Flashcards in Heart failure Deck (27):
What is heart failure?
When the heart is unable to pump sufficiently to maintain blood flow to meet the body's demands
Is heart failure curable?
No, but it is treatable
What types of heart failure can you get?
-Left ventricular failure
-Right ventricular failure
-Congestive cardiac failure (both sides)
-Systolic failure: heart can't contract properly
-Diastolic failure: heart can't relax and fill properly
What are the symptoms of heart failure?
SOB on exertion or when lying flat (orthopnoea)
Fatigue & weakness
Oedema: pulmonary, peripheral
Ascites and anasarca (widespread oedema)
What are the signs of heart failure?
Rales: rattling sound of lungs via stethoscope
What evidence of structural abnormalities of the heart could you see that would point to heart failure?
What is NTproBNP?
A hormone produced by the atria/ventricles when they are over-stretched
In heart failure the atria get stretched
Should you use NTproBNP as a tool for diagnosis?
If it is raised in may indicate HF, but it is not synonymous.
Use their symptoms mainly and NTproBNP to assist
What are the causes of heart failure?
IHD, damaged ventricle
Cardiomyopathy (damage to cardiac muscles)
Endocardial & pericardial causes
What is ejection fraction?
When blood is ejected from the ventricle it is not emptied completely, there is a residual volume left behind.
Ejection fraction is the % of blood that is ejected
What is a healthy ejection fraction in young people?
What happens to ejection fraction in heart failure?
Blood can't be pumped out as well as it should
What is cardiomyopathy?
Chronic disease of the cardiac muscle
What are the 3 types of cardiomyopathy?
Describe dilated cardiomyopathy.
Describe hypertrophic cardiomyopathy.
Small cavity caused by hypertrophy of muscle walls
Thick muscular walls
Heart contracts too well
Describe restrictive cardiomyopathy.
Heart walls are rigid, so they can't contract or relax properly
The heart can't stretch or fill properly
What is myocarditis?
What is it caused by?
Inflammation of the myocardium
Viruses, alcohol, chemotherapies
What investigations would you do for heart failure?
ECG: may indicate cause, look for ischaemia, MI, hypertrophy
Bloods: FBC, U&E, NTproBNP
CXR: look for cardiomegaly, pleural effusions etc.
Echo: indicate the cause, look for LV dysfunction
How would you manage acute heart failure?
Sit patient upright
ECG, monitor for arrhythmias
Pain relief: diamorphine
Furosemide: treats oedema, lowers BP
If systolic BP is more than 100 then start a nitrate infusion
If worsening, give more furosemide, give more nitrates IV, consider CPAP
What is CPAP?
Continuous positive airway pressure
Ventilator which applies mild pressure continuously to keep the airways open
How would you manage chronic heart failure?
Treat the cause: arrhythmia, IHD etc.
Amend lifestyle: lose weight, stop smoking, eat less salt
What drugs are used to treat chronic heart failure?
-ACE inhibitors or ARBs
-Spironlactone: K sparing diuretic, prevents body absorbing too much salt
-Digoxin: makes heartbeat stronger and more regular
-Ivabradine: slows heart rate by slowing sinus node rate
What problems are caused by left sided cardiac failure?
Pulmonary congestion (blood is back logged into lungs)
Overload of right side
Because blood can't be pumped out of the LV properly
What problems are caused by right sided cardiac failure?
Venous hypertension (blood is backlogged into IVC)
What is Cor Pulmonale?
Enlargement and failure of the right ventricle caused by increased vascular resistance in the lungs