C34. Heart Failure Flashcards
(48 cards)
what is Heart failure
impaired ventricular filling or ejection fraction. The state in which the heart is unable to pump blood at a rate commensurate with the requirements of the tissues or can do so only at high pressures
what happens when there is impairment of left ventricular filling
in diastole, the left ventricular walls relax to allow filling of the LV cavity.
Without proper LV relaxation, the volume of blood filling the cavity is reduced thus reducing stroke volume and the blood ejected with each contraction
what happens of there is LV wall damage
due to LV wall damage, the LV may have reduced ability to pump or eject the blood aka impaired ejection of blood
what are the steps for the diagnostic evaluation of new onset heart failure
- determine the type of cardiac dysfunction (systolic vs diastolic)
- determine aetiology and treat potentially reversible causes
- define prognosis
-guide therapy
what are some of the aetiology examples of Heart Failure
coronary heart disease (MI)
Hypertension
dilated cardiomyopathy
Valve disease
tachycardic arrhythmias
HFFpEF
what are some of the classic symptoms of heart failure
SOB, Orthopnea, Paroxysmal nocturnal dyspnoea, reduced exercise tolerance, fatigue, tiredness, ankle swelling
what is the new york heart association functional classification
1-4
1 - no limitation of physical activity
2- slight limitation
3- marked limitation
4- unable (symptoms at rest)
what examination techniques would you use for heart failure
- neck exam - looking for elevated JVP
- Auscultation of the lungs - rales or crackles
- Auscultation of the heart - looking for 3rd or 4th heart sounds (S3/S4)(gallop rhythm) or murmurs
- Oedema - in sacrum, feet, ankles or lower legs
what diagnostic tests can you do for heart failure
ECG - arrhythmias, past MI, LVH
Chest X ray - size/shape of heart or fluid accumulation in the lungs
Echocardiography - Transthoracic echocardiography TTE
Doppler
MRI
Angiogram
BNP (plus full blood tests)
in heart failure what do you see on the x ray
enlarged cardiac silhouette
peripheral congestion
Kerley B lines
fluid in inferior accessory fissure
guidelines recommend which diagnostic test as the most useful for HF
Echocardiography
what do Echocardiographys show
- chamber size
- right and left ventricular function
- regional wall motion abnormalities
- impaired LV filling (stiffness) a feature of diastolic dysfunction
- valvular heart disease
- diseases of the pericardium
- ejection fraction
what is ejection fraction
the percentage of blood that is pumped out of the heart during each beat
what is a normal EF
> 50%
Heart failure with an EF of 40% is known as what?
HFrEF heart failure reduced ejection fraction
what is heart failure reduced ejection fractions percentage EF
<40 %
Heart failure when ejection fraction is normal aka >50% is know as what?
HFpEF Heart Failure preserved ejection fraction
what is the equation to work out ejection fraction
amount of blood pumped out of the ventricle ////////////over total amount of blood in the ventricle
what is HFrEF
LV unable to eject and adequate amount of blood during systole
what is HFpEF
less blood ablw to fill the LV in diastole due to myocardial stiffness thus LV has less blood to eject during systole
what is BNP
it’s a hormone produced by your heart. When your heart has to work harder than usual, it releases more BNP into your blood. (ventricular hormone)
what is ANP
is a hormone produced by the heart, specifically by the atria
what scans/imaging techniques can you use
PET
Echo
Cardiac MRI
TI-1201
TC-99 SPECT
what does Late Gadolinium Enhanced Cardiac MRI show you?
This is a specific technique used within a CMR scan. After injecting a gadolinium-based contrast agent, LGE highlights areas of the heart muscle that are damaged or scarred. It helps differentiate between healthy and non-viable (damaged) heart tissue. It looks at size of LGE % and Wall thickness too
