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CVS II > Heart Failure > Flashcards

Heart Failure Flashcards

notes (52 cards)

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1
Q

Define heart failure

A

clinical syndrome caused by the inability of the heart to supply sufficient blood flow to meet the body’s needs

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2
Q

Classification of heart failure?

A 
Reduced EF (Ejection Fraction) or Preserved EF (HFrEF, HFmrEF, HFpEF)
Acute or Chronic heart failure
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3
Q

Describe the NYHA Functional Class

A

4 : breathless at rest

1 : heart muscle damaged/abnormal but no symptoms

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4
Q

Describe heart failure epidemiology

A
  • Prevalence 1-2% (6-10% in >65yo)
  • In 2030 50% increase due to increasing prevalence rather than increasing incidence
  • Commonest cause for emergency admission >65y
  • 2% total NHS health care costs
  • 70% of cost = hospital admissions
  • Quality of life affected most
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5
Q

Prevalence in over 85?

A

1/7

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6
Q

Compensatory mechanisms of failing heart?

A 
Ventricular dilatation
Increased myocardial contractility
Myocardial hypertrophy
Sympathetic stimulation
Renin-Angiotensin-Aldosterone-System (RAAS)
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7
Q

What’s the Frank-Starling Law?

A

-increased filling of the ventricle
-increased force of contraction
SV α LVEDV (left ventricular ejection end diastolic volume)

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8
Q

How does heart failure affect the Frank-Starling Law?

A

ventricle is over-stretched reducing ability to cross-link actin + myosin filaments.

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9
Q

Long term effects of compensatory mechanisms?

A 
Continuous sympathetic activation
Increased HR
Increased preload
Increased TPR
Continuous neurohumoral activation
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10
Q

Describe the effect of continuous sympathetic activation

A

β-adrenergic downregulation + desensitization (less inotropic response)

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11
Q

Describe the effect of increased HR

A

Increased metabolic demands+myocardial cell death

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12
Q

Describe the effect of increased preload

A

Beyond limits of Starling’s law, pressure is transmitted to pulmonary vasculature –> pulmonary oedema

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13
Q

Describe the effect of increased TPR

A

Higher afterload –> decreased SV + CO

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14
Q

Describe the effect of continuous neurohumoral activation

A
  • chronically elevated Ang II + aldosterone
  • production of cytokines
  • stimulate macrophages + fibroblasts
  • myocardial remodelling
  • loss of contractility
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15
Q

Equation of CO?

A

CO = SV x HR

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16
Q

Effect of ventricular dilation?

A
  • maintains SV but exhausted
  • pressure in stretched ventricle steadily increases
  • restriction to filling + increased venous pressures
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17
Q

Why was β-blocker last option for HF?

A

negatively iontropic so reduce contractility of muscle but decreases afterload

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18
Q

Effect of increased sympathetic drive?

A
  • decreased CO detected by baroreceptors
  • central + peripheral chemoreflex activation induce A, NA, VP release
  • adrenergic activation increases HR + contractility via vasoconstriction
  • increased afterload
  • increased cardiac work
  • myocyte damage
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19
Q

Effect of β-blocker?

A

decrease BP, afterload, HR, contractility

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20
Q

Effect of renin-angiotensin cctivation?

A

-decreased CO
-renin-angiotensin activation:
vaoconstriction increases afterload
Na + H2O retention increases preload
-increases cardiac work
-myocyte damage via myocyte fibrosis, + eccentric ventricular hypertrophy

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21
Q

What are ACE inhibitors+ARBs?

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A

angiotensin converting enzyme inhibitors

angiotensin-receptor blockers

22
Q

Effect of ACE + ARBs?

Study These Flashcards
A

decrease Na + H2O retention which by decreasing:

systemic vascular resistance (SVR), afterload venous p, preload

23
Q

Effect of ACE + ARBs?

Study These Flashcards
A

decrease Na + H2O retention by decreasing:

systemic vascular resistance (SVR), afterload venous p, preload

24
Q

Clinical signs of HF?

Study These Flashcards
A 
Peripheral oedema (right HF)
Pulmonary oedema (left HF)
Congestive Cardiac Failure (left + secondary right ventricular failure)
25
Mechanical causes of pump failure?
``` Impaired ventricular function Pressure overload of ventricle Inflow obstruction of ventricle Valvular disease Volume overload of ventricle ```
26
eg of impaired ventricular function?
Myocardial infarction or cardiomyopathy
27
eg of pressure overload of ventricle?
Systemic or pulmonary hypertension
28
eg inflow obstruction of ventricle?
Restrictive cardiomyopathy Diastolic heart failure Mitral stenosis
29
eg of valvular disease?
Aortic, Mitral or Tricuspid stenosis/regurgitation
30
eg of volume overload of ventricle?
Ventricular + Atrial Septal defect (VSD + ASD)
31
What's right ventricular failure?
- back pressure in RA - pressure in SVC + IVC - increases JVP - causes oedema, right and left pleural effusion, ascites (swelling in abdomen)
32
What's left ventricular failure?
- back pressure into LA | - pulmonary veins causes pulmonary oedema (leak of fluid into alveoli)
33
Symptoms of left ventricular failure?
Dyspnoea (Shortness Of Breath) Orthopnoea (SOB lying flat) Paroxysmal nocturnal dyspnoea (Sudden SOB at night)
34
Signs of left ventricular failure?
Pulmonary oedema
35
Associated features of HF?
Renal dysfunction – low perfusion + high venous pressure Iron def – changes in iron handing Gout Cardiac cachexia – skeletal muscle wasting, neurohormonal + immunologically mediated
36
Causes of left ventricular dysfunction?
CHD, hypertension
37
Primary diagnosis of HF?
``` ischaemic heart disease dilated cardiomyopathy valvular heart disease HF w preserved ejection fraction hypertensive cardiomyopathy tachycardia cardiomyopathy pul hypertension cardiac amyloidosis ```
38
Causes of heart failure with preserved ejection fraction (HFpEF) EF>50% ?
Aging heart Hypertension Secondary hypertension: Restrictive/Obliterative cardiomyopathy
39
Causes of heart failure with preserved ejection fraction (HFpEF) EF>50% ?
Aging heart Hypertension Secondary hypertension Restrictive/Obliterative cardiomyopathy
40
What's essential hypertension?
85%
41
What's secondary hypertension?
Pre-eclampsia, glomerulonephritis, pheochromocytoma, Conn’s syndrome, Acromegaly, Drugs –steroids, sympathomimetics
42
What's restrictive/obliterative cardiomyopathy?
``` PRIME Primary: Idiopathic Radiation Infiltrative: Amyloidosis, Sarcoidosis Metabolic: Glycogen storage disease, Fabry’s disease Endomyocardial fibrosis ```
43
Why's there re-classification of HFpEF?
No treatment yet proven to convincingly reduce morbidity or mortality Often highly symptomatic, poor QOL Heterogenous pathophysiology.
44
Clinical diagnosis of HF?
GPs correctly diagnose heart failure about 35% of the time + diagnosis is correct in about 70% of hospital admissions
45
What's NTproBNP?
biomarker BNP = Brain Natriuretic Peptide released from heart muscle when it's strained
46
What's the diagnostic algorithm?
-suspect HF -test for BNP: normal = test for other causes of breathlessness elevated = echo to confirm
47
Importance of NTproBNP when diagnosing HF?
Sensitive BUT not specific because raised in atrial fibrillation + hypertension Prognostic importance Diff cut-offs in acute + chronic HF
48
Importance of echocardiography when diagnosing HF?
-Confirm diagnosis -Points to aetiology of: Ischaemic CM Valvular CM Hypertensive CM Tachycardiomyopathy Infiltration
49
Why diagnose HF?
Prognosis | Treat underlying cause
50
What's Left Bundle Branch Block (LBBB)?
RV contracts before LV 30% with severe HF Progresses over time
51
What's biventricular pacemaker
RA lead LV lead RVA lead - thread backwards via coronary sinus onto LV which paces both ventricles simultaneously treats LBBB
52
Other options for HF?
Cardiac resynchronisation therapy Heart transplant Left ventricular assist devices Palliative care

CVS II (19 decks)

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