Heart failure Flashcards by Zoe Gopel

What is the definition for heart failure

Can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support physiological circulation

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What are the main causes for heart failure

Ischaemic heart disease
Dilated cardiomyopathy
Hypertension

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What are other causes for Heart failure

Other forms of Cardiomyopathy
Pericardial disease
Arrhythmias
Valvular disease
Alcohol
Diabetes
Congenital heart disease

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What is ejection fraction

percentage of blood that is pumped out of the heart during each beat (SV/EDV(end diastolic volume) x 100)

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What are the types of heart failure

Heart failure with reduced ejection fraction
Heart failure with preserved left ventricular ejection fraction
Left sided heart failure
Right sided heart failure

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What is the ejection fraction % for HF with reduced ejection fraction

<40%

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How does reduced ejection fraction HF occurs

Reduced contractility->systolic ventricular dysfunction->decreased LVEF (Left ventricular ejection fraction)->decreased cardiac output

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What is HF with reduced ejection fraction commonly caused by

Ischaemic heart disease
Valvular heart disease
Hypertension

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What is HF with preserved left ventricular ejection fraction

Consisting of symptoms and signs of heart failure with an ejection fraction of >50&

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How does HF with preserved left ventricular ejection occurs

Decreased ventricular compliance->diastolic ventricular dysfunction->reduced ventricular filling and increased diastolic pressure->decreased cardiac output

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What are the causes for HF with preserved left ventricular ejection fraction

Increased stiffness of ventricle
Impaired relaxation of ventricle

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What are the 2 types of Left-side heart failure

Heart failure with reduced ejection fraction (HFrEF)
heart failure with preserved ejection fraction (HFpEF)

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What 2 things can lead to left-side heart failure

Increased left ventricular after load
Increased left ventricular preload

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How does increased left ventricular after load lead to left-sided HF

It increases the mean aortic pressure (e.g. arterial hypertension) or by outflow obstruction (e.g. aortic stenosis)

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How does increased left ventricular preload lead to left-sided HF

left ventricular volume overload (e.g. back flow into the left ventricle caused by aortic insufficiency)

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What can cause right-sided HF

Increased right ventricular after load - increased pulmonary artery pressure
Increased right ventricular preload - right ventricular volume overload

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What are the bodies compensation mechanisms

Increased adrenergic activity
Increase of RAAS (renin-angiotensin-aldosterone system)
Increased angiotensin 2 secretion
Increased aldosterone secretion
Secretion of BNP

What does increased adrenergic activity lead to

Increased heart rate, blood pressure and ventricular contractility

What is increased RAAS activated by

activated following decrease in renal perfusion secondary to reduction of stroke volume and cardiac output

What does increased angiotensin 2 secretion result in

Peripheral vasoconstriction which increases systemic BP which increases after load
Vasoconstriction of the efferent arterioles which decreases renal blood flow and increases intraglomerular pressure which maintains GFR

What does increased aldosterone secretion result in

Increased renal N+ and H2O resorption which increases preload

What is BNP secreted in response to

secreted by the ventricles in response to increased myocardial wall stress, works to decrease blood pressure

What is the forward failure

Reduced cardiac output results in poor organ perfusion leading to organ dysfunction

What does backward failure in the left ventricle lead to

increased left ventricular pressure leads to backup of blood into the lung, increasing pulmonary capillary pressure which causes pulmonary oedema

what is the effect of backwards failure on the right ventricle

Increased pulmonary artery pressure from left ventricular failure decreases right sided cardiac output resulting in systemic venous congestion which produces peripheral oedema and progressive congestion of internal organs

Is biventricular HF of left and right side more likely than isolated failure of one ventricle?

Biventricular HF is more likely

What are symptoms of heart failure

Exertional dyspnoea Orthopnoea Paroxysmal nocturnal dyspnoea Fatigue

What are signs of heart failure

Tachycardia Elevated jugular venous pressure Cardiomegaly Third and fourth heart sounds Bi-basal crackles Pleural effusion Peripheral ankle oedema Ascites Tender hepatomegaly

What is class 1 HF (NYHA classification)

No limitation of physical activity Activity doesn't cause SOB

What is class 2 HF (NYHA classification)

Slight limitation of physical activity comfortable at rest but normal activity causes SOB

What is class 3 HF (NYHA classification)

Marked limitation oh physical activity Comfortable at rest but less than normal activity causes SOB

What is class 4 HF (NYHA classification)

Unable to carry out any activity without symptoms can be symptomatic at rest

What is the first line of testing for HF

ECG CXR Natriuretic peptides

What do you do if the first line of testing is abnormal

Enchocardiography

What do you do if the Enchocardiograph is abnormal

Asses aetiology Precipitation factors Type of cardiac dysfunction Additional diagnostic tests

What may be additional diagnostic tests

Angiogram MRI

What are the general measures to manage HF

Education Dietary modification Smoking cessation Alcohol reduction Low intensity exercise Keep vaccines up to date Lorry/Bus drivers need to notify DVLA Consider anti platelet and Statin

What is the management of HFpEF

Loop diuretic e.g. furosemide to relieve symptoms of fluid overload Manage cause/precipitating factors

What is the management for HFrEF

ABAL: ACE inhibitor (e.g. ramipril) Beta blocker (e.g. bisoprolol) Aldosterone antagonist when symptoms not controlled with A and B (spironolactone or eplerenone) Loop diuretics improve symptoms

What are the other odd treatments for HFrEF if symptoms are not controlled

Sacubitril/valsartan - stop ACEi/ARB, continue beta-blocker and spironolactone Ivabradine - sinus rhythm >75 bpm Digoxin Hydralazine + nitrates

What is the management of acute HF presentation

LMNOP: Lasix (furosemide) IV Morphine IV Nitrates - sublingual or oral Oxygen Position - sit patient up Treat cause of decompensation (MI, arrhythmia, myocarditis) Beta-blocker contraindicated

What can be the complications of HF

Arrhythmia - most commonly AF and ventricular Depression Cachexia - ongoing muscle loss Chronic kidney disease Sudden cardiac death