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Flashcards in FN: Heart Failure Deck (22):
1

Definition

CO is inadequate for the body's requirements despite adequate filling pressures

2

Epi

2% @ 50 yrs
10% @ 80 yrs

3

Pathophysiology

1. Reduced CO initially --> compensation
2. Progressive decline in CO --> decompensationcompensation

4

Compensation process

1. Starling effect dilates heart to enhance contractility
2. Remodelling - hypertrophy
3. RAS and ANP/BNP release
4. Sympathetic activation

5

Decompensation process

1. Progressive dilation - Impaired contractility and functional valve regurgitation
2. Hypertrophy - relative myocardial ischaemia
3. RAS activation - Sodium and fluid retention - increase venous pressure - oedema occurs
4. Sympathetic excess - increase afterload - reduced CO

6

Low output:

Co reduced and fails to increase with exertion

7

Low output due to (3)

1. Pump failure
2. Excessive preload
3. Excessive afterload

8

Pump failure description

1. Systolic failure - impaired contraction
2. Diastolic failure - impaired filling
3. Arrhythmias

9

Systolic failure causes

Iscaemia/MI (commonest cause)Dilated cardiomyopathy
Hypertension
Myocarditis

10

Diastolic failure causes

pericardial effusion/tamponade/constriction
Cardiomyopathy: restrictive, hypertrophic

11

Arrhythmias examples causing low output

Bradycardia, heart block
Tachycardia
Anti-arrhythmics (e.g. beta-blocker, verapamil)

12

Excessive preload causes

AR, MR
Fluid overload

13

Excessive afterload

AS
HTN
HOCM

14

High Output

increase needs - RVF initially, then LVF
1. Anaemia, AVM
Thyrotoxicosis, Thiamine deficiency (beri beri)
Pregnancy, Pagets

15

RVF causes

LVF
Cor pulmonale
Tricuspid and pulmonary valve disease

16

RVF symptoms

Anorexia and nausea

17

RVF signs

Increased JVP and jugular venous distension
Tender smooth hepatomegaly (may be pulsatile)
Pitting oedema
Ascites

18

LVF causes

1st: HD
2nd: idiopathic dilated cardiomyopathy
3rd: Systemic HTN
4th: Mitral and aortic valve disease
Specific cardiomyopathies

19

LVF symptoms

Fatigue
Exertional dyspnoea
Orthopneoa + PND
Nocturnal cough (± pink, frothy sputum)
Wt. loss and muscle wasting

20

LVF signs

Cold peripheries ± cyanosis
Often in AF
Cardiomegaly with displaced apex
S3 + yachycardia = gallop rhythm
Wheeze (cardiac asthma)
Bibasal creps

21

Acute description

New onset or decompensation fo chronic
Peripheral/pulmonary oedema
± evidence of peripheral hypoperfusion

22

Chronic description

Develops/progresses slowly
Venous congestion common
Arterial pressure maintained until v. late

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