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Cardiovascular System > Lecture 11 - Heart Failure > Flashcards

Lecture 11 - Heart Failure Flashcards

1
Q

Define heart failure

A

A state in which the heart fails to maintain an adequate circulation for the needs of the body despite an adequate filling pressure

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2
Q

What is the primary cause of systolic heart failure?

A

Ischaemic heart disesase

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3
Q

What are 8 causes of heart failure?

A 
Hypertension
Dilated cardiomyopathy
Valvular/congenital heart disease
Restrictive cardiomyopathy
Hypertrophic cardiomyopathy
Pericardial disease
High output heart failure
Arrhythmia
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4
Q

What is Starling’s law of the heart?

A

The more the fibres are stretched, the more the heart will contract (to a certain extent)

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5
Q

How does heart failure affect Starling’s law of the heart?

A

The heart can no longer produce the same amount of force for a given level of filling

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6
Q

What are the clinical characteristics of class I heart failure?

A

No symptomatic limitation of physical activity

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7
Q

What are the clinical characteristics of class II heart failure?

A

Slight limitation of physical activity
Ordinary physical activity results in symptoms
No symptoms at rest

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8
Q

What are the clinical characteristics of class III heart failure?

A

Marked limitation of physical activity
Less than ordinary physical activity results in symptoms
No symptoms at rest

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9
Q

What are the clinical characteristics of class IV heart failure?

A

Inability to carry out any physical activity without symptoms
May have symptoms at rest
Discomfort increases with any degree of physical activity

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10
Q

What is the most common cause of right sided heart failure?

A

Left sided heart failure

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11
Q

What is congestive heart failure?

A

Both ventricles are affected

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12
Q

What is heart failure divided into?

A 
Left sided
Right sided
Biventricular/congestive
Systolic
Diastolic
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13
Q

What are the signs/symptoms of left sided HF?

A 
Fatigue
Shortness of breath on exertion or lying flat, waking from sleep with it
Tachycardia
Cardiomegaly (displaced apex beat)
3rd or 4th heart sound
Functional murmur of mitral regurgitation
Basal pulmonary crackles
Peripheral oedema
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14
Q

What are the causes of right sided HF?

A 
Most commonly left sided HF
Chronic lung disease
Pulmonary embolism/hypertension
Pulmonary/tricuspid valvular disease
Left to right shunts (ASD/VSD)
Isolated right ventricular cardiomyopathy
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15
Q

What are the signs/symptoms of right sided HF?

A 
Relate to distension and fluid accumulation in areas drained by systemic veins
Fatigue, dyspnoea, anorexia, nausea
Raised JVP
Tender, smooth hepatic enlargement
Dependent pitting oedema
Ascites
Pleural effusion
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16
Q

What is the effect of the renin-angiotension-aldosterone system in HF?

A

Attempt to maintain cardiac output.

Makes a struggling heart work harder.

17
Q

What is the effect of HF on the RAAS?

A

Drop in blood pressure stimulates renin release from kidneys.
Catalyses conversion of angiotensin to angiotensin I.
ACE converts angiotensin I to II.
II is a vasoconstrictor and promotes aldosterone release from kidneys.
Causes salt and water retention in kidneys, increasing blood volume.
SNS causes vasoconstriction via a1 receptor to increase blood pressure.

18
Q

What is the effect of RAAS and SNS on the heart?

A

Increases preload and afterload.

Increases chronotropy and inotropy.

19
Q

How do ACE inhibitors work?

A

Prevent conversion of angiotensin I to II - indirect vasodilatory and diuretic effect, reducing workload on heart.

20
Q

How do diuretics work in HF?

A

Reduce blood volume and therefore oedema.

21
Q

How do B blockers work in HF?

A

Prevent sympathetic innervation of myocardium to reduce workload.

22
Q

How is HF managed?

A

Correct underlying cause
Non pharmacological measures
Pharmacological therapy
Treat complications

23
Q

How is HF treated?

A 
B blockers
ACE inhibitors
Ca channel inhibitors
Organic nitrates
Cardiac glycosides
24
Q

How do B blockers work?

A

Block B1 receptors on myocardium

25
Q

How do ACE inhibitors work?

A

Prevent conversion of angiotensin I to II

26
Q

How do Ca channel blockers work?

A

Reduce contractility of myocardium

27
Q

How do organic nitrates work?

A

Veno/vasodilator - reduce BP

28
Q

How do cardiac glycosides work?

A

Increase CO and heart contractility by inhibiting Na/K pump - raising intracellular Na inhibits NCX, so intracellular Ca increases, leading to increased contractility.

Cardiovascular System (15 decks)

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