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BNKN602 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Define Heart Failure

A

An acute or chronic condition in which the heart doesn’t pump blood as well as it should resulting in congestion (CHF) of blood backing up and unable to meet the demands of the body

  • The heart’s inability to consistently pump enough blood to organs and tissues
  • Cardiac output is insufficient to meet the metabolic demands of the body and accommodate venous return
  • Occurs from either a structural or functional abnormality of the heart
  • The resulting decreased blood supply to body impairs organs and tissue function
  • The dominant feature is inadequate tissue perfusion
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2
Q

What is a structural abnormality of the heart?

A

Valve problem/dysfunction, ventricle thickness, rigidity

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3
Q

What is a Functional abnormality of the heart?

A

Following a MI, cardiomyopathy, CAD (coronary artery disease)

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4
Q

Define Cardiac Output (CO)

A

Stroke Volume x Heart Rate (3.5-5L/min)

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5
Q

Define Stroke Volume (SV)

A

Amount of blood pumped out per heartbeat

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6
Q

Define Preload

A

(Volume) amount of ventricular stretch at the end of diastole. The greater the stretch the stronger the contraction (Starling’s Law)

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7
Q

Define Afterload

A

(Pressure) resistance to the ejection of blood from the ventricle

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8
Q

Define Ejection Fraction, what the normal is and how it is measured

A
  • The ejection fraction (EF) is the amount of blood that is pumped out of the left ventricle (LV) with each heartbeat
  • A decreased EF = decreased amount of blood being pumped out = decreased perfusion
  • It is measured in percentages
  • Normal range is 55-70%
  • An EF of 40% or less indicates HF
  • Calculated from an echocardiogram
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9
Q

What is Systolic Heart Failure?

A
  • Shortened to HFrEF which stands for Heart Failure reduced Ejection Fraction
  • Pumping problem of the heart
  • Inability of the Left ventricle to contract effectively
    ( Ventricles can’t pump hard enough during systole )
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10
Q

What is diastolic heart failure?

A
  • Shortened to HFpEF which stands for Heart failure Preserved ejection fraction
  • It is a relaxing problem
  • Inability of the Left ventricle to relax and fill effectively
    ( Not enough blood fills into ventricles during diastole )
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11
Q

Define systole and diastolic

A

Systole = The ventricles eject blood (pump)
Diastolic = The ventricles fill with blood (relax)

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12
Q

What is Right-Sided Heart Failure?

A
  • The right ventricle cannot eject sufficient amounts of blood - blood backs up in the venous system and may result in:
  • Peripheral Oedema
  • Weight gain but anorexia/nausea may be present
  • Hepatomegaly/Splenomegaly
  • Liver is the last place to send blood back to the heart
  • Ascites
  • Jugular vein distention
  • The blood can back up to the rest of the body via the right atrium and manifest as oedema, legs/ankles/feet, sacrum/penis (dependent areas) around the eyes, organ oedema

(Could experience Anorexia, GI distress, Weight loss, signs related to liver function impairments)

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13
Q

What is Left-Sided Heart Failure?

A
  • The left ventricle cannot pump blood effectively to the systemic circulation. The blood backs up in the pulmonary system so the pulmonary venous pressure increases in:
  • Decrease EF
  • Pulmonary congestion/oedema with dyspnoea
  • Cough
  • Crackles
  • Impaired oxygen exchange
  • LHF is the most common form (from left ventricular dysfunction). Blood cannot get out and around the body, so it backs up in the lungs via the left atrium and pulmonary vein
  • It causes pulmonary congestion and oedema in the lungs

(cough with frothy sputum, Cyanosis and signs of hypoxia, orthopnea)

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14
Q

What is the patho for Heart Failure?

A
  1. MI or cardiac dysfunction/structural abnormality impairs ability of L) ventricle to fill with or eject blood
  2. Poor ventricular function/myocardial damage leads to decreased stroke volume and cardiac output
  3. Leads to a neurohormonal response
  4. Either sympathetic system is activated to increase cardiac workload, or RAAS pathway is activated
  5. Results in vasoconstriction and sodium + fluid retention
  6. Further stress on the ventricular wall and remodelling leads to heart failure
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15
Q

What are some signs and symptoms of heart failure?

A

Pale, grey, SOBOE, orthopnea (unable to lie flat and breathe), nocturia (increased urination overnight due to lying flat and kidneys being well perfused), oedema, confusion, tachycardia, hypotensive, dry cough, dyspnoea, weak pulse, tachypnoea, fatigue, anxiety, ECG abnormalities, palpitations, restlessness, hypoxaemia, moist cough, diaphoresis, cyanosis, dizzy, light-headed, nausea, weight-gain, SOB, crackles on auscultation, ascites, exercise intolerance

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16
Q

What are some risk factors/aetiology for Heart Failure?

A
  • Ischaemia - Myocardial infarction (elevated Troponin)
  • Valve disease
  • Cardiomyopathy
  • Pericarditis
  • Fluid overload (renal failure, Intravenous fluid (IVF))
  • Hypertension
  • Smoking
  • Type 2 Diabetes
17
Q

What is an echocardiogram?

A

a test of the action of the heart using ultrasound waves to produce a visual display, for the diagnosis or monitoring of heart disease.

18
Q

What is an LVEF?

A

Left ventricular ejection fraction (LVEF)
Ejection fraction typically refers to the left side of the heart. It shows how much oxygen-rich blood is pumped out of the left ventricle to most of the body’s organs with each contraction.

19
Q

Which usually occurs first? LHF or RHF?

A

LHF usually develops first then RHF because the left ventricle pumps blood throughout the body.

20
Q

What does TNI stand for?

A

Troponin I
These are proteins that are released when the heart muscle has been damaged, such as occurs with a heart attack

21
Q

What is valve disease?

A

In heart valve disease, one or more of the valves in your heart doesn’t work properly.

22
Q

What is cardiomyopathy?

A

Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body.

23
Q

What is pericarditis?

A

Pericarditis is swelling and irritation of the thin, saclike tissue surrounding the heart (pericardium). Pericarditis often causes sharp chest pain.

24
Q

what are the clinical manifestations (symptoms) of left sided HF?

A

Dyspnoea (difficult or laboured breathing)
Orthopnoea (Discomfort when breathing while lying down flat)
Paroxysmal nocturnal dysponea (a sensation of shortness of breath that awakens the patient)
Pulmonary congestion - cough, crackle, wheeze

25
Q

What are Compensatory Mechanisms?

A

Baroreceptors in the aortic and carotid arteries sense a drop in the BP

The sympathetic nervous system (SNS) releases adrenaline and noradrenaline

Low cardiac output and vasoconstriction results in decreased renal perfusion → renin is released by the kidneys

This initiates the renin angiotensin aldosterone system (RAAS)

26
Q

What do the compensatory mechanisms result in?

A

SNS activation results in:
↑ Heart rate and ↑ contractility which ↑ blood pressure

Neuro-hormonal activation results in:
↑ blood volume (related to aldosterone & ADH secretion) which ↑ preload angiotensin II ↓ vascular capacity which ↑afterload

27
Q

What are the consequences of Heart failure?

A

Pathophysiological process:
↓ blood & O2 supply to
body (pump failing)

SNS & RAAS response
helps… but ultimately
harms

Signs and symptoms:
Shortness of breath
Orthopnoea/nocturia
Oedema - peripheral/pulmonary
Exercise intolerance
Fatigue
Weight ↑
Attempts to ↑cardiac output to ↑O2 delivery:
tachypnoea
tachycardia (risk of arrhythmias

28
Q

What sided Heart failure would it be if the patient has puffy ankles?

A

Right as RV is failing to pump the blood forward to the lungs, backing up in the body via the RA

29
Q

What sided heart failure would it be if the patient has crackles/fluid in the lungs?

A

Left as LV is failing to pump the blood forward to the body, is backing up in the lungs via the LA

30
Q

What are the goals of management?

A

Treat the underlying cause if possible

Aim to increase cardiac function and decrease myocardial workload – beta blockers

Prevent harmful neuroendocrine responses, e.g.. SNS, RAAS, ventricular remodelling – ACE inhibitors.

31
Q

What is the difference between Acute and Chronic HF?

A

ACUTE i.e. post surgery fluid overload – common in the elderly – correct the cause with diuretics and it goes away
CHRONIC i.e. r/t myocardial dysfunction caused by IHD, cardiomyopathy, HTN or valvular disease/disorders

32
Q

Why would a patient with MI may get HF?

A

Damage to the myocardium esp LV – is a piece of steak – ineffective pumping. Depending on the extent of the infarction that would affect the severity of the HF

33
Q

Chronic Heart Failure

A

Heart failure is commonly caused by IHD

It is common in the elderly – one of the main reasons for admission to hospital

The pathological processes that underpin heart failure result in decreased contraction, decreased filling or both.

34
Q

How would you know if someone has HF?

A

Statements of:
c/p, heavy weight, indigestion, SOB, SOBOE,
Increased HR (to pump more oxygen around body)
BP low
Ability to speak
ECG
Oxygen saturations and/or ABG
Cyanosis/colour/diaphoresis
Sounds (gurgling/snoring/apnoea)
Agitation/confusion
Anxiety
Dyspnoea

35
Q

What assessments would you use for someone with HF?

A

Rapid Ax, Posterior Chest Ax, Peripheral vascular Ax, Apical pulse – PMI, if sond displaced then eg of ventricular hypertrophy.

36
Q

Juglar Venous Pressure (JVP) measurement

A

The vein acts as a barometer to measure fluid in the right atrium
Raised JVP indicates fluid overload
Common in right sided heart failure.

BNKN602 (21 decks)

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