Heart Failure Flashcards by Shadekiel Kassie

What is Heart Failure?

Heart Failure is described as when the cardiac output is inadequate for the body’s requirments

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What is the incidence of Heart Failure in the general population?

1-3%

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What is the incidence of heart failure in the elderly population?

~10%

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What are 3 classifications of heart failure

Systolic and Diastolic
Left and Right Heart Failure
Acute and Chronic

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What is Systolic Heart Failure

The inability of the ventricles to contract normally resulting in a decreased cardiac output

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In systolic heart failure, what is the ejection fraction

<40% HFrEF

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List three causes of Systolic Heart Failure

Ischaemic Heart Disease
Cardiomyopathy
Myocardial Infarction

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What is Diastolic Heart Failure

This is when the ventricles are unable to relax and fill normally, which then leads to increased filling pressures

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What is the ejection fraction in diastolic heart failure

> 50% HFpEF

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List 5 causes of diastolic heart failure

Ventricular Hypertrophy
Constrictive Pericarditis
Tamponade
Restrictive Cardiomyopathy
Obesity

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List symptoms of Left Sided (Ventricular) Heart Failure

Dyspnoea
Paroxysmal Noctornal Dyspnoea
Orthopnea
Wheezing
Nocturia
Night Time Dry Cough
Fatigue
Weight loss
Cold peripheries

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List 3 causes of Right sided (ventricular) failure

Pulmonary Stenosis
Lung Disease
Left ventricular (sided) failure

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List symptoms of Right sided (ventricular) failure

Pulmonary Hypertension
Peripheral Oedema (thighs, sacrum, abdomen)
Ascites
Anorexia
Facial engorgement
Epistaxis
Nausea

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Left Ventricular and Right Ventricular Heart Failure is collectively called

Congestive Cardiac Failure

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How does congestive heart failure cause nocturia

When in the recumbent position, the fluid in the legs is no longer being held down by gravit. It can now moore easily enter the veins and the kidney for filtration, leading to the nocturia

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What is acute heart failure?

Acute heart failure is new onset acute or decompensated heart failure characterized by the onset of pulmonary/peripheral odema with or without hypoperfusion signs.

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What is Chronic Heart Failure

This is a gradual and slow progression of heart failure. Venous congestion is common but arterial pressures are well maintained until late

What is Low output cardiac failure?

This is when cardiac output is decreased and fails to increase on exertion to meet requirements.

List three cause of Low cardiac output failure

-excessive preload : Preload is the force that stretches the cardiac muscle prior to contraction. This force is composed of the volume that fills the heart from venous return.

-pump failure

-excessive afterload :
The afterload is the amount of vascular resistance that must be overcome by the left ventricle to allow blood to flow out of the heart

List some causes of excessive preload in Low Cardiac Output Failure

Mitral Regurgitation
Fluid Overload (renal failure, excess IV fluids)

List some causes of pump failure in Low Cardiac Output Failure

Systoli/Diastolic Heart Failure
B Blockers
Myocardial Infaction
Heart Block
Negative Inotropes

List some causes of chronic excessive afterload Low Output Cardiac Failure

Aortic Stenosis
Hypertension

The afterload is the amount of vascular resistance that must be overcome by the left ventricle to allow blood to flow out of the heart

What is High Output Cardiac Failure

Cardiac output is higher than normal due to increased peripheral demand. There is circulating overload which may lead to pulmonary edema secondary to elevated diastolic level in left ventricle

List some causes of High Output Cardiac Failure

Anemia
Pregnancy
Hyperthyroidism

List one complication of High Output Cardiac Failure

Right sided failure becomes left sided failure

List some clinical signs of Heart Failure

Cyanosis Decreased BP Narrow Pulse Pressure Pulsus Alterans Displaced apex (LV dilatation) Right Ventricle Heave (pulmonary hypertension) Signs of valve disease (murmur?) Severity (according to NYHA)

What could a displaced apex beat indicate

Left Ventricle dilatation

What could a right ventricle heave indicate

Pulmonary Hypertension

Which investigations are done in Heart Failure?

CBC : Anemia, Infection UandE : Kidney & Thyroid Function Tests ECG : Heart Blocks, Bradycardia BNP - B-type natiuretic protein: Echocardiography: Chest X-Ray:

What are the five (5) steps to management of Heart Failure

1) Lifestyle Changes 2) Treat the cause 3) Treat exacerbating factors 4) Avoid Exacerbating factors 5) Pharmacotherapy

What lifestyle changes should be advised in a patient with Heart Failure

Stop Smoking Low salt intake Stop drinking alcohol Optimize weight and nutrition

What are some exacerbating factors of Heart Failure

anemia thyroid disease infection high blood pressure

What are some drugs that can exacerbate Heart failure and should be avoided in treating these patients

NSAIDs (fluid retention) Negative Inotropes - Verapamil (CCB)

What are the 4 (four) pillars of Heart Failure Treatment

- ACE-i (Lisinopril) - SGLT2 inhibitors (Gliflozin) - B-Blocker (Carvedilol) - Aldosterone Antagonist (Spirinolactone/Eplerenone) OR 2022 Edition 1) Neprilysin Inhibitor + ARB (Vymada) 2) SGLT2i (Dapagliflozin, Empagliflozin) 3) Beta Blocker ( Carvedilol, Metoprolol, Bisoprolol) 4) Aldosterone Antagonist (Spirinolactone, Eplerenone)

What does the FRAMINGHAM CRITERIA for Congestive Cardiac Failure State

Diagnosis of CCF requires simultaneous presence of 2 major criteria OR 2 minor and 1 major criteria

What is the threshold for B-type Natiuretic peptide that "confirms" heart failure

>100mg/L

BNP at what value is used to rule out Heart Failure

<50ng/L (96% accurate)

What is Heart Failure with reduced Ejection Fraction

<40%

What is Heart Failure with mid-range Ejection Fraction

40-49%

What is Heart Failure with preserved Ejection Fraction

>50%

What is normal Ejection Fraction

55-70%