Cardiac Failure

Question 1

Types of heart failure

Answer 1

Chronic heart failure
Congestive heart failure
Congestive cardiac failure (CCF)

Question 2

Causes of heart failure

Answer 2

Failure of the heart muscle or failure of heart valves

Often secondary

• IHD (most common)
• Hypertension
• Cardiomyopathies

Question 3

Risk factors of cardiac failure

Answer 3

Pregnancy
Anaemia 
Hyper & hypothyroidism 
Fluid retaining drugs:
 - Glucocorticoids
 - NSAIDs

Question 4

What factors make up cardiac output

Answer 4

Preload
Afterload
Muscle contractility

Question 5

Effect of hypertension on heart function

Answer 5

Increase in afterload causes hypertrophy; an increase in heart size makes it less efficient and lessens the ejection fraction

Question 6

Ejection Fraction

Answer 6

Fraction of blood ejected per cardiac cycle

Used in diagnosis of heart failure

Question 7

What happens as cardiac circumference increases

Answer 7

The heart has to work harder to get blood pumping around the body

Question 8

Neurohormonal adaptation to compensate for circulatory failure

Answer 8

Sympathetic nervous system compensates, making things worse

Renin-angiotensin-aldosterone system

ADH

Atrial Natriutetic peptide (ANP)

Only mechanism that doesn’t make anything worse

Question 9

ACE-I vs ACE-II

Answer 9

ACE-I converts Angiotensin I to A II

ACE-II converts A II to angiotensin 1-7

Question 10

ACE 2 and Covid-19

Answer 10

ACE-2 is the spike protein receptor for the Sars-CoV-2 virus

It is present in lungs, heart, arteries, intestines, kidneys

Question 11

Dangers of neurohormonal adaptations against cardiac failure

Answer 11

Increased afterload
Increased circulating volume (> pre and afterload)
Increased resistance will lead to impaired renal function; further activation of RAAS

Vicious cycle develops which further impairs the pump activity of hear and leads to myocyte dysfunction

Question 12

Left sided heart failure

Answer 12

Often secondary to hypertension

LV gets impaired, building up pressure in LV and cardiac circulation

Leads to pulmonary oedema as pulmonary venous pressure increases which opposes reabsorption of fluid in lungs; fluid accumulates in lung tissue - Oedema

Question 13

Right sided heart failure

Answer 13

RV output fails

Often due to

• lung disease (Cor Pulmonale)
• Pulmonary vavular stenosis

Question 14

Biventricular failure

Answer 14

Both chambers

Disease (e.g. IHD gas affected both ventricles)

Or, LVF leads to pulmonary congestion, increasing load on right side, leading to right failure

Question 15

Signs and Symptoms of Left Ventricle Failure

Answer 15

Pulmonary Oedema
Dyspnoea (breathlessness) - Sensation of drowning
Cough
Orthopnoea Breathless on lying which is relieved by sitting up
- Nocturnal problem?
Inspiratory Crepitations

Question 16

Signs and Symptoms of Right Ventricle Failure

Answer 16

Raised venous pressure
Increased Jugular Venous Pressure
Enlarged liver
Oedema - ankles (if lying down, rises to thighs/abdomen)

Question 17

Diagnosis of Heart Failure

Answer 17

B-type natriuretic peptide (BNP) levels
Echocardiogram: Ejection fraction <45%
Symptoms and examination
Chest X-ray showing a much larger cardiac silhouette

Question 18

How does heart failure lead to Atrial fibrillation

Answer 18

LV/valve failure leading to increased pressure in left atria, leading to distension which leads to atrial fibrillation

Question 19

Goals of cardiac failure treatment

Answer 19

Identify/treat any cause

Reduce cardiac workload

Increase cardiac output

Counteract maladaptation

Relieve symptoms

Prolong quality life - reduce hospitalisation