Systolic heart failure
Ventricles can’t pump enough during systole
Diastolic heart failure
Not enough blood fills in ventricles in diastole
Systolic and diastolic heart failure leads to
Congestive heart failure
Ejection fraction?
Portion of blood pumped out the left ventricle
Normal ejection fraction
50-70
40-50= borderline
<40= systolic heart failure
Diastolic heart failure features
Ejection is preserved
Stroke volume is low
Ejection fraction normal
Thick ventricle walls mean not enough blood flows in
Left ventricle heart failure feature
Blood backed up into lungs
Pulmonary hypertension
Pulmonary oedema
Symptoms of LV heart failure
Dyspnea
Orthopnea- difficulty breathing when lying flat
Crackles / roles on auscultation
Severe left ventricular heart failure
Pulses alternans
Alternating strong + weak peripheral pulses
Ejection fraction low
Stroke volume low
More blood stays in ventricle
Next systole muscle is stretched further
RVHF symptoms and signs
Blood backed up in the body
Jugular distension
(Can been seen when patient at 45 degrees)
3cm above sterna angle
RV HF blood backs up so…
Blood goes to liver + spleen so it en,argues
Excess fluid moves into interstitial spaces, collects in peritoneum and produces ascites
Pitting oedema in legs
Left sided heart failure can cause
Right sided heart failure (common)
And vice versa
Patients usually have symptoms of both
Symptoms of right ventricle heart failure
Arterial remodelling
3 beats (new beat ) on auscultation
advanced heart failure symptoms
Decreased tissue perfusion resting sinus tachycardia
Cool,pale,cyanotic extremia
Ventricular stroke volume down
Diagnosis heart failure
ECG chest only
Arrhythmias
Natriuretic peptide level for heart failure
Heart failure > 400 pg/ml
Classification of heart failure
Clsss 1= symptoms of extreme extertion
Class2= moderate extertion
Class 3= mild extertion
Class 4= rest
Treatment for heart failure right side o and left side
Treated the same
Treatment for heart failure
Manage associated conditions (hypertension, diabetes , ischemic heart disease, rheumatic factor)
Lifestyle mods
Drugs for heart failure
Beta blocker + ace or angiotensin receptor blocker
Class 2 + diuretic
Class 3 + aldosterone antagonist + vasodilation
Class4+ digoxin
Drugs need to be administered how
Start at low dise then increased to max rolerable load
If ischemic then what therapy
Aspirin and statin need t Be added to therapy
automatic implantable cardioverter defibrillator applied when
Left ventricle ejection fraction below 35
Or
Recurrent ventricular tachycardia
Or
Malignant arrhythmias
When do you need cardiac desynchronisation therapy
When QRS over 120ms
If all other measures fail what do you do
Heart transplant
Left ventricle assist device
LVAD can be used to hold some till transplant or to cure others
Acute decomposed heart failure
Congestive heart failure progressively worsens
02 sat <90% = supplement 02
02< 80% =assisted ventilation
Heart failure affects kidney how
02 sats low
Can’t perfuse kidney so volume overload + pulmonary congestion
Treatment for volume overload + pulmonary congestion
IV loop diuretic
Who uses intravenous inotropic agents?
Name?
Low ejection fraction
Severe hypotension
End organ dysfunction
