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Flashcards in Heart failure Deck (27):
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

-Systolic failure: heart can't contract properly
-Diastolic failure: heart can't relax and fill properly

4

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)

5

What are the signs of heart failure?

Tachycardia
Tachypnoea

Rales: rattling sound of lungs via stethoscope

Murmurs
Pleural effusion
Raised JVP
Oedema
Hepatomegaly

6

What evidence of structural abnormalities of the heart could you see that would point to heart failure?

Cardiomegaly
S3 beat
Murmur

7

What is NTproBNP?

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

In heart failure the atria get stretched

8

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

9

What are the causes of heart failure?

Myocardial damage:
IHD, damaged ventricle

Hypertension

Alcohol excess

Cardiomyopathy (damage to cardiac muscles)

Valve problems

Endocardial & pericardial causes

Cor pulmonale

10

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

11

What is a healthy ejection fraction in young people?

About 65%

12

What happens to ejection fraction in heart failure?

It reduces.

Blood can't be pumped out as well as it should

13

What is cardiomyopathy?

Chronic disease of the cardiac muscle

14

What are the 3 types of cardiomyopathy?

Dilated
Hypertrophic
Restrictive

15

Describe dilated cardiomyopathy.

Stretched ventricles
Leaky valves

16

Describe hypertrophic cardiomyopathy.

Small cavity caused by hypertrophy of muscle walls

Thick muscular walls
Heart contracts too well

17

Describe restrictive cardiomyopathy.

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

The heart can't stretch or fill properly

18

What is myocarditis?
What is it caused by?

Inflammation of the myocardium
Viruses, alcohol, chemotherapies

19

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

20

How would you manage acute heart failure?

Sit patient upright

Oxygen

ECG, monitor for arrhythmias

Pain relief: diamorphine

Furosemide: treats oedema, lowers BP

GTN spray

If systolic BP is more than 100 then start a nitrate infusion

If worsening, give more furosemide, give more nitrates IV, consider CPAP

21

What is CPAP?

Continuous positive airway pressure

Ventilator which applies mild pressure continuously to keep the airways open

22

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

23

What drugs are used to treat chronic heart failure?

-Diuretics

-ACE inhibitors or ARBs

-Beta blockers

-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

-Vasodilators

24

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

25

What problems are caused by right sided cardiac failure?

Venous hypertension (blood is backlogged into IVC)

Congestion

26

What is Cor Pulmonale?

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

27

What causes Cor Pulmonale?

Anything that causes vascular resistance in the lungs.

Pulmonary hypertension
Stenosis of pulmonary artery