Heart failure Flashcards
(37 cards)
Typical heart failure symptoms
breathlessness
ankle swelling (peripheral oedema)
fatigue
Typical heart failure signs
elevated JVP
pulmonary crackles
peripheral oedema
What is the New York Heart Association (NYHA) functional classes?
classify severity of cardiovascular disability through severity of exertional dyspnoea or discomfort at rest
class 1 = no limitations on activity
class 2 = comfortable at rest, ordinary physical activity causes symptoms
class 3 = comfortable at rest, patients have marked limitation of physical activity
class 4 = patients have symptoms even at rest
How is ejection fraction calculated?
stroke volume = end-diastolic volume - end-systolic volume
ejection fraction = (stroke volume/end-diastolic volume)x100
What is HFpEF?
heart failure with preserved ejection fraction
Causes of HFpEF/diastolic heart failure
hypertension
diabetes
obesity
old age
restrictive cardiomyopathies (amyloidosis, HCM, Fabry’s)
HOCM
cardiac tamponade
restrictive pericarditis
Pathophysiology of HFpEF
impaired LV relaxation
increased LVEDP
reduced diastolic filling
reduced cardiac output
Causes of HFrEF
ischaemic heart disease (post-MI)
dilated cardiomyopathy
myocarditis
infiltration (eg. haemochromatosis or sarcoidosis)
What is HFrEF?
heart failure with reduced ejection fraction
What is heart failure and what can it also be called?
when the heart is unable to pump sufficiently to maintain blood flow to meet the body’s needs
congestive cardiac failure (CCF)
congestive heart failure (CHF)
Describe high output cardiac failure
cardiac output is normal but there is an increase in peripheral metabolic demands which exceed those that can be met with maximal cardiac output
Causes of high output cardiac failure
AAPPTT
anaemia
arteriovenous malformation
paget’s disease
pregnancy
thyrotoxicosis
thiamine deficiency
Clinical features of left heart failure
pulmonary congestion (pressure builds up behind the left heart)
systemic hypoperfusion (reduced left heart output)
NB Sometimes left sided heart failure can lead to pulmonary congestion which in turn also pushes the right ventricle into failure. In these cases signs and symptoms of both left and right sided heart failure may be present
Symptoms caused by pulmonary congestion
SOBOE
orthopnoea
paroxysmal nocturnal dyspnoea
nocturnal cough (+ pink frothy sputum)
Signs caused by pulmonary congestion
tachypnoea
bibasal fine crackles on lung auscultation
Signs caused by systemic hypoperfusion
cyanosis
prolonged capillary refill time
hypotension
Less common signs of left heart failure
Pulsus alternans (alternating strong and weak pulse)
S3 gallop rhythm (produced by large amounts of blood striking a compliant left ventricle)
features of functional mitral regurgitation
Clinical features of right heart failure
venous congestion (pressure builds up behind the right heart)
pulmonary hypoperfusion (reduced right heart output)
Venous congestion symptoms
ankle swelling
weight gain
abdominal distension + discomfort
anorexia/nausea
Venous congestion signs
raised JVP
pitting ankle/sacral oedema
tender smooth hepatomegaly
ascites
transudative pleural effusions (typically bilateral)
Primary care investigations for heart failure
12 lead ECG
NTproBNP
Blood tests (FBC, U&E, LFTs, thiamine, B12/folate, vitamin D, calcium, magnesium, HbA1c)
CXR
Secondary care investigations for heart failure
echocardiogram
cardiac MRI
invasive angiogram
cardiac CT coronary angiogram
nuclear imaging
What is BNP released?
released by the ventricles in response to myocardial stretch
What BNP level would warrant an urgent 2 week referral for a trans-thoracic echocardiogram?
> 2000
400-2000 = 6 week referral
