What is the definition of congestive heart failure?
The inability of the heart to meet metabolic demand and reduced CO
What symptoms characterise CHF?
Poor exercise tolerance, reduced CO, peripheral oedema, breathlessness
Why is the terminal decline after a period of stabilisation in CHF?
MI causes decline and LV remodelling and dysfunction, however increased peripheral vascular resistance stabilizes this - caused by neurohormonal stimulation
How does neurohormonal stimulation cause reduced heart function?
- It causes increased peripheral resistance which increases cardiac workload
- It directly causes myocyte cell death - adrenaline and neuradrenaline
Which neurohormonal concentrations are increased in CHF?
Neuradrenaline, vasopressin, renin, ANP, endothelin-1
What are the 4 chronic effects of increased neurohormonal stimulation?
- Increased afterload
- Reduced SV
- Myocyte apoptosis / necrosis
- Sodium retention
What are some of the aetiologies of CHF?
- MI
- Hypertension
- Idiopathic dilated cardiomyopathy
- Valvular disease
- Myocarditis
- Secondary cardiomyopathy (alcohol etc.)
What is myocarditis?
Inflammation of the heart muscle
What are the signs and symptoms of left sided HF?
- Dyspnoea
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Cough
- Chest crackles
- S3 and S4 sounds
What are the signs and symptoms of right sided HF?
- Oedema
- Elevated JVP
- Hepatomegaly
- Abdominal distension and loss of appetite
What are the 4 initial managements of acute heart failure?
- Sit patient up
- Give oxygen
- Check ECG rhythm
- IV loop diuretic
What are the 3 main neurohormonal pathways that impact heart function in CHF?
- Beta receptors
- Angiotensin II receptors
- Aldosterone receptors
What are ACE inhibitors?
They block the conversion of angiotensin 1 to angiotensin 2
- are used to treat hypertension and CHF
What are beta blockers?
Beta-adrenergic receptor blockers
- produce negative chronotropic and negative ionotropic effects
What are the 2 types of CHF?
- CHF with reduced EF
- Diastolic HF with preserved EF
- NOTE: there is no clear treatment for diastolic HF - just need to control fluid intake etc.
What percent of CHF patients die of sudden cardiac death?
30%
Why should chest X-rays be performed upright?
Supine increases venous return to the heart - increases heart size
Basilar infiltrates also exaggerated
How does AP orientation impact chest X-rays?
It enlarges the heart as the heart is more anterior
How many ribs does an inspiratory CXR usually show?
9 or 10 ribs
What is the usual cause of an enlarged heart on CXR?
Cardiomegaly (but sometimes pleural effusion or fat deposits)
What are the 3 stages of congestive heart failure seen on CXR?
- Redistribution - increased pulmonary markings, cardiomegaly, broad vascular pedicle
- Interstitial oedema - Kerley lines, hazy contour of vessels, thickened interlobular fissure
- Alveolar oedema - consolidation, air bronchogram, cotton wool appearance, pleural effusion
