Intro HF

Question 1

What is HF?

Answer 1

HF refers to a state of reduced cardiac output. It’s the end stage of many cardiac diseases. 50% will die within 5 years

Question 2

Representation & Clinical signs of HF

Answer 2

SOB (esp Orthopnea), fatigue, ankle oedema. Signs: hepatomegaly, tachycardia, tachypnoea & raised JVP.

Question 3

What’s hepatomegaly?

Answer 3

Is the condition of having an enlarged liver

Question 4

What’s tachypnoea?

Answer 4

refers to rapid breathing

Question 5

What is the treatment plan for HF?

Answer 5

ACE-inhibitors (ARB if cannot use ACE)
Diuretics (particularly frusemide) and Spironolactone (with Systolic dysfunction & symptomatic) - with fluid overload
GTN (Nitroglycerin) (widens blood vessels)
B-blockers (can improve systolic function by blocking the effects of adrenaline)
Digoxin (increases the force of myocardial contractions/filling of ventricles + slows heart rate) - with atrial fibrillation

Question 6

Whats LHF?

Answer 6

Inability of the left ventricle to pump adequate amount of blood leading to PULMONARY circulation congestion’s and pulmonary oedema.
*usually results in RHF due to pulmonary hypertension
Ejection Fraction below 40%

Question 7

What’s RHF?

Answer 7

Inability of the right ventricle to pump adequate amount of blood leading to SYSTEMATIC venous congestion = peripheral edema, hepatic congestion and tenderness. (Esp Raised JVP + Peripheral edema = signs of RHF)
*usually the result of Respiratory disease (esp COPD)

Question 8

Most common causes of HF?

Answer 8

Ischaemic Heart Disease✔️

• Myocardial Ischemia (Oxygen/blood flow blockage of coronary artery due to atherosclerosis)
• Myocardial Infarction (plague rupture/full obstruction to any part of heart)

Hypertension (HTN)✔️
- heart strain due to pumping blood against a high afterload 🔜hypertrophy (thickening of heart muscle/ventricles) 🔜arrhythmias🔜heart gets too big🔜IHD + compromised ventricular function

Question 9

Other diseases that cause HF?

Answer 9

Valvular disease✔️

• Mitral Regurgitation (blood leakage backward as mitral valve doesn’t close properly during LV contractions)
• Aortic Stenosis (narrowing of aortic valve opening🔜restricts blood flow from LV to the aorta)
• Tricuspid Regurgitation (valve does not close tight enough so blood leaks backwards into the Right Atrium when RV contracts)

Pericardial disease✔️

• Pericarditis (inflammation of the lining surrounding the heart aka the pericardial sac).
• Pericardial effusion (excess fluid between the heart and the sac surrounding the heart, known as the pericardium🔜heart pressure overload)

Question 10

Drugs causing HF

Answer 10

Chemotherapeutic drugs✔️
-Beta-blockers (most common), calcium channel blockers and anti-arrhythmics

Alcohol✔️

• alcoholics: acute HF, arrhythmias such as AF and dilated Cardiomyopathy (enlarged chambers due to weakened heart muscle) + risk of infection
• Cocaine (Systolic dysfunction or LV failure/enlargement)

Question 11

Types of Cardiomyopathies leading to HF

Answer 11

Congestive✔️

• weakening & dilation of V walls🔜overstretching/reduced force of contractions. (Most common cause in the absence of IHD, VD, HTN)
• Might have a genetic link

Hypertrophic✔️

• thickening of the heart muscle wall🔜reduced CO (blood pumped per minute). Increases chances of Arrhythmias, such as Ventricular Fibrillation (common cause of death in young people)
• strong genetic link

Restrictive✔️
-reduced heart compliance