WEEK 9 Flashcards
Describe the clinical presentation of heart failure.
SYMPTOMS
- breathlessness
- Fatigue
- Odema
- Reduced exercise capacity
SIGNS
- Odema
- Tachycardia
- raised JVP
- chest crepitations or effusions
- 3rd heart sound
- Displaced or abnormal apex beat
Discuss treatment options in heart failure and evidence for their use.
- Diuretics
- ACE inhibitors
- Betablockers
- Aldosterone receptor blockers
Know the relevant investigations of heart failure.
- ECG
- BNP!!!
- Low BNP = NO HF/LVSD
- High BNP = Need for echo/cardiac assessment
Very hard to diagnose as symptoms are generic.
Describe the hormonal and physiological responses to heart failure and the potential sites for therapeutic intervention.
- Cardiac output falls
- The body registers this as a loss in circulatory volume
- Vasoconstrictor system activation (Sympathetic systems)
- Salt and water retaining system activation (RAAS)
FRANK STARLING LAW
if the muscle of a healthy heart is stretched it will contract with greater force and pump out more blood.
- In the failing or damaged heart this relationship is lost
- As circulatory volume increases the heart dilates, the force of contraction weakens and cardiac output drops further
THE FINAL RESULT
- A failing heart that can not pump out sufficient blood to supply the needs of the body
- Progressive retention of salt and water which results in peripheral and pulmonary oedema
- Progressive vasoconstriction, myocyte death and fibrosis
Discuss the strengths and weaknesses of ACE inhibitors in the treatment of heart failure.
STRENGTHS
1. reduces mortality
2. reduces morbidity
WEAKNESSES
1. cough
2. angioedema
3. renal impairment
4. renal failure
5. hyperkalaemia
Discuss the strengths and weaknesses of diuretic therapy in the treatment of congestive heart failure.
STRENGTHS
- Reduce symptoms of tiredness/fatigue and improve exercise capacity
WEAKNESSES
1. Dehydration
2. Hypotension
3. Hypokalaemia, hyponatraemia
4. Gout
5. Impaired glucose tolerance, diabetes
Define the terms exudate and transudate.
TRANSUDATE - Hydrostatic pressure
- Alterations in the haemodynamic forces which act across the capillary wall
- Cardiac failure, fluid overload
- Not much protein/albumin (few cells)
- Lots of H2O & electrolytes
- Low specific gravity
EXUDATE
- Part of inflammatory process* due to vascular permeability
- Tumour, inflammation, allergy
- Higher protein/albumin content (cells)
- H2O & electrolytes
- High specific gravity
Explain congestive heart failure.
Relative excess of blood in vessels of tissue or organ
- Passive process, secondary phenomenon
- Not like acute inflammation - active hyperaemia
- Acute (DVT) or chronic (Congestive cardiac failure)
Describe the clinical presentations of atrial fibrillation.
- Some patients may be asymptomatic
- Palpitations
- Dyspnea (shortness of breath)
- Chest pain
- Fatigue
- Dizziness or feeling light-headed
- Reduced ability to exercise
- Confusion
- Embolism (in severe cases)
Describe atrial fibrillation and flutter.
Atrial fibrillation is characterized by rapid and irregular beating of the atrial chambers, while atrial flutter is characterized by a fast but regular rhythm.
Explain “supraventricular tachycardia”
Supraventricular Tachycardia (SVT): This is a rapid heart rhythm (tachycardia) that originates above the ventricles, in the atria or AV node.
The heart rate during SVT can be as high as 150 to 250 beats per minute.
Symptoms may include palpitations, lightheadedness, and shortness of breath.
Describe Wolff-Parkinson-White Syndrome
In this syndrome, an extra, abnormal electrical pathway exists, which bypasses the usual route, leading to faster than normal heart rate.
Symptoms may include palpitations, lightheadedness, fainting, and shortness of breath.
It is often diagnosed via an Electrocardiogram (ECG) which shows a specific pattern called a “delta wave”.
Describe ventricular tachycardia and fibrillation.
Ventricular Tachycardia: This is a rapid heart rhythm that originates from the ventricles, with a rate of over 100 beats per minute.
Ventricular Fibrillation: The heart’s ventricles contract in a rapid, chaotic rhythm and can’t pump blood to the body. This condition is a medical emergency and is the most common cause of sudden cardiac death.
Explain sinus arrest.
This is a condition where the sinoatrial (SA) node temporarily fails to initiate an electrical impulse.
This results in a pause in the rhythm of the heart, which can lead to a temporary stop in the heartbeat.
The length of the pause can vary, and it can lead to symptoms such as lightheadedness or fainting (syncope) if the pause is long enough.
Understand the difference between atrial and ventricular ectopic beats.
Atrial Ectopic Beats: These are premature heartbeats originating from the atria, outside the sinoatrial (SA) node. They can be caused by stress, caffeine, alcohol, or underlying heart conditions. On an ECG, atrial ectopic beats can be identified by an abnormal P wave.
Ventricular Ectopic Beats: These are premature heartbeats originating from the ventricles. They can occur in both healthy individuals and in those with heart disease. On an ECG, ventricular ectopic beats can be identified by a wide and abnormal QRS complex.
