Flashcards in Heart Failure Deck (15)
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1
Define Heart Failure
syndrome of sub-physiological metabolism as a result of poor tissue perfusion Caused by structural or functional cardiac disease
2
2 systems activated by low perfusion
resulting in positive feedback loop.
Adrenergic
+ Renin-Angiotensin- Aldosterone
3
Adrenerigic and RAAS cardiac effects:
they improve CO in acute response- worsen problem in chronic disease
Vasoconstriction
Increased Rate
Increased Contractility
Retention of Na and H20
(increase 02 demand -> ischaemia, enlarging heart ->ineffective contraction, adrenaline production ->cardiotoxic)
4
Left Heart Failure
definition and causes
Left Systolic Ventricular Dysfunction
Causes: IHD
HTN
Valvular disease
5
Congestive Heart Failure
definition and causes
Right Heart Failure secondary to Pulmonary vascular congestion, secondary to LHF
6
Diastolic Heart Failure
definition and causes
Preserved ventricular ejection fraction >45%
Causes; HTN, elderly, cardiomyopathy
7
Right Heart Failure causes
Causes:
cardiac pathology confined to right heart (tricuspid/ pulmonary valve disease, RV myopathy, RV ishaemia, Left to right shunt)
Pulmonary Pathology (COR PULMONALE)
-PE
-Pulmonary HTN
-Lung CA
-Fibrosis
8
High Output Cardiac Failure
Structural normal heart with symptoms of heart failure due to abnormal demand
-thyrotoxicosis
-anaemia
-AV shunt
-Beri Beri syndrome
-sepsis
-pregnancy
-pagets
9
Symptoms and Signs of LVSD
Exertional Dysponea
Orthopnoea
Paroxysmal Noctural Dysponea
Fatigue
Wheeze
Cough
Haemoptysis
Tachy
Pulsus Alternans
peripheral cyanosis
cardiomegaly
s3 Gallop
Basal Creps
Mitral Regurge
Pleural Effusion
10
COR Pulmonale (right heart failure signs)
Fatigue
Nausea
Wasting
Swollen Ankles
abdominal discomfort
anorexia
breathlessness
raised JVP
smooth hepatomegaly
liver tenderness
pitting oedema
ascites
tricuspid regurge
tahcy
RV 3rd HS
11
Diagnosis HF
Hx and Exam suggestive of HF
+ Echo showing reduced ventricular function
Once diagnosed must identify cause.
12
Investigations HF
BLoods: FBC, U&E, LFT, Cardiac Enzymes, TFTs, Brain Natriuretic peptide
12 lead ECG
CXR
Echo
(Cardiac MRI
Cardiac catheter +/- biopsy
Nuclear cardiology SPECT/ PET/ RNAngio
Stress Echo)
13
Classsification HF by disability
(NY Heart Association)
1= No limitation
2= mild limitation
3=marked limitation
4=symptomatic at rest
14
Treatment HF
Stage A (high risk) =Education and lifestyle factors
Stage B(asymptomatic structural) = ACE inhibitor & Beta blocker (first one then 2nd Angi2RB if ACE not suitable)
Stage C (symptomatic) = Add Loop Diuretic
Specialist may also ADD Digoxin/ Spironalactone/ hydralzine and Nitrate/ Valsartan / explore surgical options)
Stage D (refractory) = Inotropes eg. Ivabradine, Heart Transplant, Palliative Care.
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