Working Problem 2- Heart failure Flashcards
What is heart failure
Heart failure is a condition in which the heart is unable to generate a cardiac output sufficient to meet the demands of the body without increasing diastolic pressure.
What do you ask for in the history?
A history of hypertension; diabetes mellitus; dyslipidemia; tobacco use; coronary, valvular, or peripheral vascular disease; rheumatic fever; heart murmur or congenital heart disease; personal or family history of myopathy; mediastinal irradiation; and sleep-disturbed breathing should be enquired about.
What are clinical features on physical examination?
- Dyspnoea on exertion or at rest
- tachycardia,
- peripheral oedema
- neck vein distension as an indicator of elevated jugular venous pressure
- third heart sound (S3)
- Pulmonary rales
- Hepatomegaly
- Right ventricular heave
What investigation do you carry out for someone with Heart failure
• ECG
o evidence of underlying CAD, LVH, or atrial enlargement; may be conduction abnormalities and abnormal QRS duration
• transthoracic echocardiogram
o systolic heart failure: depressed and dilated left and/or right ventricle with low ejection fraction; diastolic heart failure: left ventricular ejection fraction (LVEF) normal but left ventricular hypertrophy (LVH) and abnormal diastolic filling patterns
CXR
- May reveal pulmonary congestion(vascular redistribution,kerly B lines)
- Cardiomegaly(increased cardiothoracic ratio or —-
- pleural effusions(usually right sided or bilateral)
BNP
- elevated in HF
- Increased BNP associated with increased LV filling ,acute MI and ischemia
- Increased BNP support dx of abnormal ventricular fucniton
- Decreased BNP rules out decompensated HF and points to pulmonary cause
FBC Serum creatinine and BUN -Rule out renal disease Blood glucose -diabetes LFT -reflects abdominal congestions TFTs -hypo and hyperthyroidism Blood lipids -metabolic syndrome
How do you manage heart disease disease?
- Identification and correction of the underlying condition causing heart failure
- Elimination of the acute precipitating cause of symptoms in a patient with heart failure who was previously in a compensated state
- Management of heart failure symptoms
a. Treatment of pulmonary and systemic vascular congestion – diuretics, salt restriction, fluid management
b. Measures to increase forward cardiac output and perfusion to vital organs – ACE inhibitors(FIRST LINE), angiotension II receptor blockers, nitrates and hydralazine, beta-blockers, inotropes, digoxin
c. Treatment of atrial and ventricular arrhythmias – amiodarone, cardiac resynchronisation - Modulation of the neurohormonal response – aldosterone antagonists, beta-blockers, ACEi, ARBs
- Improvement of long-term survival
What is cardiomyopathy?
heterogeneous group of heart muscle diseases that make a significant contribution to morbidity and mortality. They are associated with mechanical and/or electrical dysfunction. Inappropriate ventricular hypertrophy or dilatation is usually present.
How do you assess cardiomyopathy?
History of present illness
• The most common symptoms associated with cardiomyopathy are dyspnoea, chest discomfort, palpitations, and syncope.
Medical history
• History of coronary artery disease
• History of any causes of secondary cardiomyopathies
Family history
• Family history of premature cardiac death or arrhythmia
• hereditary causes of secondary cardiomyopathy
What do you find in physical examination?
- Examination is directed towards seeking signs of cardiac dysfunction.
- A sustained prominent apical impulse on palpation
- diffusely palpable cardiac impulse with apical displacement
- murmurs, an S4 gallop or an S3 gallop
- Auscultation of the lungs may demonstrate crackles
- Pedal and leg oedema, and jugular venous distension
What are the initial tests done in diagnosing cardiomyopathy?
- Designed to find cause.
- ECG
- FBC, metabolic panel, and thyroid function
- B-type natriuretic peptide
- cardiac markers including troponins or CK-MB
- chest x-ray
- Echocardiography, cardiac MRI and cardiac CT
- Other specific testing