Flashcards in Cardiac Failure (Acute and Chronic) Deck (48):
When does cardiac failure occur.
Occurs when the heart is unable to pump blood at a rate required by metabolizing tissues.
Cardiac output is inadequate for the body's requirements.
What are some causes of cardiac failure. (8)
Ischaemic heart disease.
Valvular heart disease.
Hypertensive heart disease.
Congenital heart disease.
Pulmonary embolism (PE).
What are some precipitating factors of cardiac failure. (9)
Vitamin deficiencies such as BeriBeri.
What are the clinical signs of left sided heart failure. (14)
Poor exercise tolerance.
Nocturnal cough (with pink frothy sputum).
Wheeze ('cardiac asthma').
Paroxysmal nocturnal dyspnoea.
What are the clinical signs of right sided heart failure. (9)
Tender pulsatile hepatomegaly.
Increased jugular venous pressure (JVP).
What are the clinical signs of severe heart failure. (5)
Reduced pulse pressure.
3rd and 4th heart sounds.
What investigations should be carried out in a patient with suspected heart failure. (11)
Cardiac enzymes (BNP).
Echo with colour Doppler studies (may indicate cause of heart failure).
Endomyocardial biopsy is rarely needed.
How is heart failure treated. (5)
Treat any risk factors.
Treat any exacerbating factors (anaemia, thyroid disease, infection, raised BP).
Treat the cause (eg if dysrhythmias, valvular disease).
Avoid exacerbating factors (NSAIDs, verapamil).
Drugs treatment: diuretics, ACEi, ARBs, Beta blockers, spironolactone, dogoxin, vasodilators.
What are the risk factors for heart failure. (4)
What drugs are used to treat heart failure. (6)
ACE inhibitors/angiotensin receptor blockers.
What is the prognosis for patient's with heart failure.
Poor. 20-25% of patients die within 5 years of initial diagnosis.
What is the prevalence of heart failure. (2)
1-3% of the general population.
10% amongst the elderly population.
What is systolic heart failure.
Inability of the ventricle to contract normally, resulting in a decreased CO.
What is the ejection fraction in a patient with systolic heart failure.
What are the causes of systolic heart failure. (3)
Ischaemic heart disease.
What is diastolic heart failure.
Inability of the ventricle to relax and fill normally, causing increased filling pressure.
What is the ejection fraction in a patient with diastolic heart failure.
What are some causes of diastolic heart failure. (4)
What is important to note about diastolic and systolic heart failure.
They usually coexist.
What is congestive heart failure.
Failure of both the left ventricle and right ventricle.
What are some causes of right heart failure. (3)
Left ventricular failure.
What is meant by acute heart failure. (2)
Often used exclusively to mean new onset acute or decompensation of chronic heart failure characterised by pulmonary and/or peripheral oedema.
With or without signs of peripheral hypoperfusion.
What is meant by chronic heart failure. (2)
It develops slowly.
Venous congestion is common but arterial pressure is well maintained until very late.
What is meant by low output cardiac failure.
CO is decreased and fails to increase normally with exertion.
What are some causes of low output cardiac failure. (3)
Chronic excessive afterload.
What are some causes of pump failure. (3)
Systolic and/or diastolic heart failure.
Decreased HR (eg beta blockers, heart block, post MI).
Negatively inotrophic drugs (antiarrhythmic agents).
What are some causes of excessive preload. (2)
Fluid overload (NSAID causing fluid retention).
What may fluid overload cause if renal excretion is impaired (or if large volumes are involved).
Left ventricular failure.
Who is most at risk of developing low output heart failure due to excessive preload. (2)
In those with simultaneous compromise of cardiac function.
In the elderly.
What are some causes of chronic excessive afterload. (2)
What is high output heart failure. (3)
It is rare.
The output is normal or increased in the face of increased physiological need.
Failure occurs when CO fails to meet the needs.
When will high output heart failure occur. (2)
It will occur in a healthy heart.
But it will occur even earlier if there is heart disease.
What are some causes of high output heart failure. (6)
What are the consequences of high output heart failure. (2)
Initially features of right ventricular failure.
Later left ventricular failure becomes evident.
What are the physical signs of heart failure. (10)
Narrow pulse pressure.
Displaced apex (LV dilatation).
RV heave (pulmonary hypertension).
Murmurs of mitral or aortic valve disease.
Wheeze (cardiac asthma).
What may be seen on the CXR of a patient with heart failure. (8)
Cardiomegaly (cardiothoracic ration >50%).
Prominent upper lobe veins (upper lobe diversion).
Diffuse interstitial or alveolar shadowing.
Classical perihilar 'bat's wing' shadowing.
Fluid in the fissures.
Septal (Kerley B) lines.
What are septal lines attributed to. (2)
Engorged peripheral lymphatics.
What is the 5 year mortality for heart failure.
What is the ABCDE of left ventricular failure. (5)
Alveolar oedema (Bats wings).
Kerley B lines (interstital oedema).
Dilated prominent upper lobe vessels.
What criteria is used to diagnose congestive heart failure.
What is needed in the framingham criteria to positively diagnose congestive cardiac failure. (2)
At least 2 major criteria.
1 major criteria and 2 minor criteria.
What are the major criteria in the Framingham criteria. (9)
Increased central venous pressure.
Weight loss >4.5kg in 5 days in response to treatment.
Neck vein dilatation.
Acute pulmonary oedema.
What are the minor criteria in the Framingham criteria. (7)
Bilateral ankle oedema.
Dyspnoea on ordinary exertion.
Decrease in vital capacity by 1/3 of maximum recorded.
What is the benefit of using diuretics to treat heart failure.
They can reduce the risk of death and worsening heart failure.
What loop diuretics might you give a patient with chronic heart failure. (3)
Furosemide (loop diuretic).
Spironolactone (Potassium sparing).
When might you give a patient with heart failure ARBs instead of ACEi.
ACEi may cause an irritating cough, give ARBs if this is the case.
Who should you consider giving an ACEi to.
All patients with left ventricular heart failure.