Pathophysiology of Heart Failure Flashcards
What is the 5yr mortality rate for heart failure?
45%
How do you treat Heart Failure?
ACE- inhibitor and beta blocker
Aldosterone receptor antagonist if still effected despite ACEI and BB.
Valsartan can replace ACEI if still symptomatic when you’ve tried the other three in combination.
Define heart failure.
A clinical syndrome caused by an abnormality of the heart and recognised by a characteristic pattern of haemodynamic, renal, neural and hormonal responses.
Despite adequate filling pressure the heart cannot maintain adequate circulation to meet the demands of the metabolising tissues.
What is the aetiology of heart failure
Tends to be a disease of the elderly but is not exclusive to older people
Outline the basic physiology that leads to hypertension
Reduced CO from High preload, myocardial contractility problems, abnormal heart rate or abnormal afterload.
For any given level of filing the output is reduced.
How do heart failure patients end up with oedema
Venous pressure that returns to that side of the heart builds up. Higher pre load. The veins have increased hydrostatic pressure and so fluid leaks out.
How does heart failure progress?
Class 1- no symptoms and normal life
Class 2- limited physical activity, asymptotic at rest, symptoms in normal life activity
Class 3- marked limitation of physical activity, no symptoms at rest, heavily effected in day to day life
Class 4- may have symptoms at rest, symptoms with any physical activity , increased activity means increased discomfort
What is left ventricular systolic dysfunction?
Increased LV capacity but reduced output. Thining of the myocardium in the LV. Mitral valve incomptence. Neurohumoural activation. Risk cardiac arrhythmia as muscle is thin and fibroses.
Peripheral oedema suggests which side of the heart is failing?
Right
On th cellular level what happens in LVSD?
Myocyctolysis and vacuolation of cells.
Myocyte hypertophy
SR synfucntion
Calcium availability and receptor regulation lacks control
What is left ventricular systolic dysfunction?
Ventricular remodelling in heart failure:
Increased LV capacity but reduced output.
Thinning of the myocardium in the LV.
Mitral valve incomptence.
Neurohumoural activation.
Risk cardiac arrhythmia as muscle is thin and fibroses.
On the cellular level what happens in LVSD?
Myocyctolysis and vacuolation of cells.
Myocyte hypertophy
SR synfucntion
Calcium availability and receptor regulation lacks control
What does endothelia do in heart failure?
renal vasocconstrictor- activtes RAAS
Poor prognosis if elevated in HF patient
What stimulates prostaglandin release?
Noradrenaline and RAAS
What is the affect of prostaglandin?
Attentuates RAAS and NA effect by vasodilation of afferent renal arteriole
