3+ Heart Failure Flashcards
What is heart failure?
A clinical syndrome in which the heart is unable to pump enough blood to meet the metabolic needs of the body
Ultimately caused by a reduced CO from a structural or functional abnormality
What are some general underlying causes of heart failure?
Primary abnormality of heart muscle
CAD
Valvular defects
Congenital defects
HTN/Hypertensive crisis
Cardiomyopathy
Toxins: EtOH, cocaine
Chagas Disease
MI/ACS
What is the pathogenesis of heart failure?
Frank-Starling Law of Heart:
- Normally SV increases as EDV increases in the ventricles
- THe blood stretches the muscle fibres so you have increased contraction
- In HF, something impacts the contraction ability of the heart so SV doesn’t increase and CO decreases
What are the precipitating factors that can exacerbate heart failure?
Infection
Anaemia
HTN
Thyrotoxicosis
Pregnancy
Arrhythmia
Tachycardia
Carditis: rheumatic, bac, viral
Acute MI
PE
What is the ‘typical’ presentation of someone with heart failure?
Symptoms:
- Dyspnoea
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Cough: worse at night, pink frothy sputum
- Oedema
Signs:
- Cyanosis
- Bibasal crackles
- Cardiac wheeze
- Cardiac cachexia: masked my weight gain from fluid
- Laterally displaced apex beat
- S3 heart sound
- Right sided: elevated JVP, ankle oedema, hepatomegaly
What Ix do you do for heart failure?
Bedside:
- ECG: LV hypertrophy, previous ischaemia, arrhythmia
Labs:
- Increased BNP
- FBC
- UEC: hyponatremia = bad prognosis
- Trop to rule out ACS
CXR:
- Differentiating HF from pul causes
- Cardiomegaly: CT ratio >0.5
- Kerley B line
- Dilated upper lobe vessels
- Pleural effusions (blunted costophrenic angles)
Transthoracic echo:
- Calculate EF
- Look at A/V
- Evaluate valves
- Septum thickness
What is the non-pharm management of heart failure?
- Fluid restriction (1.5-2L)
- Salt restriction (<2g/day)
- Exercise
- Smoking cessation
- Alcohol reduction
- Daily weight in morning after voiding
What is the pharm management of heart failure?
1st line= ACEI/ARBs: prognostic and symptomatic improvement
- Better tolerated when congested/wet
2nd line= BBlocker
- Better tolerated when not congested/dry
3rd line= Aldosterone antagonist
PLUS: frusemide (loop diuretic) for symptomatic relief
What is the escalation therapy when decompensation occurs and you get renal dysfunction and lack of diuresis?
Inotropics: dobutamine and low dose NA
Can wean off as symptoms improve
What are some complications of heart failure?
Acute decompensated heart failure
Cardiorenal syndrome: progressive decline in renal function
Arrhythmias
Cardiogenic shock
Stroke
CKD
What is HFrEF?
HF with an EF <35-40%
Often a systolic problem
What is HFpEF?
HF with an EF >45-50%
Often a diastolic problem
What are some causes of HFrEF?
Typically a systolic problem
- Impaired ventricular contraction
- Dilated cardiomyopathy (DCM)
- Ischaemic heart disease
- Myocarditis
- Arrhythmia
- Valve regurgitation - Increased afterload:
Left:
- Systemic HTN
- Aortic stenosis
Right side:
- Pul HTN
- Pul stenosis
What are some causes of HFpEF?
Typically a diastolic problem
- Reduced compliance/impaired ventricular relaxation:
- Hypertrophic obstructive cardiomyopathy (HOCM)
- Restrictive Cardiomyopathy (RCM)
- Ventricular hypertrophy - Impaired ventricular filling:
- Mitral or tricuspid stenosis
- Cardiac tamponade
- Constrictive pericarditis
Are most HFrEF and HFpEF left or right sided?
Most are left side
