Clinical Case Studies - Heart Failure Flashcards
1
Q
What is heart failure?
A
Inability of cardiac output to meet physiological demands.
It can be divided into left and right heart failure.
2
Q
Describe the pathophysiology of heart failure
A
- Cardiac damage leads to increased workload, decreased cardiac output and decreased contractility
- Decreased stoke volume → Activates baroreceptors → sympathetic NS → increase HR and peripheral vasoconstriction → increased afterload → more cardiac damage/dilation
- Activates RAAS → fluid and Na retention → peripheral constriction → increases preload → exacerbates symptoms as failing heart maxed out on starling curve
3
Q
What are common causes of Left Sided Heart Failure?
A
- Coronary artery disease
- Hypertension
- Aortic valve disease
- Mitral valve disease
- Myocardial disease
4
Q
What are common causes of Right Heart Failure?
A
- Left-sided heart failure
- Tricuspid valve disease
- Pulmonary valve disease
- Pulmonary vascular disease (Cor Pulmonale)
5
Q
What are symptoms of Left Heart Failure?
A
- Dyspnoea
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Wheeze
- Cough with frothy pink sputum
6
Q
What are signs of left heart failure?
A
- Increase respiratory rate
- Hypoxia
- Tachycardia
- 3rd Heart Sound
- Bilateral basal crackles (sounding “wet”) on auscultation
- Hypotension in severe cases (cardiogenic shock)
7
Q
Why does left heart failure cause these signs/symptoms?
A
- Inefficient cardiac output
- Increase of pressure in left ventricle
- Back pressure to pulmonary vessels
- Interstitial fluid forced out into alveoli
- Poor gas exchange
8
Q
What are symptoms of Right Heart Failure
A
- Asymptomatic
- Shortness of breath (also caused by the the chronic lung diseases)
- Peripheral oedema
- Abdominal swelling (ascites)
9
Q
What are signs of right heart failure?
A
- Hypoxia
- Cyanosis
- Raised JVP (due to a back-log of blood in the jugular veins)
- Peripheral oedema
- Third heart sound
- Hepatomegaly due to back pressure in the hepatic vein (pulsatile in tricuspid regurgitation)
10
Q
Why does right heart failure cause these symptoms?
A
- Increased pressure/resistance in the pulmonary arteries
- OR chronic cardiac damage to right side heart
- Right ventricle unable to effectively pump blood
- Back pressure of blood in the right atrium, the vena cava and the systemic venous system.
- Fluid accumulation
11
Q
What investigations would you undertake for heart failure?
A
- Bloods - inc TFT, BNP
- CXR
- Transthoracic Echocardiogram
- ECG
12
Q
What would you see on a CXR in heart failure?
A
- Alveolar oedema
- Kerley B lines (edematous interlobular septa)
- Cardiomegaly
- Dilated upper lobe vessels
- Pleural Effusions
13
Q
What could you see on an Echo in heart failure?
A
- Dysfunction of contraction (global vs local)
- Size of chambers
- Thickening of walls
- Valvular disease
