Introduction to case Flashcards
what is heart failure
the inability of the heart to meet the circulatory demands of the body or the ability to do so only at abnormally high cardiac filling pressures
what are the causes of heart failure
- ischaemic heart disease
- previous N/STEMI is most common cause in UK - hypertension- 1/3 of cases
- valve disease
- diabetes
- cardiomyopathies
- alcohol, drugs, pregnancy
- arrhythmias
- right sided failure: chronic pulmonary problems
give examples of cardiomyopathies
- hypertrophic obstructive cardiomyopathy
- dilated cardiopathy
- arrhythmogenic right ventricular cardiomyopathy
- restrictive cardiomyopathy
give examples of valve disease
aortic stenosis, mitral regurgitation
what is ejection fraction
amount of blood pumped out of ventricle/ total amount of blood in ventricle
what is left ventricular systolic dysfunction
- impaired LV contraction
- associated with a reduced ejection fraction
what is the most common cause of heart failure
LVSD
- also called heart failure with reduced ejection fraction
what is heart failure with preserved ejection fraction
- impaired LV relaxation (diastolic)
- preserved ejection fraction
- common in hypertension particularly in elderly
describe what happens to the ventricles in systolic dysfunction
- the enlarged ventricles fill with blood
- the ventricles pump out less than 40-50% of blood
describe what happens to the ventricles in diastolic dysfunction
- the stiff ventricles fill with less blood than normal
- the ventricles pump out about 60% of blood, but amount may be lower than normal
what are the precipitants of heart failure
- non compliance
- medication
- fluid intake - infection- chest infection increases heart rate and demand on heart
- arrhythmias
- tachyarrhythmias- loss of atrial component to cardiac output
- bradyarrhythmias- rate too slow to provide enough cardiac output - XS etoh/fluid- fluid/cardiomyopathy
- anaemia
- check thyroid and renal function
what are the signs of heart failure
- hypotension
- cold peripheries
- raised JVP
- 3rd heart sound
- lung crackles/wheeze
- fluid retention
what are the symptoms of heart failure
- SOB
- swelling of feet and legs
- chronic lack of energy
- difficulty sleeping at night due to breathing problems
- swollen or tender abdomen with loss of appetite
- cough
- increased urination at night
- confusion or impaired memory
describe the prevalence of heart failure
prevalence increasing in ageing population
- more patients surviving N/STEMI but left with LVF
- incidence increasing by 10%/year
- median age presentation is 76
- 2:1 male to female ratio
describe the prognosis of heart failure
- poor survival rates
- 30-40% patients diagnosed die within 1 year
- difficult to define prognosis due to high risk of sudden cardiac death
