Heart Failure

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  1. 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.
  2. Symptoms of heart failure include:
    • Pulmonary Congestion
    • Systemic Venous Congestion
    • Low Cardiac Output
  3. Sub-Symptoms of Pulmonary Congestion are:
    • SOBOE
    • Orthopnoea (SOB whilst lying flat)
    • Paroxysmal Nocturnal Dyspnoea
  4. Sub-Symptoms of Venous Congestion are:
    • Peripheral Oedema
    • Ascites
    • Abdominal pain (nerve compression)
  5. Sub-Symptoms of lowered CO are:
    • Decreased exercise tolerance/fatigue
    • Change in mental status/confusion
  6. What is NYHA class I heart failure?
    No symptoms with ordinary activity
  7. 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
  8. 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
  9. What is NYHA class IV heart failure?
    • Unable to carry out physical activity without discomfort
    • Symptoms of cardiac insufficiency may be pesent at rest
  10. 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
  11. What confirms diagnosis of HF?
    LV dysfunction
  12. What are the non-invasive investigations:
    • Chest X Ray
    • TTEcho
  13. What echo measurements can be performed for EF?
    • M mode assessment
    • Simpson's (volume)
  14. What are the restrictions with doing M Mode assessment?
    Cuts ventricle so is very specific point
  15. Other investigations for HF include:
    • ECG for electrical and rhythmic abnormalities
    • Blood Tests (BNP - raised in people with LV dysfunction)
  16. Other investigations for ischaemia:
    • ETT
    • Angiography
    • Myocardial Perfusion Scan
    • Cardiac MRI
  17. Other non cardiac investigations include:
    Lung Function
  18. Treatment depends on what?
    • Underlying cause
    • Severity
    • Prognosis
  19. What may cause Acute HF?
    • Cardiogenic Shock
    • Acute/Severe MI
    • MI Complications (e.g. rupture)
  20. 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
  21. Treatments for Chonic HF include:
    • Treat underlying cause
    • Health education
    • Optimise medical therapy
    • Device therapy

  22. Name a diuretic:
    • Bendroflumethiazide
    • Frusemide
  23. Functions of Diuretics:
    Counterbalance the negative feedback on renal system to promote water and sodium excretion
  24. Why must some diuretics be used in conjunction with ACE inhibitors?
    Diuretics may stimulate RAAS system, worsening HF
  25. Name an ACE inhibitor
  26. Functions of Enalapril
    Prevent angiotensin being converted and thus stopping the RAAS system from taking effect
  27. Name an aldestorone antagonist:
  28. How do they work?
    Used in conjuction with ACE and diuretic to treat severe HF
  29. Why does digoxin cause stronger contractions and why is this beneficial to the heart
    Positive inotrope and helps increase CO
  30. How does digoxin help in heart failure?
    Decreases conc of noradrenaline and suppresses renin release
  31. What elements can cause ventriculay dysynchrony?
    • Electrical - LBBB and RBBB
    • Structural - myocardial collagen impairing electrical signalling
    • Mechanical - Regional wall motion abnormalities
  32. How can synchrony be established?
    • CRT - Cardio Resynchronisation therapy
    • Using an ICD, leads are placed into both L and R ventricles for synchronised pacing
Card Set:
Heart Failure
2012-05-16 16:32:49
heart failure

Heart Failure
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