Heart Failure - treatment Flashcards
when does R heart failure only commonly occur?
in severe lung diseasenot likely to be asked about in cardiovascular system questionheart failure tends to refer to LV heart disease
two types of heart failure?
systolic and diastolic
systolic heart failure (HFrEF - heart failure reduced ejection fraction)
heart has turned into a skinny bag that cannot function properlyDecreased pumping function of the heart, which results in fluid back up in the lungs and heart failureLVSD usually occurs following myocardial damage ie post MI
diastolic heart failure (HFpEF - Heart Failure with a Preserved Ejection Fraction ie it is normal)
Involves a thickened and stiff heart muscle due to high BPAs a result, the heart releases all the blood but it does not fill with blood properly as it can’t relax properlyThis results in fluid backup in the lungs and heart failureheart failure usually occurs following sustained hypertension
Chronic heart failure
2-10% of population affectedPeople with severe heart failure are very symptomatic – QOL affected greatly. Peripheral oedema, if severe, can reduce mobility
risk factors for heart failure
Coronary artery diseaseprevious MIHypertension (LVH)Valvular heart diseaseAlcoholism – v common causeInfection (viral)diabetescongenital heart defectsthen general:- age, obesity, smoking, obstructive sleep apnoea
what is the most severe risk factor of heart failure
hypertensionLV diastolic dysfunction can be prevented if hypertension is tackled aggressively
frank starling law and systolic dysfunction?
if the muscle of a healthy heart is stretched it will contract with greater force and pump out more blood. Failing or damaged heart - lose this relationshipHealthy heart – contraction force is in proportion with the amount it is stretchedDamaged heart - More you stretch the heart due to increased circulatory volume (H20 and salt retention) the weaker the force of contraction and CO drops furtherdrop in CO activates vasoconstrictor system (sympathetic) and RAAS
how does a drop in CO due to HF cause further problems?
drop in CO activates RAAS system which then increases plasma vol and therefore increases venous return so cardiac performance deteriorates further
how does the heart weaken
As the heart starts to dilate the cardiac myocytes undergo hypertrophy and then fibrosis and thus the heart is further weakenedmyocytes that become hypertrophic become ischaemic and die
The RAAS system causes the release of what?
angiotensin II – causes vasoconstrictionaldosterone
what does the Natriuretic peptide system ANP/BNP
cause salt watter loss
what does EDRF do?
muscle relaxationvasodilation
treatment options to improve SYMPTOMS of heart failure? (2)
diuretics - no other drug that alters physical state of patient like them - gets rid of excess fluid so they don’t have peripheral oedema - also improves exercise capacitydigoxin - slows and controls heart rate
treatment options to improve SYMPTOMS AND SURVIVAL of heart failure? (3)
ACE inhibitors/ARBsSpironolactone – mineralocorticoid - steroid hormoneValsartan-sacubitril – expensive, inhibits the breakdown of natriuretic peptides resulting in varied effects including increased diuresis, natriuresis, and vasodilation.
