LV Dysfuction 1

Question 1

N.I.C.E definition of heart failure?

Answer 1

Complex clinical syndrome of symptoms that lead you to believe that the efficiency of the heart as a pump is impaired

Question 2

European society of cardiology definition of heart failure?

Answer 2

Abnormality of cardiac structure or function which leads to the failure of the heart to deliver O2 at a rate commensurate with the needs of metabolising tissues

Question 3

Why do filling pressures increase in early heart failure?

Answer 3

In order to maintain the frank starling mechanism

Question 4

Epidemiology of Heart Failure - incidence, cost of NHS, mortality rate etc?

Answer 4

• 1 million cases in UK
• increase of 50% in the next 25 years
• 2% of the NHS fund spent on heart failure
• 30% mortality within 1 year
• Poor prognosis (similar to cancer)

Question 5

Main cause of HF, and why wouldn’t you treat by trying to stimulate contraction?

Answer 5

CORONARY HEART DISEASE - most common cause

Wouldn’t try and treat by stim contraction of the heart –> treat by dealing with peripheral effects!!!

Question 6

Main reasons for HF, and which is more common out of chronic and acute?

Answer 6

• Left ventricular systolic dysfunction
• Heart failure with preserved ejection fraction

Chronic more common due to sustained systolic dysfunction

Question 7

Differences between HF and LVD??

Answer 7

Both different, can have both at the same time but can have LVD but not Heart Failure

Question 8

Symptoms of decreased cardiac output (compromised FORWARD FLOW observed as a result of HF)

Answer 8

Fatigue

Decreased tolerance to exercise

Question 9

Symptoms of increased filling pressures on LHS of heart (compromised BACKWARDS FLOW observed as a result of HF)

Answer 9

Increased left atrial pressure –> increased pulmonary venous pressure as blood is draining from the lungs into the left atrium. = PULMONARY OEDEMA.
Causes extreme breathlessness as gas exchange interrupted by fluid!

Question 10

Symptoms of increased filling pressures on RHS of heart (compromised BACKWARDS FLOW observed as a result of HF)

Answer 10

Obvious veins in the neck –> fixed congestion of jugular veins due to increased pressure in veins.
High pressure in veins causes fluid to be pushed into tissues –> OEDEMA –> aggravated by gravity so common in the ankles.
Can also find fluid in the abdominal cavity and lung cavities. - MICHELIN MAN

Question 11

What does the Frank Starling Mechanism refer to?

Answer 11

Represents the relationship between the stroke volume and the end diastolic pressure of the heart

Question 12

Adverse effects of Diuretics?

Answer 12

Hypotension, Erectile Dysfunction, Raised uric acid (gout), low serum K+ Na+ Ca2+ and Mg2+, hypotension, hypovolaemia

Question 13

What are the main impacts of Diuretics (refer to graph) and main types?

Answer 13

Overall the cause an increase in Na+ and H2o excretion at the kidney.
THIAZIDES - Bendroflumethiazide- distal tubule targeted
LOOP DIURETICS - Furosemide - loop of henle targeted
K+ - SPARING - Spironalactone

Question 14

How do ALDESTERONE ANTAGONISTS work?

Answer 14

They block the renin/angiotensin system and have a continuous benefit by increasing survival, particularly with Spironalactone

Question 15

Impact of Vasodilator therapy on after load?

Answer 15

Decreases the afterload of the heart so that the heart is pumping into a lower resistance system

Question 16

Impact of Vasodilator therapy on veins?

Answer 16

Cause veins to store blood so that they act as a buffer, decreases the preload of the blood to decrease left ventricular and end diastolic pressure

Question 17

Why are Vasodilator therapies more effective in afro caribbeans?

Answer 17

Genetic differences mean that their renin-angiotensin system is not as active

Question 18

How are arterial/venous dilators effective in treating heart failure? Examples?

Answer 18

HYDRALAZINE AND ISOSORBIDE
Improved left ventricular ejection fraction
decreased mortality over 3 years by 36%