left ventricular failure, Right Ventricular failure, Congestive Cardiac Failure Flashcards
what are the causes of heart failure?
- ischaemic heart disease
- hypertension
- valve disease
- infection e.g. chaga’s disease
- toxins e.g. alcohol
- drugs e.g. chemotherapy
- nutritional deficiency e.g. beri beri (vit b1 def)
- tachycardia induced Afib / atrial flutter
- genetic - duchene muscular dystrophy, hypertrophic obstructive cardiomyopathy
what are the symptoms of left vent failure?
- SOB on exertion
- Orthopnoea
- paroxysmal nocturnal dyspnoea
- fatigue
- wheeze
- cough
- haemoptysis (rare) - sputum pink and frothy due to pulmonary oedema
what are the signs of left vent failure?
- tachypnoea
- tachycardia
- pulsus alternans
- low puls volume
- peripheral cyanosis
- cardiomegaly
- third heart sound (S3 gallop)
- functional mitral valve regurgitation
- Basal crepitations (pulmonary oedema)
- Pleural effusion
- Raised JVP (RHF)
- peripheral ankle oedema (CCF)
- Ascities (RHF, CCF)
- tender hepatomegaly (RHF)
What factors confirm diagnosis of heart failure?
1) Symptoms (normal / low ejection fraction)
2) ECG (ventricular hypertrophy, ischaemia, arrhythmia)
3) CXR (cardiomegaly, pulmonary congestion, fluid in fissures)
4) Raised natriuretic peptides (ANP, BNP, C-type) in response to myocardial stretch and stress.
5) abnormal echo
6) Bloods (FBC, U&Es, LFTs, Cardiac enzymes, thyroid, clotting)
What is the management of heart failure?
Lifestyle:
- stop smoking,
- no alcohol, drugs
- reduce salt intake
- exercise
Medical:
-hypertension (ACEi - ramipril, ARB - losartan, CCB - amlodipine, beta blockers - bisopropolol)
- hypercholesterolaemia (statins)
- control diabetes (metformin)
- fluid overload - (loop diuretic - furosemide, thiazide diuretic - bendroflumethiazide, Potassium sparing - spironolactone)
- reduce cardiac demand by slowing heart rate with digoxin
- increase blood flow to heart with vasodilators - isosorbide dinitrate
- anticoagulant (aspirin + clopidogrel)
SURGERY:
- revascularisation of coronary arteries
- mitral valve surgery
- transplant
- cardio - defib implant
What are the adverse effects of ACEi?
- cough
- hypotension
- hyperkalaemia
- renal dysfunction
DO NOT USE in renal artery stenosis
what side effect can occur in 1 in 10 men treated with spironolactone?
gynaecomastia or breast pain
Digoxin is a cardiac glycoside - what is it used for?
atrial fibrillation with heart failure
Why are anticoagulants given in heart failure?
Many heart failure patients have arrhythmias such as A fib. This increases the risk of clot formation and stroke. so antiplatelets such as aspirin and clopidogrel given to avoid this.
What does ivabradine do?
Ivabradine selectively decreases heart rate without affecting blood pressure.
It is used in patients with high heart rate despite use of beta-blockers. Or in those who cannot tolerate bblockers.
What are the causes of acute heart failure?
- ischaemic heart disease
- Valvular heart disease
- hypertension
- AKI / CKD –> fluid overload
- Atrial fibrillation
What is the difference between left and right sided heart failure/
Left HF - usually caused by cardiovascular pathology usually due to myocardial ischaemia.
Right HF - can be caused by cor pulmonale due to COPD.
In congestive cardiac failure (late stage) - both sides effected.
What is the pathophysiology behind left sided heart failure?
1) Heart / pump failure:
- Ventricular dilatation caused by heart muscle stretch. (ischaemia weakens walls, so low ejection fraction, more blood remains in ventricles —> increased afterload)
- Myocyte hypertrophy
- increased blood volume (RAAS –> salt / water retention) —> Increased preload
- high blood pressure (atherosclerosis, peripheral vasoconstriction) —> increased resistance so heart has to pump harder.
- restricted filling (scarring of heart tissue)
- decreased heart rate so more blood remains in heart —> increased afterload —> dilatation (drugs e.g bblockers, heart block, post MI)
What does the chest Xray of heart failure show?
ABCDE:
A- alveolar oedema (Bat's wings) B - Kerley B lines (interstital oedema) C- Cardiomegaly D - Dilated prominent upper lobe vessels E - pleural Effusions
What is the prognosis of heart failure?
50% at 5 years
What are the symptoms of RVF?
- peripheral oedema (up to thighs, sacrum, abdo wall)
- ascites
- nausea
- anorexia
- facial engorgement
- pulsation in neck and face due to tricuspid regurgitation
- epistaxis
What are the causes of RVF?
- pulmonary stenosis
- LVF
- lung disease (pulmonary hypertension)
What are the examination signs of CCF?
- cool peripheries
- increased cap refill
- cyanosis
- reduced BP
- pulsus alternans (change in volume of pulse)
- displaced apex (LV dilatation)
- RV heave (pulmonary hypertension)
- murmurs of mitral or aortic valve disease
- wheeze (cardiac asthma)
What is systolic failure?
+ causes
Systolic failure:
- inability for ventricle to contract properly –> so decreased cardiac output (ejection fraction< 40%)
caused by:
Ischaemic heart disease
MI
Cardiomyopathy
What is diastolic failure?
Inability for the ventricle to relax and fill normally leads to increased filling pressure.
Ejection fraction is more than 50%.
Causes: -constrictive pericarditis - tamponade - restrictive cardiomyopathy - hypertension -
