Week 4/7 Flashcards
What are the 3 typical symptoms of heart failure
breathlessness
* ankle swelling
* fatigue
What usually causes heart failure
Caused by a structural and/or functional cardiac abnormality, resulting in a
reduced cardiac output and/or elevated intracardiac pressures
What are the 3 main signs of heart failure
elevated jugular venous pressure
* pulmonary crackles
* peripheral oedema
Symptom burden is classified by what
The New York Heart Association (NYHA)
What is class 1 of NYHA
Comfortable at rest.
‘Mild’ heart failure
Annual mortality 10%
But ordinarily physical activity results in symptoms
What is class 3 of NYHA
Comfortable at rest
Patients have a marked limitation in physical activity
Moderate heart failure
Annual mortality 12-16%
What is incidence of heart failure
Due to ageing population, the overall incidence is ↑ * 5/1000 person-years in adults
What is the prevalence of heart failure
1-2% of all adults * ↑ with age:
* 1% in <55 years old
* >10% in ≥70 years old
What is class IV of NYHA
Patients have sdymptoms at rest
Severe heart failure
Annual mortality 15-20%
Worse prognosis than cancer
What are the main causes of heart failure
Coronary artery disease
Hypertension
Valve disease
These 3 are 70% of the causes of heart failure
Other:
Arrhythmia
Cardiomyopathy
Infective
Drug-induced
What is pathophysiology of heart failure
Ageing etc increase strain on heart muscle - heart muscle injury - decreases cardiac output - reduced renal perfusion and carotid barometer - increases sympathetic NS and RAAS - Increases heart rate 02 consumption and vasoconstriction - increasing pre and after load - causes hypertrophy etc - causes muscle injury
What is the ejection fraction
= (stroke volume/end-diastolic volume)*100
What are the 3 types of heart failure
HFpEF
HFmEF
HFyEF
What is Heart failure with preserved ejection fraction
On the rise * >50% of all HF
* Predominantly ♀
* Causes: Hypertension, diabetes, obesity, old age, restrictive
cardiomyopathies (Amyloidosis, HCM, Fabry’s) * Pathophysiology:
Impaired LV relaxation -> ↑LVEDP ->↓diastolic filling ->↓cardiac output * Treatment: Treat primary cause, diuretics, non specific.
What is HFmEF and HFrEF
Slowly decreasing * Main cause: ischaemic heart disease
(post-myocardial infarction) * Other causes of non-ischaemic cardiomyopathy
* Dilated cardiomyopathy * Alcohol induced cardiomyopathy * Nutritional * auto-immune * arrythmia induced
What investigations would you do for suspected heart failure
Primary care tests
* 12 ECG + NTproBNP
* Blood tests (FBC, U&Es, LFTs, thiamine, B12/folate, vitamin D,
calcium, magnesium, HBA1c) * CXR
* Secondary care tests
* Echocardiogram
* Cardiac MRI
* Invasive angiogram
* Cardiac CT coronary angiogram
* Nuclear Imaging
What are some of the drug treatments in HFrEF
ACEi * ARB * Angiotensin-Neprilysin inhibitors
(Valsartan/Sacubitril) B-blockers * Loop diuretics, thiazides * MRA * Ivabradine * Nitrates/hydralazine
Diuretics
4 types of cardiomyopathy (2 common 2 uncommon)
Common
Hypertrophic cardiomyopathy
Dilated vardiomyopathy
Uncommon
Restrictive cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy
What is hypertrophic cardiomyopathy
Unexplained LV hypertrophy (most commonly asymmetric septal
hypertrophy)
n Commonest cause of sudden cardiac death in < 35yrs
What is syncope?
Transient loss of consciousness due to global cerebral hypoperfusion
The brain can autoregulate be but what are the 2 things that influence BP
BP = TPR xCO (cardiac output)
What are the 3 types of reflex syncope?
Vasovagal, situational, carotid sinus syndrome.
