Heart 6a Heart Failure

Question 1

Heart failure

Answer 1

A complex clinical syndrome with typical signs that generally occur at exertion but can also occur at rest.
It is secondary to an abnormal of cardiac function that impairs the ability of the heart to fill with blood at normal pressure or eject blood sufficiently

Question 2

Heart failure prevalance

Answer 2

1-2%
3 or mkee times higher in elderly population
Higher in indigenous and in rural population

Question 3

Aboriginal and ts hf

Answer 3

Higher incidence of hf at an early age

Hospitalization are higher in indigenous population

Question 4

Heart failure diagnostic criteria

Answer 4

Herat failure with reduced ejection fractions

Heart failure with preserved ejection fraction

Question 5

Heart failure with reduced ejection traction

Answer 5

Singa of hf
Lvef<50%

Systolic heart failure

Question 6

Heart failure with preserved ejection fractional

Answer 6

Signs of hf
Lvef >50 %
And objective evidence of:
Relevant structural heart disease
And
Diastolic dysfunction with high filling pressure demonstrated by any of the following
- diastolic dysfunction, eith high filling pressure demonstrated by any of the ff

Invasive means
Echocardiography
Biomarker
Exercise

Question 7

Systolic heart failure

Pathophysiology

Answer 7

Inability of the heart ti pump blood effectively causee by impaired contractile function , increased afterload, cardiomyopathy and mechanical abnormalities
The lv loses its ability to generate enough pressure to eject blood forward through the aorta abd eventually becomes dilated
The hallmark is reduced lvf

Question 8

Diastolic failure

Answer 8

Inability of the ventricles to relax and fill during diastole
Decreased filling of the ventricles results in decreased sv and co
Characterised by high filling pressure because of stiff ventricles that result in venous engorgement both in the pulmonary and systemic vascular system
Usually result of left ventricular hypertrophy from htn, ml, valve disease

Question 9

Causes of Chronic heart failure

Answer 9

Mycocyte damage
Abnormal loading conditions
Arrhythmia

Question 10

Myocyte damage

Answer 10

Ischaemia
Inflammation
Endomyocardial pathology 
Metabolic abnormalities
Nutritional abnormalities
Genetic abnormalities 
Pregnancy and peripartum causes

Question 11

Abnormal loading conditions

Answer 11

Hypertension 
Valve and myocardium 
Pericardial pathology
High output states
Volume overload

Question 12

Arrhythmia

Answer 12

Tacharrhythmia

Bradyarrhtthmias

Question 13

Causes of heart failure

Answer 13

Primary causes

Precipitating causes

Question 14

Primary causes of chronic heart failure

Answer 14

Coronary heart disease 
Hypertension 
Idiopathic dilated cardiomyopathy 
Rheumatic heart disease
Pulmonary hypertension 
Hyperthyroidism
Myocarditis
Valvular disorders

Question 15

Precipitating factors chirnic heart failure

Answer 15

Anaemia
Infection
Thyrotoxicosis
Hypothyroidism
Arrythmia
Bcterial endocarditis
Pulmonary embolism 
Pagets disease
Nutritional deficiencies
Hypervolaemia

Question 16

Modifiable risk factors if chf

Answer 16

Htn
Cad
Tobacco use
Physical inactivity 
Obesity 
Diabetes

Question 17

Non-modifiable risk factors of chf

Answer 17

Age> 60 years 
Gender
Diabetes 
Family history
Valvylar heart disease

Question 18

Cardiac output

Answer 18

Multiplying stroke volume （sv) (amount of blood ejected per heartbeat) x heart rate

Co= sv x hr

Question 19

Ejection fraction

Answer 19

The percentage of the volume of blood that is ejected with each stroke of the left ventricle.

The normal adult is 54-75%. EF is often reduced in patients with chf

Question 20

Symptoms and signs of heart failure
Typical symptoms
More specific signs

Answer 20

Dyspnoea
Ortgonoea
Paroxysmal nocturnal dyspnoea
Fatigue

Elevated jugular venous pressure
Hepatojugular reflux
Third heart sound
Laterally displaced apex beat

Question 21

Less typical symptoms

Less specific signs

Answer 21

Nocturnal cough 
Wheese
Abdominal bloating
Anorexia
Confuaion
Depression 
Palpitations
Dizziness 
Sycope
Bandipnoea

Weight gain( more than 2kg oer week)
Weight loss
Cardiac murmur
Tachycardia 
Tachypnoea
Ascites
Pulmonary crackles

Question 22

Nyha functional classification of heart disease class 1

Answer 22

No limitation of physical activity. Ordinary physical activity does not cause fatigue, dyspnoea, palpitation or anginal pain

Question 23

Nyha functional classification of heart disease class 2

Answer 23

Slight limitation of physical activity. No symptoms at rest. Ordinary physical activity result in fatigue, dyspnoea, palpitations or anginal pain

Question 24

Nyha functional classification of heart disease class 3

Answer 24

Marked limitation of physical activity but usually comfortable at rest. Less than ordinary physical activity causes fatigue, dyspnoea, palpitation or anginal pain

Question 25

Nyha functional classification of heart disease class 4

Answer 25

Inability to carry one any physical activity without discomfort. Symptoms of cardiac insufficiency or of angina may be present even at rest. If any physical activity is undertaken, discomfort is in increased