Left ventricular failure Flashcards

1
Q

What is the definition of left ventricular failure?

A

Syndrome that results from any structural or functional cardiac disorder in the LV that impairs the ability of the heart to function as a pump

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2
Q

What is the epidemiology of left ventricular failure?

A

5% of admissions to hospital medical wards

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3
Q

What is the pathology of left ventricular failure?

A
  • 2 types: systolic failure and diastolic failure
  • Systolic: LV cannot contract normally so the heart cannot pump with enough force to push enough blood into circulation
  • Diastolic: LV cannot relax normally due to stiffness so the heart cannot properly fill with blood during
  • Categorised into Classes I-IV via the New York Heart Associations Classification of Heart Failure
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4
Q

What are the risk factors/aetiology of left ventricular failure?

A
  • ↑ age
  • Ischemic heart disease
  • Cardiomyopathy
  • MI
  • Myocarditis
  • Coronary artery narrowing
  • Hypertension
  • Aortic stenosis/incompetence
  • Mitral incompetence
  • Congenital septal defects
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5
Q

What are the signs/symptoms of left ventricular failure?

A
  • Dyspnoea
  • Poor exercise tolerance
  • Fatigue
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea (sometimes with pink, frothy sputum)
  • Wheeze
  • Nocturia
  • Cold peripheries
  • Weight loss
  • Muscle wasting
  • Peripheral/central cyanosis
  • Tachypnoea
  • Tachycardic
  • Hypotensive
  • Narrow pulse pressure – difference between systolic and diastolic pressure readings
  • Pulsus alternans – pulse showing alternate strong and weak beats
  • Aortic/mirtal valve murmurs
  • Displaced apex beat
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6
Q

What investigations are carried out in suspected left ventricular failure?

A
  • ECG
  • Doppler echocardiography
  • BNP/NTproBNP serum levels
  • Bloods: FBC, U&E, creatinine, LFTs, glucose, fasting lipids, TFTs, cardiac enzymes
  • CXR – cardiomegaly, ventricular hypertrophy, ‘bat wings’, pleural effusion, kerley B lines
  • Cardiac MRI – gold standard
  • Urinalysis
  • Lung function tests
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7
Q

What are the pharmacological treatments for left ventricular failure?

A
  • Oxygen
  • ACE inhibitor
  • Diuretic
  • Beta blocker
  • Digoxin
  • Vasodilators
  • Opiate analgesia
  • GTN
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8
Q

What are the non pharmacological treatments for left ventricular failure?

A
  • Sit patient up
  • Smoking cessation
  • Low salt diet
  • Weight management
  • Healthy diet
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