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Systems: Cardiovascualar AB > Heart Failure: Presentation + Investigation > Flashcards

Heart Failure: Presentation + Investigation Flashcards

1
Q

Heart failure

A

A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction, either at rest or on exertion with accompanying neurohormonal activation

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2
Q

What should heart failure be qualified by?

A

Underlying structural abnormality

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3
Q

What factors increase the prevalence of CHF?

A
  • Treatment of AMI
  • Aging population
  • Hypertension
  • CHD
  • Obesity
  • Diabetes
  • HLP
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4
Q

What factors decrease the prevalence of CHF?

A

Treatment and diagnosis of:

  • HLP
  • Hypertension
  • CHD
  • Diabetes
  • Obesity
  • CHF
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5
Q

Describe re-admission rates of heart failure.

A
  • High

- Often occur early

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6
Q

What are the symptoms of heart failure?

A
  • Dyspnoea
  • Fatigue
  • Oedema
  • Reduced exercise capacity
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7
Q

What are the signs of heart failure?

A
  • Oedema
  • Tachycardia
  • Raised JVP
  • Chest crepitations or effusions
  • 3rd HS
  • Displaced or abnormal apex beat
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8
Q

Why can heart failure be difficult to diagnose on clinical grounds alone?

A
  • Non-specific symptoms

- No signs

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9
Q

What is mandatory for a heart failure diagnosis?

A

Objective evidence of cardiac dysfunction

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10
Q

What are the European society of cardiology guidelines for the diagnosis of heart failure?

A
  1. Symptoms or signs of HF (rest or exercise)
  2. Objective evidence of cardiac dysfunction
  3. Response to therapy
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11
Q

How can evidence of cardiac dysfunction be collected?

A
  • ECHO
  • Radionuclide ventriculography
  • MRI
  • Left ventriculography
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12
Q

What potential screening tests are there for heart failure?

A
  • 12 lead ECG

- BNP

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13
Q

How can BNP be used in diagnosis of HF?

A
  • Amino acid peptide can be measured in the blood
  • Elevated in HF
  • Low BNP effectively excludes HF
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14
Q

What is very unlikely if the ECG is normal?

A

LVSD

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15
Q

What are the benefits of using BNP as a screening test for HF?

A
  • High sensitive test for HF
  • Stable for up to 72 hours
  • Bedside testing available
  • Relatively inexpensive
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16
Q

What does elevate BNP indicate?

A

Need for an ECHO/cardiac assessment

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17
Q

If HF is sufficiently severe can be the underlying cause?

A

Almost any structural cardiac abnormality

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18
Q

Possible causes of HF

A
  • LV systolic dysfunction
  • Valvular heart disease
  • Pericardial constriction or effusion
  • LV diastolic dysfunction/ HF with preserved systolic function/HF with normal ejection fraction
  • Cardiac arrhythmias
  • Myocardial ischaemia/infarction
  • Restrictive cardiomyopathy
  • Right ventricular failure
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19
Q

What are the causes of LV systolic dysfunction?

A
  • Ischaemic heart disease
  • Dilated cardiomyopathy (LVSD not due to IHD or secondary to other lesions)
  • Sever aortic valve disease or MR
20
Q

What can cause DCM?

A
  • Inherited
  • Toxins
  • Viral
  • Other infective
  • Systemic disease
  • Muscular dystrophie
  • Peri-partum
  • Hypertension
  • Isolate non compaction
  • Tachycardia
  • RV pacing induced
  • End stage hypertrophic
  • End stage arrythmogenic RV
21
Q

What needs to be excluded when diagnosing LVSD?

A
  • Renal failure
  • Anaemia
  • Thyroid problem
  • Phaechromocytoma
  • Sarcoid
  • Muscular dystrophies
  • CHD
22
Q

How is LVSD evaluated?

A
  • Detailed history
  • TFTs
  • Autoantibodies/viral serology
  • ECG
  • CXR
  • ECHO
  • Coronary angiography
  • CT coronary angigram
  • Cardiac MRI
23
Q

What is ECHO used to identify and quantify?

A
  • LV systolic dysfunction
  • Valvular dysfunction
  • Pericardial effusion/tamponade
  • Diastolic dysfunction
  • LVH
  • Atrial/ventricular shunts/ complex congenital heart defects
  • Pulmonary hypertension/ right heart dysfunction
24
Q

What may an ECHO miss?

A

-May not identify constriction/ may miss shunts but will see atrial dilatation

25
Q

What is a continuous biological variable?

A

LV ejection fraction

26
Q

What can increase/decrease LVEF?

A

Disease/physiological states

27
Q

What is LVEF analogous to?

A

Haemoglobin/anaemia

28
Q

Why can LVEF be difficult to quantify accurately and reproduce by ECHO?

A
  • Quality of images
  • Experience of operator
  • Calculation method
  • Use of contrast agents
  • Time consuming to perform accurately
  • Normal range is centre specific but LVEF not routinely measured and NR not routinely established
29
Q

What is the scale of LVEF?

A
  • 50-80% Normal
  • 40-50% Mild
  • 30-40% Moderate
  • <30% Severe
30
Q

How does the Biplane modified Simpsons rule divide the LV?

A

Divides LV cavity into multiple slices of known thickness and diameter

31
Q

What type of slices in the biplane modified Simpson’s rule have the most accurate volume estimation?

A

Thinner slices

32
Q

What does the Biplane modified Simpson’s rule require?

A

Endocardial border traced accurately (often major technical difficulty with this method)

33
Q

What 2 methods can be used to calculate LVEF?

A
  • M-mode

- Simpsons biplane

34
Q

What are the advantages of using MUGA for the LVEF?

A
  • Much easier to obtain an accurate figure

- Greater reproducibility

35
Q

What are the disadvantages of using MUGA for the LVEF?

A
  • Ionising radiation
  • No additional structural information
  • Centre specific normal range
36
Q

NYHA class I HF

A

No symptoms during usual activity with no limitation on exercise tolerance

37
Q

NYHA class II HF

A

Comfortable with rest or mild exertion with mild limitation on exercise tolerance

38
Q

NYHA class III HF

A

Comfortable only at rest with moderate limitation on exercise tolerance

39
Q

NYHA class IV HF

A

Any physical activity brings on discomfort and symptoms occur at rest with severe limitation on exercise tolerance

40
Q

Why is HF not all about cardiac output?

A

A dilated heart can have the same CO with the same HR despite having half the EF by having double the EDV

41
Q

Why is HF considered a systemic disorder?

A
  • Cardiac dysfunction
  • Renal dysfunction
  • Skeletal muscle dysfunction
  • Systemic inflammation
  • neurohormonal activation
42
Q

What role does the renin-angiotensin-aldosterone system play in HF?

A
  • Salt and water retention
  • Adverse haemodynamics
  • LV hypertrophy/remodelling and fibrosis
  • Hypokalaemia and hypomagnesaemia
43
Q

What pharmacological therapy is there for HF due to LVSD?

A
  • Diuretics
  • ACEI
  • B blockers
  • Aldosterone receptor blockers
  • ARBs
44
Q

What role does the SNS play in HF?

A
  • Arrhythmogenic
  • Adverse haemodynamics
  • Increase renin etc
45
Q

What 2 systems foes the neurohormonal hypothesis of HF include?

A
  • Renin-angiotensin-aldosterone system

- Sympathetic nervous system

Systems: Cardiovascualar AB (42 decks)

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