Card Set Information
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.
Symptoms of heart failure include:
Systemic Venous Congestion
Low Cardiac Output
Sub-Symptoms of Pulmonary Congestion are:
Orthopnoea (SOB whilst lying flat)
Paroxysmal Nocturnal Dyspnoea
Sub-Symptoms of Venous Congestion are:
Abdominal pain (nerve compression)
Sub-Symptoms of lowered CO are:
Decreased exercise tolerance/fatigue
Change in mental status/confusion
What is NYHA class I heart failure?
No symptoms with ordinary activity
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
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
What is NYHA class IV heart failure?
Unable to carry out physical activity without discomfort
may be pesent at rest
Name some causes of heart failure:
Papillary muscle rupture (acture MR)
Cardiomyopathy e.g. HCM
What confirms diagnosis of HF?
What are the non-invasive investigations:
Chest X Ray
What echo measurements can be performed for EF?
M mode assessment
What are the restrictions with doing M Mode assessment?
Cuts ventricle so is very specific point
Other investigations for HF include:
ECG for electrical and rhythmic abnormalities
Blood Tests (BNP - raised in people with LV dysfunction)
Other investigations for ischaemia:
Myocardial Perfusion Scan
Other non cardiac investigations include:
Treatment depends on what?
What may cause Acute HF?
MI Complications (e.g. rupture)
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
Treatments for Chonic HF include:
Treat underlying cause
Optimise medical therapy
Name a diuretic:
Functions of Diuretics:
Counterbalance the negative feedback on renal system to promote water and sodium excretion
Why must some diuretics be used in conjunction with ACE inhibitors?
Diuretics may stimulate RAAS system, worsening HF
Name an ACE inhibitor
Functions of Enalapril
Prevent angiotensin being converted and thus stopping the RAAS system from taking effect
Name an aldestorone antagonist:
How do they work?
Used in conjuction with ACE and diuretic to treat severe HF
Why does digoxin cause stronger contractions and why is this beneficial to the heart
Positive inotrope and helps increase CO
How does digoxin help in heart failure?
Decreases conc of noradrenaline and suppresses renin release
What elements can cause ventriculay dysynchrony?
Electrical - LBBB and RBBB
Structural - myocardial collagen impairing electrical signalling
Mechanical - Regional wall motion abnormalities
How can synchrony be established?
CRT - Cardio Resynchronisation therapy
Using an ICD, leads are placed into both L and R ventricles for synchronised pacing