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CVS 10 Heart Failure Flashcards

1
Q

What is ejection fraction?

A

Stroke volume / end diastolic volume (EDV)

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2
Q

What % is ejection fraction typically?

A

60-70%

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3
Q

If stroke volume increases what happens to ejection fraction?

A

If SV increases, EF increases too

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4
Q

Increasing demand of heart is met by what two factors?

A

CO needs to increase so increasing: - heart rate
- stoke volume

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5
Q

What determines the ability to increase stroke volume?

A

Pre load
Myocardial contractility
After load

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6
Q

Define heart failure

A

Inability of heart to meet demand of body

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7
Q

Describe heart failure - what are the components?

A

Clinical syndrome of reduced cardiac output, tissue hypoperfusion, increased pulmonary pressures + tissue congestion

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8
Q

What does reduced cardiac output in heart failure arise from?

A
  • Impaired ventricular filling and/or emptying
  • Due to remodelling (e.g. Loss of myocytes, fibrosis) of cardiac muscle, changes in ventricular shape or function
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9
Q

What is the most common cause heart failure?

A

Coronary artery disease - ischaemic heart disease

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10
Q

Causes of heart failure

A
  • ischaemic heart disease (most common)
  • Hypertension
  • Valvular disease e.g. aortic stenosis
  • Cardiomyopathies
  • AF
  • HIV
  • chronic lung disease
  • previous cancer chemo drugs
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11
Q

Explain heart failure caused by ejection problem

A
  • a contractility (systolic) problem
  • can’t pump with enough force for given EDV - ventricles don’t empty well
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12
Q

Reasons for heart failure caused by ejection problem

A

Thin + fibrosed muscle walls
Enlarged chamber space
Abnormal or uncoordinated myocardial contraction

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13
Q

Explain heart failure caused by filling problem

A
  • filling (diastolic) problem
  • ventricular volume for blood is reduced so EDV/preload is reduced
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14
Q

Causes of heart failure caused by filling problem

A

Ventricular chambers too stiff - not relaxing enough
Thickened ventricular walls

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15
Q

What is a rare cause of heart failure?
Examples that cause this

A

Due to increased demand on cardiac output
e.g sepsis, thyrotoxicosis

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16
Q

What is a systolic problem of the heart also called?

A

Ejection problem
Contractility problem

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17
Q

What is a diastolic problem of the heart also called?

A

Filling problem

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18
Q

How do we determine if heart failure is due to an ejection or filling problem?

A

Measuring ejection fraction
EF < 40% ejection problem HFrEF
EF >50% filling problem HFpEF

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19
Q

Key symptoms of heart failure

A
  • Dyspnoea
  • Fatigue
  • peripheral oedema
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • cough
20
Q

Why is an echocardiogram performed for suspected heart failure patients?

A

Confirms diagnosis
Can identify LV damage
Identifies potential causes
Implications of treatment options + prognosis

21
Q

What is used to measure ejection fraction?

A

Echocardiogram

22
Q

What is ejection problem involving the left ventricle called?

A

Left ventricular systolic dysfunction

23
Q

How does reduced cardiac output trigger neuro-hormonal activation?

A

Decreased CO > decreased BP
- detected by baroreceptors
- RAAS

24
Q

Explain the neuronal activation with low CO

A
  • Decreased CO > decreased BP
  • Detected by baroreceptors
  • Increased sympathetic activity > ^ HR + peripheral resistance (afterload) > increased cardiac work > heart failure
25
What would the ejection fraction be in left ventricular systolic dysfunction?
Ejection problem - HFrEF <40%
26
Explain the hormonal activation due to low CO
- Decreased CO > decreased BP > less renal perfusion - RAAS activated - AngII made > aldosterone release - aldosterone (+ ADH) causes Na+ and fluid retention = increase in preload - AngII increases sympathetic activity > vasoconstriction = increased afterload - increased cardiac work > heart failure
27
Damaging effects of neuro-hormonal corrective mechanisms of heart failure
- Increased afterload + circulating volumes cause increased cardiac work > further deterioration of CO - Increased pressure within ventricles due to failure of sufficient ejection - Increased tissue fluid in lungs and peripheries - Cardiotoxic effects from long term activation of SNS + AngII
28
How does LV heart failure cause pulmonary + peripheral oedema?
- increased pressure within LV due to failure to eject volume sufficiently - increased pressure in pulmonary circulation - increased hydrostatic pressure at venule end of pulmonary capillary beds - gradient between hydrostatic + oncotic pressure causes fluid to move out - increased volume of tissue fluid accumulates within interstitium - oedema
29
How does RAAS cause peripheral oedema?
Causes Na+ reabsorption Water follows **Water retention**
30
Presentation of pulmonary oedema
**due to LV heart failure** Dyspnoea Basal pulmonary crackles on auscultation Orthopnoea Paroxysmal nocturnal dyspnoea
31
Orthopnoea meaning
Dyspnoea worsens on lying flat
32
What is paroxysmal nocturnal dyspnoea?
Waking up in middle of night gasping for breath
33
How does RV heart failure cause peripheral oedema?
- increased pressure in RV due to failure to eject volume sufficiently - increased pressure in systemic circulation - increased central venous pressure = increased jugular venous pressure - increased hydrostatic pressure at venule end of systemic capillary bed - gradient between hydrostatic + oncotic pressure causes fluid to move out - increased volume of tissue fluid accumulates within interstitium - oedema in gravity dependent areas - peripheral oedema in legs
34
Signs and symptoms of LV heart failure
Fatigue Dyspnoea Paroxysmal nocturnal dyspnoea Orthopnoea Peripheral (RAAS) + pulmonary oedema Basal pulmonary crackles Cariomegaly
35
What indicates cardiomegaly?
Displaced apex beat
36
Signs + symptoms of RV heart failure
Fatigue Dyspnoea Peripheral oedema Raised jugular venous pressure Tender, smooth liver Hepatomegaly
37
What drugs can be used to reduce effects of heart failure?
**ACE inhibitors** **Beta blockers** **AngII blockers** **Diueretics** - decrease circulating volume > preload **Calcium channel blocker** - vasodilation
38
Drugs for atrial fibrillation
Rate or rhythm control Rate control - **B blockers + Ca2+ channel blockers** Worried about strokes - anticoagulants needed - *warfarin* or *DOACs*
39
Displaced apex beat to left indicates what?
LV heart failure Cardiomegaly
40
How does activation of the sympathetic nervous system effect preload + afterload of heart in heart failure?
Increases afterload only
41
How are ACE inhibitor and Ang receptor inhibitors effective at decreasing heart failure?
Reduce the effect of RAAS system - vasodilation >> reduces preload - reduced ADH + aldosterone release >> reduces blood volume >> reduces afterload Reduced preload + afterload >> reduced work load on heart
42
Compare and contrast the signs and symptoms of left and right sided heart failure
**Both**: - fatigue - dyspnoea - peripheral oedema **Left**: - paroxysmal nocturnal dyspnoea - Orthopnoea - basal pulmonary crackles - cardiomegaly **Right**: - raised jugular venous pressure - tender, smooth enlarged liver
43
Adverse effects of ACEi
- dry cough - angioedema - hypotension - tinnitus or vertigo - hyperkalaemia
44
Adverse effects of ARBs
Hyperkalaemia Hypotension
45
How do you classify heart failure?
Ejection fraction
46
How does sacubitril work? What is it often given with?
- **neprilysin inhibitor** - inhibtis natriuteric inactivating enzyme > ^ effect of ANP/BNP > natriuresis - stops breakdown of bradykinin > vasodilatation . - ARBs *e.g. valsartan*
47
How can left sided heart failure cause right sided heart failure?
- decrease in blood pumped out by LV - back up of blood - increases pulmonary pressure - pulmonary congestion - increases work of RV > weakens + fails

CVS (26 decks)

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