Heart Failure Flashcards
(22 cards)
What is the typical symptom of heart failure ?
Breathlessness
What is congestive heart failure ?
Heart failure due to congestion in tissues away from the heart
What is likely if you have left sided heart failure ?
Right sided heart failure
What is likely if you have right sided heart failure ?
Left sided heart failure
Heart failure is assessed using what measurement?
Left ventricular ejection fraction
Heart failure with preserved Left Ventricular Ejection Fraction (LVEF)
Diastolic heart failure
Heart failure with reduced LVEF
Systolic heart failure
Normal ejection fraction is
More than 50 %
The value of Reduced LVEF is …
Less than 40%
What is the formula for ejection fraction
Stroke volume / end diastolic volume
Which is the preferred terminology:
Preserved/ reduced LVEF
Or
Systolic / diastolic heart failure
Preserved/ reduced LVEF
What is Class I Heart failure ?
No limitation, normal physical exercise does not cause fatigue
What is Class III heart failure ?
Marked limitation, comfortable at rest but gentle physical activity causes marked symptoms of heart failure
What is class II heart failure
Mild limitation. Comfortable at rest but normal physical activity causes symptoms
Class IV heart failure is
Symptoms of heart failure occur at rest and are made worse with physical activity
What is the most common cause of Heart Failure
IHD
why does the heart increasing in size not help in heart failure
Accompanied with deposition of fibrous tissue in the form of interstitial fibrosis. Due to mismatch of supply and demand of nutrients in the Heart, the hypertrophied heart is vulnerable to ischaemic related decompensation
Also heart remodelling
Impairment of endothelium dependent vasodilation in peripheral blood vessels, the effect of nitric oxide is blunted
Circulatory levels of endothelium are increased, many functions that contribute to pathophysiology of heart
What happens to the Renin-angiotensin aldosterone system in heart failure
Reduced cardiac output leads to a decrease in renal perfusion and the RAA system is activated.
Enhanced salt and water retention.
This further increases venous pressure
How is the sympathetic system effected in heart failure
Reduction in stroke volume means increase heart rate.
Chronic sympathetic activation has deleterious effects (e.g myocyte apoptosis)
This explains why beta blockers can be used in cardiac failure .
What is the role of natriuretic peptides in heart failure
They act as a counter regulatory system for the RAAS
Cause Decrease in blood volume, arterial pressure, central genius pressure and cardiac output
Can use measurement of plasma natriuretic in the workup of suspected heart failure
What are the features of left sided heart failure
pooling of blood in the pulmonary circulation
Pulmonary congestion and oedema
Pleural effusions (cause starboard, Orthopnea and paroxysmal nocturnal dyspnoea) —
Inadequate perfusion downstream tissues
E.g renal and cerebral hypoperfusion
Hemosiderin laden macrophages in alveolar spaces May be found which arise due to haemorrhage
Dilation if left atrium leading to atrial fibrillation and increasing risk of stroke
What are the causes and features of right sided heart failure
Also what is the name if there’s isolate right heart failure
Causes : pulmonary hypertension
Right ventricular infarction
Right ventricular cardiomyopathy
Adult congenital heart disease
Features:
If isolated known as cor pulmonale
Congestion of liver and portal system, can lead to congestive hepatomegaly => nutmeg liver
Hepatic necrosis can occur (especially with left side failure)
Portal genius hypertension can lead to enlargement of spleen
Chronic congestion and oedema in bowel was
Fluid accumulation Pleural, pericardial and peritoneal spaces
Oedema of the peripheral and dependent portions of the body especially ankle and Pretibial oedema hall mark of right sided failure
Anasarcs = massive oedema May occur
