what is the next investigation that should be done?
Echocardiography
What is the biggest cause of Heart failure
Left ventricular systolic dysfunction
What causes LVSD
Ischaemic heart disease
Severe AV disease or Mitral regurgitation
Dilated Cardiomyopathy
or Viral, Toxins, Pregnancy, inherited.
What is the first step in making a diagnosis of LVSD
Take a detailed history
What can a detailed history exclude in a LVSD diagnosis
MI DM (myotonic dystrophy) Hypertension Post partum Alcohol Lymes disease HIV Renal failure Phaechromocytoma Sarcoid Muscular dystrophy
What investigations should you do if suspect LVSD
ECG and CXR and always do an ECHO
When should you do a coronary angiogram in LVSD diagnosis
If chest pain
If >70 years old
Why is it important to always do an ECHO when investigating LVSD
It identifies and it quantifies the heart failure
What can an ECHO show
LVSD Valvular dysfunction Pericardial effusion Pulmonary hypertension Dyastolic dysfunction LVH Shunts
What heart feature are ECHOs not accurate at measuring
Left ventricular ejection fraction
What is Left ventricular ejection fraction
The percentage of blood that has been ejected each beat from the ventricle
What are the classifications of LVEF
Normal -
Mild
Moderate
Severe
What is an normal LVEF
50-80%
What is a mild LVEF
40-50%
What is a moderate LVEF
30-40%
What is a severe LVEF
<30%
What is the gold standard for investigating LVEF
Cardiac MRI (takes 1 hour) (CMR)
Does a reduction in cardiac output mean the patient has Heart failure
NO
A reduction in Cardiac output is caused by many things
What can cause a reduction in cardiac output
Heart failure Renal Skeletal inflammation Neurohormonal
What are symptoms of Left ventricular Failure
paroxysmal nocturnal dyspnoea
Wheeze
nocturnal cough with pink sputum (caused by pulmonary oedema)
What are symptoms of Right ventricular Failure
LVF (causes RVF)
Lung disease (causes RVF)
peripheral Oedema
Ascites (The abnormal buildup of fluid in the abdomen)
What are the stages in the New York Heart Association classification for heart failure
I. No limitation of physical activity
II. Slight limitation of physical activity
iii. Marked limitation of physical activity
IV. Inability to carry out physical activity
