CVR 42 Flashcards
What is heart failure
cardiac disorder that impairs the ability of the ventricle to fill with, or eject blood (Hunt, Baker et al. 2001).
Characterised by impaired effort tolerance, fatigue, fluid retention and death
Differences between primary and secondary cardiomyopathy
primary - problem in heart muscle
secondary - diseased muscle secondary to underlying condition
Systolic is _____ as diastolic is to _______
Pumping
Filling
Left ventricular dysfunction is more likely to be a problem in?
Systolic
Common symptoms of heart failure?
Dyspnoea Chest pain Oedema Fatigue Early Satiety Palpitations Syncope/Sudden death
Heart failure causes baroreceptor dysfunction sending _____ inhibitor signals to the _____ which stimulates ______ secretion and ______ activity which causes the kidney and adrenal glands to lower _____, incraese ______,, increase ______ and increase ______. Additionally the SNS causes blood flow to ______.
afferent central nervous system vasomotor center vasopressin SNS renal blood flow aldosterone sodium reabsorb H20 reabsorb decrease
About __ percent of male and ___ percent of female heart attack (MI) victims will be disabled with heart failure within ___ years.
22%
46%
6 years
What accounts for 70% of heart faiure
Coronary heart disease
In left ventricular dysfunction the initial compensatory hypertrophy is followed by ______, _____, and _______.
fibrosis
dilation
progressive dysfunction
What is hypertension in relation to heart failure
2nd most common cause.
Elderly females
left ventricular fibrosis and hypertrophy causing initial relaxation than abnormal contraction
As a rule, volume overload causes ________ (e.g. Aortic incompetence, __________)
Pressure overload leads to __________ (Aortic stenosis)
Either situation can lead to adverse left ventricular remodelling
chamber dialtation
mitral regurgitation
hypertrophy
Five phenotypes have been identified:
DCM with muscular dystrophy
juvenile DCM
DCM with hypokinesis of the left ventricle
DCM with conduction defects
DCM with sensorineural hearing loss (MELAS)
What presents as Genetic – usually sarcomeric mutations
Can present with preserved systolic function or later (“burnt out”) systolic dysfunction
Hypertrophic cardiomyopathy
Restrictive Cardiomyopathy
Restrictive cardiomyopathy (RCM) is a rare form of heart muscle disease that is characterized by restrictive filling of the ventricles. the contractile function (squeeze) of the heart and wall thicknesses are usually normal, But the relaxation or filling phase of the heart is very abnormal.
Tests ordered for suspected hearrt faulure
Full blood count, Renal profile, Liver Function tests, fasting glucose & lipids, thyroid function tests, Brain Natriuretic Peptide (? Ferretin),
ECG (very rare to have a normal ECG in heart failure) – almost any abnormality – ST changes nearly always present
CXR (?)
Echocardiogram - Most useful test. Size, shape, function, valves, hypertrophy
Coronary Angiogram in selected patients
Right heart catheterization (Swan Ganz) in selected patients
Cardiac MRI – especially for rare forms of cardiomyopathy
