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Westy50
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What is the definition of heart failure?
A clinical syndrome, based on abnormal structure or function of the heart, resulting in SOB, fluid retention and fatigue due a decreased CO.
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Symptoms of heart failure include:
- Pulmonary Congestion
- Systemic Venous Congestion
- Low Cardiac Output
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Sub-Symptoms of Pulmonary Congestion are:
- SOBOE
- Orthopnoea (SOB whilst lying flat)
- Paroxysmal Nocturnal Dyspnoea
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Sub-Symptoms of Venous Congestion are:
- Peripheral Oedema
- Ascites
- Abdominal pain (nerve compression)
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Sub-Symptoms of lowered CO are:
- Decreased exercise tolerance/fatigue
- Change in mental status/confusion
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What is NYHA class I heart failure?
No symptoms with ordinary activity
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What is NYHA class II heart failure?
- Slight limitation of physical activity
- Comfortable at rest
- Normal physical activity results in fatigue, palps, angina or SOB
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What is NYHA class III heart failure?
- Marked limitation of physical activity
- Comfortable at rest
- Less than ordinary physical activity results in palps, angina, SOB and fatigue
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What is NYHA class IV heart failure?
- Unable to carry out physical activity without discomfort
- Symptoms of cardiac insufficiency may be pesent at rest
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Name some causes of heart failure:
- CAD
- Acute MI
- Papillary muscle rupture (acture MR)
- Severe Hypertension
- Genetic
- Cardiomyopathy e.g. HCM
- Wall rupture
- Cardiogenic Shock
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What confirms diagnosis of HF?
LV dysfunction
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What are the non-invasive investigations:
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What echo measurements can be performed for EF?
- M mode assessment
- Simpson's (volume)
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What are the restrictions with doing M Mode assessment?
Cuts ventricle so is very specific point
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Other investigations for HF include:
- ECG for electrical and rhythmic abnormalities
- Blood Tests (BNP - raised in people with LV dysfunction)
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Other investigations for ischaemia:
- ETT
- Angiography
- Myocardial Perfusion Scan
- Cardiac MRI
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Other non cardiac investigations include:
Lung Function
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Treatment depends on what?
- Underlying cause
- Severity
- Prognosis
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What may cause Acute HF?
- Cardiogenic Shock
- Acute/Severe MI
- MI Complications (e.g. rupture)
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Treatements for acute HF include:
- Early PCI for MI
- Surgery to correct rupture
- Increase BP (Vasopressors i.e Dopamine)
- Inotropic Support (Improve LV contraction i.e. Dobutamine)
- Intra-Aortic Balloon pump - Reduces Systolic afterload and augments diastolic perfusion pressure
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Treatments for Chonic HF include:
- Treat underlying cause
- Health education
- Optimise medical therapy
- Device therapy
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Name a diuretic:
- Bendroflumethiazide
- Frusemide
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Functions of Diuretics:
Counterbalance the negative feedback on renal system to promote water and sodium excretion
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Why must some diuretics be used in conjunction with ACE inhibitors?
Diuretics may stimulate RAAS system, worsening HF
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Name an ACE inhibitor
Enalapril
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Functions of Enalapril
Prevent angiotensin being converted and thus stopping the RAAS system from taking effect
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Name an aldestorone antagonist:
Spironolactone
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How do they work?
Used in conjuction with ACE and diuretic to treat severe HF
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Why does digoxin cause stronger contractions and why is this beneficial to the heart
Positive inotrope and helps increase CO
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How does digoxin help in heart failure?
Decreases conc of noradrenaline and suppresses renin release
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What elements can cause ventriculay dysynchrony?
- Electrical - LBBB and RBBB
- Structural - myocardial collagen impairing electrical signalling
- Mechanical - Regional wall motion abnormalities
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How can synchrony be established?
- CRT - Cardio Resynchronisation therapy
- Using an ICD, leads are placed into both L and R ventricles for synchronised pacing
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