Cardiac Failure (Acute and Chronic) Flashcards Preview

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Flashcards in Cardiac Failure (Acute and Chronic) Deck (48)
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1

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.

2

What are some causes of cardiac failure. (8)

Ischaemic heart disease.
Valvular heart disease.
Hypertensive heart disease.
Congenital heart disease.
Cardiomyopathy.
Myocarditis.
Endocarditis.
Pulmonary embolism (PE).

3

What are some precipitating factors of cardiac failure. (9)

Myocardial infarction.
Infection.
Arrhythmia.
Anaemia.
Thyrotoxicosis.
Electrolyte imbalances.
PE.
Pregnancy.
Vitamin deficiencies such as BeriBeri.

4

What are the clinical signs of left sided heart failure. (14)

Dyspnoea.
Orthopnoea.
Poor exercise tolerance.
Nocturnal cough (with pink frothy sputum).
Wheeze ('cardiac asthma').
Nocturia.
Cold peripheries.
Weight loss.
Muscle wasting.
Paroxysmal nocturnal dyspnoea.
Fatigue.
Lung crepitations.
Pleural effusions.
Cyanosis.

5

What are the clinical signs of right sided heart failure. (9)

Peripheral oedema.
Nausea.
Anorexia.
Facial engorgement.
Epistaxis.
Abdominal distention/ascites.
Tender pulsatile hepatomegaly.
Increased jugular venous pressure (JVP).
Hepatojugular reflex.

6

What are the clinical signs of severe heart failure. (5)

Reduced pulse pressure.
Hypotension.
Cool peripheries.
3rd and 4th heart sounds.
Gallop rhythm.

7

What investigations should be carried out in a patient with suspected heart failure. (11)

FBC.
UandE.
LFTs.
Lipid profile.
TFTs.
Glucose.
Cardiac enzymes (BNP).
ECG.
CXR.
Echo with colour Doppler studies (may indicate cause of heart failure).
Endomyocardial biopsy is rarely needed.

8

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.

9

What are the risk factors for heart failure. (4)

High cholesterol.
High sugar.
Increased weight.
Smoking.

10

What drugs are used to treat heart failure. (6)

Diuretics.
ACE inhibitors/angiotensin receptor blockers.
Beta-blockers.
Digoxin.
GTN infusion.

11

What is the prognosis for patient's with heart failure.

Poor. 20-25% of patients die within 5 years of initial diagnosis.

12

What is the prevalence of heart failure. (2)

1-3% of the general population.
10% amongst the elderly population.

13

What is systolic heart failure.

Inability of the ventricle to contract normally, resulting in a decreased CO.

14

What is the ejection fraction in a patient with systolic heart failure.

EF

15

What are the causes of systolic heart failure. (3)

Ischaemic heart disease.
Myocardial infarction.
Cardiomyopathy.

16

What is diastolic heart failure.

Inability of the ventricle to relax and fill normally, causing increased filling pressure.

17

What is the ejection fraction in a patient with diastolic heart failure.

EF>50%.

18

What are some causes of diastolic heart failure. (4)

Constrictive pericarditis.
Cardiac tamponade.
Restrictive cardiomyopathy.
Hypertension.

19

What is important to note about diastolic and systolic heart failure.

They usually coexist.

20

What is congestive heart failure.

Failure of both the left ventricle and right ventricle.

21

What are some causes of right heart failure. (3)

Left ventricular failure.
Pulmonary stenosis.
Lung disease.

22

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.

23

What is meant by chronic heart failure. (2)

It develops slowly.
Venous congestion is common but arterial pressure is well maintained until very late.

24

What is meant by low output cardiac failure.

CO is decreased and fails to increase normally with exertion.

25

What are some causes of low output cardiac failure. (3)

Pump failure.
Excessive preload.
Chronic excessive afterload.

26

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).

27

What are some causes of excessive preload. (2)

Mitral regurgitation.
Fluid overload (NSAID causing fluid retention).

28

What may fluid overload cause if renal excretion is impaired (or if large volumes are involved).

Left ventricular failure.

29

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.

30

What are some causes of chronic excessive afterload. (2)

Aortic stenosis.
Hypertension.