heart failure Flashcards
preload
stretch that the cardiac muscle fibres at the end of diastole
- reflects the volume of blood in the ventricles
- determined by venous return (the amount of blood returning to the heart)
- and the ventricular compliance - the ability of the ventricle to stretch and accommodate blood
baso blood volume
afterload
- resistance the heart must overcome to eject blood during systole
- related to the pressure in the aorta and systemic vasculature
like trying to push open a heavy door
define heart failure
inability of the heart to deliver blood at a rate of commensure with the requirements of the matabolism, tissues, despite normal or increased filling pressures
epidemiology
common
costly
disabling
deadly
phenotypes of HF (5)
- HR w reduced ejection fraction
- HR w preserved ejection fraction
other:
- HF due to severe vulvar disease
- HF w pulmonary hypertension
- HF due to PV systolic dysfunction
new york heart association classification
class I - asymptomatic
class II - slight limitation - mild HF
class III - marked limitation - symptomatically moderate HF
class IV - inability to carry out everyday activities without physical dyscomfort - symptomatically severe HF
ways to classify HF
- acute or chronic
- left and right sided
- systolic or diastolic
what ejection fracture counts as abnormal?
below 50%
in chronic HF, how does the body compensate for the decreased blood around the body?
- baroreceptors sense lower BP - inc RAAS - inc water retention and vasoconstriction to inc BP to compensate for low volume
- inc in SNS - release of adrenaline to inc heart rate and contractility
this will then fail
- cardiac remodelling - hypertrophy, dilation of chambers - this can make the walls thinner
right sided HF pathology
- cant pump blood towards the lungs very well
- backs up from where it came from - the systemic circulation
- this leads to systemic congestion and oedema
right sided HF causes?
any increase in pulmonary pressure makes it harder for the right side of the heart to beat
- left-sided HF
- chronic lung disease
- Pulm hypertension
- R sided MI
- COPD
left-sided HR pathology
- cant pump blood towards the body
- backs up onto lungs
- pulmonary congestion and oedema
left sided HR causes
- causes prevent blood flow
- CAD
- hypertension
- MI
- valve disease
acute HF pathology
- rapid onset of symptoms
- often life threatening
- no time for the body to compensate eg RAAS and SNS and cardiac remodelling
acute HF causes
anything sudden:
- STEMI / NSTEMI
- hypertensive crisis
- severe tachycardia or bradycardia
- pulmonary embolism
- severe infection / sepsis
- acute valve dysfunction
acute HF symtpoms
- severe dyspnea
- pink frothy sputum
- hypoxia and cyanosis
- severe hypertension and cardiogenic shock
- rapid weight gain from fluid overload
acute HF treatment
emergency:
- diuretics
- oxygen
- vasodilator
- inotropes
chronic HF pathology
- develops gradually over time allowing the body to compensate
- bc its gradual, symptoms are persistant
- RAAS and SNS and cardiac remodelling occurs but this can acc worsen HF and will eventually fail
chronic HF causes
- CAD
- long term hypertension
- dilated cardiomyopathy - weak, enlarged heart muscle
- valvar HD
- diabetes, obesity, alcohol abuse
chronic HF symptoms
- fatigue and exersize intolerance
- dyspnoea
- orthopneoa and PND
- peripheral oedema and weight gain
- ascites
chronic HF treatments
- lifestyle changes
- beta blockers
- ace inhibitors
- diuretics
- ARNI
- implantable devices
signs of HF
Tachycardia
Tachypnoea (raised respiratory rate)
Hypertension
Murmurs (indicating valvular disease)
3rd heart sound
Bilateral basal crackles (indicating pulmonary oedema)
Raised jugular venous pressure (caused by a backlog on the right side of the heart)
Peripheral oedema
risk factors of HF
Age (65+)
Smoking
Obesity
Previous MI
Male sex
diagnostic tests
Blood Test (High NT-proBNP)
ECG
Chest x-ray (see image for results)
ECHO – analyse chamber dimensions (GOLD STANDARD)
