Left ventricular failure Flashcards
What is the definition of left ventricular failure?
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
What is the epidemiology of left ventricular failure?
5% of admissions to hospital medical wards
What is the pathology of left ventricular failure?
- 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
What are the risk factors/aetiology of left ventricular failure?
- ↑ age
- Ischemic heart disease
- Cardiomyopathy
- MI
- Myocarditis
- Coronary artery narrowing
- Hypertension
- Aortic stenosis/incompetence
- Mitral incompetence
- Congenital septal defects
What are the signs/symptoms of left ventricular failure?
- 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
What investigations are carried out in suspected left ventricular failure?
- 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
What are the pharmacological treatments for left ventricular failure?
- Oxygen
- ACE inhibitor
- Diuretic
- Beta blocker
- Digoxin
- Vasodilators
- Opiate analgesia
- GTN
What are the non pharmacological treatments for left ventricular failure?
- Sit patient up
- Smoking cessation
- Low salt diet
- Weight management
- Healthy diet