Heart Failure Treatments and Challenges Flashcards
Types of heart Failure
HFpEF and HFrEF
what is heart failure
heart’s inability to meet body’s metabolic needs
Heart failure is defined by
insufficient cardiac output
what limits cardiac output in heart failure (2)
LV filling or geometry
LV
Left ventricle
what is HF associated with at rest or with stress
elevated intracardiac pressure
HF common feature
cardiac hypertrophy
HFrEF features (3)
reduced ejection fraction, impaired contractility, systolic dysfunction
HFpEF features (3)
preserved ejection fraction, impaired relaxation, diastolic dysfunction
reduced ejection fraction
<50% LV EDV
preserved ejection fraction
> /= 50% LV EDV
LV EDV
Left ventricular end diastolic volume
HF signs (7)
dyspnea, orthopnea, reduced exercise tolerance, fatigue, peripheral oedema, elevated JVP, third heart sound, age
JVP
jugular venous pressure
dyspnea
breathlessness
what can cause dyspnea
pulmonary oedema
orthopnea
difficulty breathing lying down
how does peripheral oedema commonly present
ankle swelling
HFpEF male age risk
> 70
HFpEF female age risk
> 75
HF comorbidities (12)
ischaemia, AF, valvular heart disease, lung disease, hypertension, stroke, kidney dysfunction, kidney failure, obesity, diabetes, hypokalaemia, hyperkalaemia, hyperlipidaemia
ischaemia
CAD
CAD
coronary artery disease
common lung diseases with HF (2)
COPD and asthma
COPD
chronic obstructive pulmonary disease
Clinical signs for HF dignosis (3)
elevated JVP, laterally displaced apical beat, third heart sound
increased ventricular pressure will lead to increased (3)
pulmonary pressure, pressure in right heart, pressure in central veins
what causes a lateral shift of heart apex
hypertrophy
S1
mitral and tricuspid valve closure
S2
aortic and pulmonary valve closure
when does S3 occur
early diastole
S3
turbulent blood flow into LV
what does S3 indicate
high intracardiac pressure
what makes HF diagnosis hard
signs can be variable and indicative
indicative
normal
How is MI excluded
no elevation in cardiac enzymes
what cardiac enzymes are assessed
Troponin I
what is normally increased more in HFrEF than HFpEF
NT-proBNP
NT-proBNP
plasma natriuretic peptide
when is NT-proBNP also elevated (3)
renal failure, age, AF
what can be used to exclude ischaemic events and AF
ECG
is an ECG conclusive for HF
no
what is an M mode echo
ultrasound echo motion mode
Tests for HF (3)
non invasive stress exercise test, invasive intra cardiac pressure exercise and imaging, M mode echo
ideal HF test
M mode echo
non invasive stress exercise test limitations (2)
false positives and requires treadmill use
invasive intra-cardiac pressure exercise and imaging limitations (2)
invasive and not ideal for older patients
m mode echo measures (3)
hypertrophy, left atrial dimension, central pressure
