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Flashcards in Heart failure Deck (26):
1

What is heart failure?

When the heart is unable to pump sufficiently to maintain blood flow to meet the body's demands

2

Is heart failure curable?

No, but it is treatable

3

What types of heart failure can you get?

-Left ventricular failure
-Right ventricular failure
-Congestive cardiac failure (both sides)

ALSO

Reduced ejection fraction (LV failure to contract properly)

Preserved ejection fraction (LV able to contract but unable to relax and fill properlY0

4

What are the symptoms of heart failure?

SOB:
- on exertion, then at rest
- orthopnoea
- paroxysmal nocturnal dyspnoea

Fatigue + weakness

Oedema: pulmonary, peripheral

5

What are the signs of heart failure?

SOB

Bilateral basal crackles

Murmurs, S3 (or S4) heart sounds
Pleural effusion
Raised JVP
Oedema: pulmonary or peripheral
Hepatomegaly

6

What is NTproBNP?

A hormone produced by the atria/ventricles when they are over-stretched

In heart failure the atria get stretched

7

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

8

What are the causes of heart failure?

Myocardial damage:
IHD, damaged ventricle

Hypertension

Alcohol excess

Cardiomyopathy (damage to cardiac muscles)

Valve problems

Endocarditis and pericarditis

Cor pulmonale

9

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

10

What is a healthy ejection fraction in young people?

About 65%

11

What happens to ejection fraction in heart failure?

Can be preserved or reduced

Preserved: ventricle can contract ok but can't relax and fill

Reduced: ventricle can't contract properly

12

What is cardiomyopathy?

Chronic disease of the cardiac muscle

13

What are the 3 types of cardiomyopathy?

Dilated
Hypertrophic
Restrictive

14

Describe dilated cardiomyopathy.

Stretched ventricles
Can't contract properly
Reduced EF

15

Describe hypertrophic cardiomyopathy.

Small cavity caused by hypertrophy of muscle walls

Thick muscular walls

Ventricle can't relax and fill properly
Preserved EF

16

Describe restrictive cardiomyopathy.

Heart walls are rigid, so they can't contract or relax properly

The heart can't stretch or fill properly

17

What is myocarditis?
What is it caused by?

Inflammation of the myocardium
Viruses, alcohol, chemotherapies

18

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

19

What medical emergency can happen as a result of heart failure?

Clinical features?

Acute pulmonary oedema

Severe SOB: at rest, PND, orthopnoea
Sweaty, nauseated and anxious
Cough: dry or productive (pink, frothy sputum)

Tachypnoea
Cyanosis
Raised JVP
Clammy
Bilateral basal crackles
S3 heart sounds or murmurs
Cardiogenic shock: hypotension, oliguria, low cardiac output

20

How would you manage acute heart failure?

ABCDE
Sit patient upright

Nitrates (GTN)
IV Furosemide: treats oedema, lowers BP
Analgesia (opiates)

Consider CPAP

21

How would you manage chronic heart failure?

Treat the cause: arrhythmia, IHD etc.

Amend lifestyle: lose weight, stop smoking, eat less salt

Drugs

Transplant

Implantable pacemaker

Palliative care

22

What drugs are used to treat chronic heart failure?

ABCDD

ACEi/ARBs

Beta blockers

C: mineraloCorticoid receptor antagonist (aldosterone)

Diuretics (furosemide)
Digoxin

Ivabradine (slows HR)
Opiates in severe cases

23

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

24

What problems are caused by right sided cardiac failure?

Venous hypertension (blood is backlogged into IVC)

Congestion

25

What is Cor Pulmonale?

Enlargement and failure of the right ventricle caused by increased vascular resistance in the lungs

26

What causes Cor Pulmonale?

Anything that causes vascular resistance in the lungs.

Pulmonary hypertension
Stenosis of pulmonary artery