Systolic Heart Failure

Question 1

What is systolic heart failure?

Answer 1

heart loses the ability to pump enough blood to meet metabolic needs (loses pumping reserve) - first in exercise and then at rest

Question 2

What are the structural abnormalities present in systolic heart failure?

Answer 2

Dilated ventricles  (because Starling's law suggests the heart normally contracts more strongly if it is more stretched)
Valve regurgitation due to ventricular dilation stretching valve rings

Question 3

What is myocarditis/inflammatory cardiomyopathy?

Answer 3

Inflammation of the heart muscle

Can be caused by infection, immunology, drugs and toxins

Question 4

How can the flu cause systemic heart failure?

Answer 4

Causes myocarditis - heart muscle is infected by the virus, and then antibodies that fight the virus damage the heart muscle more

Question 5

What type of drug can cause myocarditis?

Answer 5

Chemotherapy

Question 6

What types of virus can cause myocarditis?

Answer 6

adenovirus 
HIV
Enterovrisu
Parvovirus 
rubella
polio

Question 7

Symptoms

Answer 7

Shortness of breath
Fatigue
Orthopnoea (breathlessness when lying flat)
Paroxysmal nocturnal dyspnoea (breathlessness at night)
nocturne
oedema 
loss of appetite
confusion and impaired memory

Question 8

Why would a patient have dyspnoea?

Answer 8

Dilated cardiomyopathy can effect the lungs

Question 9

Why would a patient have oedema?

Answer 9

Heart not beating fluid around efficiently so it gets backed up

Question 10

Signs

Answer 10

Tachycardia
Hypotension 
High JVP
Oedema
loss of skeletal muscle mass
anorexia

Question 11

How much blood is being pumped out in systemic heart failure?

Answer 11

less than 40-50%

Question 12

Abnormal test results?

Answer 12

Echo - dilated chambers, weak contraction, leaky valves
Blood test - raised brain natriuretic peptide (BNP)
ECG - abnormal due to underlying disease
X-ray - cardiomegaly

Question 13

Why would BNP (brain natriuretic peptide) be raised in bloods?

Answer 13

BNP causes vasodilation by decreasing renin secretion - trying to reduce blood pressure due to pressure overload

Question 14

Define cardiomegaly

Answer 14

Large heart

Question 15

What are diuretics?

Answer 15

Cause fluid loss to treat symptoms

Question 16

What are ionotropics?

Answer 16

Increase heart muscle activity (rate and strength of contraction) by increasing amount of calcium

e.g. digoxin

Question 17

Treatment?

Answer 17

ACE inhibitors, beta blockers,aldosterone antagonists (THESE ALL DECREASE SYMPATHETIC TONE)

loop diuretic e.g. furosemide - prevent vasoconstriction

pacemaker to resync right and left systolic contraction