L.23 Heart Failure

Question 1

How does a patient with heart failure present

Answer 1

Shortness of breath on exertion- worse lying down: lungs not compliant, diffusion
􀁸 Lower extremity oedema
􀁸 Decreased exercise tolerance
􀁸 Unexplained confusion or fatigue in elderly- brain perfusion
􀁸 Nausea or abdominal pain (ascites or hepatic engorgement
3rd heart sound

Question 2

What are the signs of left sided heart failure

Answer 2

lung crackles, tachycardia, low O2 GI symptoms : ischaemia to the gut

Question 3

What are the signs of right sided heart failure

Answer 3

jugular venous distension, liver engorgement, ascites- fast weight gain, peripheral oedema

Question 4

What is heart failure with preserved ejection fraction and what does it mean

Answer 4

Heart failure with preserved ejection fraction= ejection fraction higher than 50%. usually associated with diastolic dysfunction:
i.e. an impaired ability to fill the heart, with elevated left ventricular diastolic pressures.
HFpEF is often a consequence of concentric remodelling (muscle cells becoming wider),
secondary to increased afterload (e.g. systemic hypertension, aortic stenosis, etc).
In older women

Question 5

What is heart failure with reduced ejection fraction and what does it mean

Answer 5

Heart failure with reduced ejection fraction (>40%) is usually associated with systolic dysfunction,
i.e. an impaired ability of the cardiac muscle to contract, with an increased end-diastolic
volume. HFrEF is the result of DILATED cardiac myopathy where the individual myocytes have
increased in length, typically a consequence of the remodelling in response to a myocardial
infarction.

Question 6

What is the cycle of the failing heart

Answer 6

After myocyte death there is remodelling which requires more oxygen to the heart which it can’t get because cells have died etc

Question 7

What is the neurohormonal

Answer 7

Reduced cardiac output and increased stretch in heart activates the neurohormonal system to increase sympathetic activity to vasoconstrict, the renal system to retain salt and water. oxidative stress and inflammation from dying cells makes cardiotoxicity and increases remodelling.
This all increases the blood pressure due to increased TPR and inotropy and therefore demand on the heart.

Question 8

What are basic management options for heart failure

Answer 8

Reduce afterload/ inotropy to reduce the work of heart.
-Diuretic : reduce venous pressure, oedema
-ACE inhibitors: vasodilation, reduce blood v & remodelling
- Beta blockers: reduce energy demand
-Nitrates: reduce afterload
Other options are pacemakers, assist devices and transplant.