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*CVS Jeny > S9) Heart Failure > Flashcards

S9) Heart Failure Flashcards

1
Q

What is heart failure?

A

Heart failure is a state in which the heart fails to maintain an adequate circulation for the needs of the body despite an adequate filling pressure

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2
Q

Outline the aetiology of heart failure

A
  • Ischaemic Heart Disease
  • Hypertension
  • Dilated/hypertrophic Cardiomyopathy
  • Valvular/Congenital Heart Disease
  • Pericardial disease
  • Arrhythmias
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3
Q

What are the clinical signs of chronic heart failure?

A
  • Pulmonary congestion
  • Venous congestion
  • Dependent oedema
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4
Q

What are the symptoms of chronic heart disease?

A
  • Dyspnoea
  • Lethargy
  • Orthopnoea
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5
Q

Describe the clinical features of Class I heart failure

A

No symptomatic limitation of physical activity

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6
Q

Describe the clinical features of Class II heart failure

A
  • Slight limitation of physical activity
  • Ordinary physical activity results in symptoms
  • No symptoms at rest
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7
Q

Describe the clinical features of Class III heart failure

A
  • Marked limitation of physical activity
  • Less than ordinary physical activity results in symptoms
  • No symptoms at rest
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8
Q

Describe the clinical features of Class IV heart failure

A
  • Inability to carry out any physical activity without symptoms
  • May have symptoms at rest
  • Discomfort increases with any degree of physical activity
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9
Q

What are the factors affecting cardiac output?

A
  • Heart rate
  • Venous capacity (preload)
  • Myocardial contractility
  • Arterial and peripheral impedance (afterload)
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10
Q

What is Starling’s Law of the Heart?

A

“The force developed in a muscle fibre depends on the degree to which the fibre is stretched.”

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11
Q

Describe the pathophysiology of Left Ventricular Systolic Dysfunction

A
  • Increased LV capacity
  • Reduced LV cardiac output
  • Thinning of the myocardial wall

I. Fibrosis and necrosis of myocardium

II. Activity of matrix proteinases

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12
Q

What are the causes of Left Ventricular Systolic Dysfunction?

A
  • Mitral valve incompetence
  • Neuro-hormonal activation
  • Cardiac Arrhythmias
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13
Q

Which structural heart changes occur after Left Ventricular Systolic Dysfunction?

A
  • Loss of muscle
  • Uncoordinated myocardial contraction
  • Changes to the ECM (increase in collagen)
  • Change of cellular structure and function (myocyte hypertrophy)
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14
Q

Describe ventricular remodeling after acute infarction

A
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15
Q

Describe ventricular remodeling in diastolic and systolic heart failure

A
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16
Q

Label the following images:

A
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17
Q

Identify the 5 different pathways for neuro-hormonal activation

A
  • Sympathetic Nervous System
  • Renin-Angiotensin-Aldosterone System
  • Natriuretic Hormones
  • Anti-Diuretic Hormone
  • Endothelin
18
Q

Why is SNS stimulated in heart failure?

A

Early compensatory mechanism to improve cardiac output:

  • Cardiac contractility
  • Arterial and venous vasoconstriction
  • Tachycardia
19
Q

Outline the long-term deleterious effects of the SNS in heart failure

20
Q

When is RAAS commonly activated in heart failure?

A
  • Reduced renal blood flow
  • SNS induction of renin from macula densa
21
Q

Outline the action of RAAS in heart failure

22
Q

In terms of the brain, blood vessels, heart and kidney, explain how Angiotensin II plays a key role in organ damage

23
Q

When are natriuretic peptides released in heart failure?

A
  • Atrial distension
  • Increased blood volume and pressure
24
Q

Outline the action of natriuretic peptides in heart failure

25
Q

Outline the effect of ADH (vasopressin) in heart failure

A

ADH is increased in heart failure:

  • Increased H2O retention
  • Tachycardia and increased TPR → increased CO
26
Q

Outline the action of endothelin in heart failure

A
  • Endothelin is secreted by vascular endothelial cells resulting in renal vasoconstriction via autocrine activity
  • Activates RAAS (increased levels in some patients with heart failure)
27
Q

Outline the effect of other chemicals in heart failure:

  • Prostaglandin E2 and I2
  • Nitric oxide
  • Bradykinin
A
  • Prostaglandins: vasodilators stimulated by NA and RAAS to counter their effects
  • Nitric oxide: potent vasodilator produced by endothelial cells via NO synthase (NO synthase may be blunted in HF)
  • Bradykinin: promotes natriuresis, vasodilatation and stimulates production of PGs
28
Q

What is oedema?

A
  • Oedema is the excessive volume of fluid within the tissues (interstitial / intracellular) which can occur due to changes in capillary dynamics
  • It is often seen in heart failure as there is increased capillary hydrostatic pressure
29
Q

Vascular endothelium increases in peripheral arterial resistance.
Why is this?

A
  • SNS
  • RAAS
  • Reduced NO
  • Increased endothelin
30
Q

Changes in vascular endothelium leads to skeletal muscle changes.

Identify some

A
  • Reduced skeletal muscle blood flow
  • Reduction in skeletal muscle mass (cachexia)
  • Abnormalities of structure and function
31
Q

Describe the renal effects associated with changes in the vascular endothelium

A
  • GFR is maintained in early HF by haemodynamic changes at the glomerulus – increased Na+ /H2O retention due to neurohormonal activation
  • GFR falls in severe HF due to reduced renal blood flow leading to a subsequent rise in serum urea and creatinine
32
Q

Describe the multi-factorial aetiology of anaemia associated with vascular endothelium changes

A
  • Chronic inflammatory disease
  • Expanded plasma volume
  • Drug therapy (ACEi / Aspirin)
  • Iron malabsorption
  • Chronic renal failure
33
Q

Heart Failure with Preserved Ejection Fraction (HFpEF) occurs in almost 50% of heart failure patients.

Describe the clinical features of this condition

A
  • Frequently elderly and female
  • Often history of hypertension / diabetes / obesity
  • Normal LV function with concentric remodelling
34
Q

In four steps, describe the pathophysiology of HFpEF

A

⇒ Reduced LV compliance and impaired myocardial relaxation

⇒ Impaired diastolic LV filling (dependent on high LA pressure)

⇒ RV dysfunction results from high LA and PA pressure

⇒ Triggers neuro-hormonal activation as per systolic heart failure

35
Q

Identify the 5 clinical syndromes of heart failure

A
  • Left Sided Heart Failure
  • Right Sided Heart Failure
  • Congestive cardiac failure
  • LVSD (pump failure)
  • HFpEF (failure of LV relaxation)
36
Q

Identify the symptoms of Left Sided Heart Failure

A
  • Fatigue
  • Exertional dyspnoea
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea (PND)
37
Q

What are the clinical signs of Left Sided Heart Failure?

A
  • Tachycardia
  • Cardiomegaly (displaced apex beat)
  • 3rd or 4th heart sound (‘Gallop rhythm’)
  • Functional murmur of mitral regurgitation
  • Basal pulmonary crackles (fluid in the lungs)
  • Peripheral oedema
38
Q

Describe the aetiology of Right Sided Heart Failure

A
  • Chronic lung disease
  • Pulmonary embolism / pulmonary hypertension
  • Pulmonary/tricuspid valvular disease
  • Left-to-right shunts (ASD/VSD)
  • Secondary to left heart failure (most frequent)
39
Q

What are the signs and symptoms of Right Heart Failure?

A
  • Fatigue
  • ↑ JVP
  • Pitting oedema
  • Ascites
  • Pleural effusion
  • Dyspnoea
40
Q

What is congestive (biventricular) heart failure?

A
  • Congestive heart failure is a chronic progressive condition in which the heart’s function as a pump is inadequate to meet the body’s needs
  • Both the right and left sides of the heart fail to pump adequately, hence, the signs and symptoms of both right and left heart failure develop

*CVS Jeny (17 decks)

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