Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CVS Pathology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Definition of heart failure

A

A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction, either at rest or on exertion, with accompanying neurohormonal activation

A state in which the heart is unable to pump blood at a rate commensurate with the requirements of the tissues or can only do so from high pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does HF stand for?

A

Heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of HF

A

Heart failure due to LVSD due to IHD

Heart failure due to severe aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does LVSD stand for?

A

Left ventricular systolic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Examples of myocardial injury in the pathology of HF

A 
Coronary artery disease
HTN
DM
Cardiomyopathy 
Valvular disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does myocardial injury lead to?

A

Neurohormonal stimulation

Myocardial toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is involved in ventricular remodelling?

A

Fibrosis and scarring and myocytes healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pathology of systolic dysfunction

A

If failing or damaged heart - as circulatory volume increases, the heart dilates, the force of contraction weakens and CO drops further.
Decreased CO then activates RAAS further (which increases salt and water retention)
This is then viscous cycle of RAAS activation, circulatory volume increases and cardiac performance deteriorates further.
As heart starts to dilate, the cardiac myocytes undergo hypertrophy and then fibrosis and thus the heart is further weakened

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When does HF usually occur?

A

Following sustained HTN (diastolic dysfunction/preserved ejection fraction HF)
Following myocardial damage i.e. an MI (i.e. systolic dysfunction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What happens when CO falls?

A

Body registers this as loss in circulatory volume - vasoconstrictor system activation (sympathetic systems)
Salt and water retaining system (RAAS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does RAAS stand for?

A

Renin Angiotensin Aldosterone system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does RAAS cause the release of?

A

Angiotensin II

Aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does RAAS result in?

A

Salt and water retention
Vasoconstriction
Hypertrophy and fibrosis of cardiac myocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does activation of the sympathetic system cause activation of?

A

Noradrenaline

Adrenaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does the release of noradrenaline and adrenaline result in?

A

Vasoconstriction
Stimulates renin release which feeds into RAAS system
Myocyte hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causes salt and water excretion and vasodilation?

A

Natriuretic peptide system ANP/BNP (weaker than RAAS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do ANP and BNP stand for?

A

Atrial natriuretic peptide

Brain natriuretic peptide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do ANP and BNP do?

A

Potent vasodilators and natriuretic peptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Does the body have a weak or strong system to excrete and retain salt and water?

A

Retain - very strong

Excrete - weak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Risk factors for HF

A 
Age
HTN (LVH)
Chronic heart disease
Obesity
DM
Hyperlipidaemia
Coronary artery disease
Valvular heart disease
Alcoholism 
Infection (viral)
Congenital heart defects
Smoking
High or low haematocrit level 
OSA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does OSA stand for?

A

Obstructive sleep apnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the number 1 risk factor for heart failure?

A

HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If sufficiently severe, almost any structural cardiac abnormality will cause HF; e.g.

A

LVSD
Valvular heart disease
Pericardial constriction or effusion
LV diastolic dysfunction/HF with preserved systolic dysfunction/HF with normal ejection fraction
Cardiac arrythmias; tachy or brady
Myocardial ischaemia/infarction (usually with LVSD)
Restrictive cardiomyopathy e.g. amyloid
Right ventricular failure; primary or secondary to pulmonary HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Causes of LVSD

A

Ischaemic heart disease (usually MI)
Dilated cardiomyopathy (DCM)
Severe aortic valve disease or mitral regurg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Explain DCM further
An umbrella term - means LVSD not due to IHD or secondary to another lesion i.e. valves/VSD
26
Causes of DCM
Inherited Toxins e.g. alcohol, catecholamines (pheochromocytoma or stress cardiomyopathy) Viral; acute myocarditis or chronic DCM HIV, Lyme's disease, Chagas disease Sarcoidosis, hemochromatosis, SLE, mitochondrial disease Muscular dystrophies Peri partum cardiomyopathy HTN Isolated non compaction Tachycardia related cardiomyopathy Right ventricular pacing induced cardiomyopathy End stage hypertrophic cardiomyopathy End stage arrhythmogenicity RV cardiomyopathy
27
How does HF affect neurohormonal factors?
``` RAAS - salt and water retention - adverse haemodynamics - LV hypertrophy / remodelling and fibrosis - hypokalaemia and hypomagnesia SNS - arrhythmogenic - adverse haemodynamics - increases renin etc ```
28
Overall effects of neurohormonal activation
Vasoconstriction Endothelial dysfunction Renal sodium retention
29
Mean age for HF
74 y/o
30
What is a potent predictor of death in HF?
Left ventricular systolic dysfunction
31
Presentation of HF
``` Breathlessness Fatigue Oedema Reduced exercise capacity Tachycardia Raised JVP Chest crepitations or effusions 3rd heart sound Displaced or abnormal apex beat ```
32
What classification is used for HF?
New York Association (NYHA) classification
33
What does NYHA look at in HF?
Exercise tolerance | Symptoms
34
NYHA class I
No limitation of exercise, no symptoms during usual activity
35
NYHA class II
Mild limitation of exercise, Comfortable with rest or symptoms with mild exertion
36
NYHA Class III
Moderate limitation, comfortable only at rest
37
NYHA Class IV
Severe limitation, any physical activity brings on discomfort and symptoms occur at rest
38
Investigations for LVSD
``` Antibodies / viral serology Ferritin FBC RFTs, TFTs Consider causes and exclude them ECG CXR ECHO Coronary angiography Cardiac MRI ```
39
What would a cardiac MRI show?
Infarction Inflammation Fibrosis
40
What is needed to diagnose HF?
Symptoms and signs of HF (rest or exercise) AND Objective evidence of cardiac dysfunction AND Response to therapy i.e. diuretics (in doubtful cases)
41
What are ways of obtaining objective evidence of cardiac dysfunction?
ECHO Radionucleotide ventriculography (RNVG/MUGA) MRI Left ventriculography
42
Potential screening tests for HF
ECG | BNP
43
BNP in HF
Elevated in heart failure
44
What does BNP stand for?
Brain (b-type) natriuretic peptide
45
What is BNP and where is it found?
Amino acid peptide | Blood
46
Low BNP does what?
Excludes HF
47
Is BNP produced in a healthy heart?
Yes at low levels | When the heart is stressed it produces more
48
How long is BNP stable for?
Up to 72 hours
49
What can BNP predict in HF?
Mortality | Morbidity
50
What can ECHO identify?
``` LVSD Valvular dysfunction Pericardial effusion/tamponade Diastolic dysfunction LVH Atrial/ventricular shunts/complex congenital heart defects Pulmonary HTN/ Right heart dysfunction Atrial dilatation ```
51
What may ECHO not identify?
Constriction | Shunts
52
Different stages of LV ejection fraction dysfunction
Normal 50-80% Mild 40-50% Moderate 30-40% Severe <30%
53
Treatment of HF (due to LVSD)
Diuretics ACEIs or ARBs BBs Aldosterone receptor blockers
54
What characterises HF?
``` Progressive cardiac dysfunction SOB Tiredness Neurohormonal disturbances Sudden death ```
55
Types of HF
Systolic HF Diastolic (or relaxation) HF Chronic HF
56
What happens in systolic HF?
Heart failure reduced ejection fraction (HFrEF) | Decreased pumping function of the heart, which results in fluid back up in the lungs and HF
57
What happens in diastolic HF?
Involves a thickened and stiff heart muscle As a result, the heart does not fill with blood properly This results in fluid back up in the lungs and HF
58
What % of the population has chronic HF?
2 - 10%
59
Prognosis of chronic HF
5 year mortality 50% - poor
60
Which gender has more HF?
Males
61
Aims of treatment of HF and how they do so
``` To improve symptoms - Diuretics - digoxin To improve symptoms and survival - ACEIs/ARBs - spironolactone - valsartan-sacubitril To improve survival - BBs - Ivabradine ```
62
What does spironolactone do?
Special type of diuretic which antagonises aldosterone
63
What is the mainstay of symptomatic treatment for HF?
Loop diuretics - furosemide or - bumetanide
64
What are used to block the detrimental hormone changes in HF?
Carvedilol, bisoprolol, metoprolol | Beta blockers
65
What does angiotensin II do?
Potent vasoconstrictor - salt and water retention
66
What drugs block the effects of angiotensin II?
ACEIs | Angiotensin antagonists
67
Example of an ACEI
Ramipril
68
Example of angiotensin antagonists
Valsartan, losartan
69
What drug blocks effects of aldosterone?
Spironolactone
70
What drugs can enhance cardiac function?
Positive inotropes | Vasodilators
71
Example of a positive inotrope
Digoxin
72
How do positive inotropes work?
Improve the ability of the heart to pump and so can improve cardiac status
73
How do vasodilators work?
Reduce preload and improve after load which improves cardiac function
74
Examples of vasodilators
Isosorbide mono or dinitrate
75
How do loop diuretics work?
Remove excess salt and water Induce profound diuresis Inhibit Na-K-Cl transporter in the ascending loop of henle
76
If the patient is diuretic resistant, what can it be used in combination with?
Thiazide diuretics
77
S/Es of thiazide diuretics
``` Dehydration Hypotension Hypokalaemia Hyponatraemia Gout Impaired glucose tolerance, DM ```
78
What drugs interact with furosemide
``` Aminoglycosides (aural and renal toxicity) Lithium (renal toxicity) NSAIDs (renal toxicity) Anti-HTNs (profound HTN) Vancomycin (renal toxicity) ```
79
What drugs reduce mortality in HF?
Angiotensin blockage Beta receptor blockade Aldosterone blockade ANP/BNP enhancement
80
S/Es of ACEIs
``` First dose hypotension COUGH Angioedema Renal impairment Renal failure Hyperkalaemia ```
81
What drugs do ACEIs interact with?
NSAIDs (acute renal failure) | Potassium supplements and potassium sparing diruetics (hyperkalaemia)
82
What is spironolactone?
Potassium sparing diuretic
83
How does spironolactone work?
Inhibits actions of aldosterone Acts in distal tubule Used in combination with loop diuretics
84
When is spironolactone particularly useful?
Resistant oedema
85
What is ivabradine?
Specific inhibitor of the If current in the sinoatrial node
86
How does digoxin work?
Increases availability of calcium in the myocyte
87
S/Es of digoxin
Narrow therapeutic index - digoxin toxicity Arrhythmias Nausea Confusion
88
In UK, digoxin is only used if the patient has what?
AF
89
What do beta blockers block the action of?
Sympathetic system
90
Therapeutic regime summary for HF
1. furosemide (and possibly thiazide) 2. furosemide (and possibly pulsed metolazone) 3. ACEI 4. ARBs 5. ARNI 6. BBs 7. MRA-spironolactone 8. Digoxin 9. Warfarin
91
What should be monitored regularly in HF?
Weight
92
What is the possible feature to be heard on auscultation of the chest in left sided HF?
Third heart sound
93
What may be a S/E of loop diuretics?
Ototoxicity
94
NICE guidelines for the management of HF due to LVSD
1. ACEI + BB 2. If symptoms persist consider - ARB - Aldosterone antagonist - Hydralazine and nitrate 3. If symptoms persist consider - Cardiac resynchronisation therapy - Digoxin
95
What should all patients with HF be taking?
ACEI + BB
96
Name a drug contraindicated in HF
Verapamil
97
What can verapamil not be taken with and why?
BB | Risk of complete heart block
98
1st line treatment of a patient with HF with reduced LVEF
BB AND ACEI
99
Signs of left sided HF
``` SOB on exertion Orthopnoea Paroxysmal nocturnal dyspnoea Wheeze Cough ```
100
Signs of right sided HF
Raised JVP Ankle oedema Hepatomegaly

CVS Pathology (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions