Heart failure Flashcards
(33 cards)
Define HF
- Heart muscle gets damaged and becomes weak
- Cannot pump properly
- Unable to generate sufficient CO to meet the demands of the body without an increase in diastolic BP
Define congestive heart failure
- Breathless
- Abnormal sodium and water retention resulting in oedema
How can HF be defined?
Based of left ventricular ejection fraction (LVEF)
Define HFrEF
- Signs and symptoms
- LVEF <40%
Define HFmrEF (mid-range)
- Signs and symptoms
- LVEF 40-49%
- Elevated natriuretic peptides
- At least one:
1) Relevant structural heart disease (LVH, left atrial enlargement)
2) Diastolic dysfunction
Define HFpEF (preserved)
- Signs and symptoms
- LVEF >50%
- Elevated natriuretic peptides
- At least one:
1) Relevant structural heart disease (LVH, left atrial enlargement)
2) Diastolic dysfunction
What are natriuretic peptides?
- Peptides that induce natriuresis - excretion of sodium by the kidneys
Signs and symptoms of HF
- Weak
- Tired
- Breathlessness
- Swollen extremities
- Exercise intolerance
- Hypotension
- Weight gain (sometimes loss)
- Dizzy
- Lost appetite
- Coughing
- Signs of inadequate perfusion
Prevalence HF Western world
1-2%
Gender prevalence - HF
M slightly more prevalent than F
Incidence of HF is …..
increasing
HF is primarily a condition of the ….
elderly
Which is more common - HFpEF or HFrEF
HFrEF
Risk factors for HF
- HTN
- Coronary disease inc. MI
- Diabetes
- Valve disease
- Cigarette smoking
- Obesity
Aetiology of HF
MANY CAUSES
- Coronary artery disease
- HTN
- Valvular disease
- Myocarditis
- Infiltrative disease (amyloidosis, sarcoid etc)
- Congenital disease
- Pericardial disease
- Toxin-induced
- Infection
- endocrine
- Systemic collagen vascular diseases
- Chemotherapy
- Nutritional deficiencies
- Pregnancy
- Familial cardiomyopathy
- Tachycardia-induced cardiomyopathy
Pathophysiology of HF
- Initial myocardial insult causes over-expression of multiple peptides with a variety of short and long term effects on the CVS
- Neurohormonal
- Remodeling after MI, cardiomyopathy, HTN, valvular disease
- Remodeling leads to mitral regurgitation - volume overload - disease progression and further remodeling
Stages of HF
A-D
Diagnosis of CHF - what criteria
Framingham - clinical diagnosis - need 2 major or 1 major/2 minor
Major criteria in Framingham
- Neck vein distension
- Rales (crackles)
- Acute pulmonary oedema
- S3 gallop
- Increased venous pressure
- Circulation time >25 seconds
- Hepatojugular reflux
- Cardiomegaly
- Paroxysmal nocturnal dyspnoea/orthopnoea
Minor criteria in Framingham
- Ankle oedema
- Night cough
- Dyspnoea of exertion
- Hepatomegaly
- Pleural effusion
- <1/3 max vital capacity
- Tachycardia (>120)
Major/minor criteria in Framingham
- Weight loss >4.5kg in 5 days in response to treatment
Most common symptoms of LEFT-SIDED heart failure
Dyspnoea of exertion or at rest
DDx HF
- Age
- COPD
- Pulmonary fibrosis
- Pneumonia
- PE
- Post-partum cardiomyopathy
- Cirrhosis
- Nephrotic syndrome
- Pericardial disease
- Venous stasis
- DVT
Diagnosing HF
- Echocardiogram
- ECG = no specific features, yet can see risk factors
- Coronary angiogram
- CXR = look for fluid retention and vascular congestion
