Heart Failure

Question 1

Common Causes of Heart Failure

Answer 1

Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Idiopathic
Lifestyle
Chronic alcohol use
Medications
Viral inflammation
Uncontrolled hypertension
MI
Genetics

Question 2

Symptoms of Heart Failure

Answer 2

SOB
Increased RR
Coughing
Crackles
Hypoxia
Fatigue
Intolerance to exercise
Oedema

Question 3

Pathophysiology of Left Sided Heart Failure

Answer 3

Right side loses ability to efficiently move oxygen-depleted blood to the lungs, often caused by left sided heart failure

Increased backflow into pulmonary vessels = increased pulmonary pressure = harder to pump = right sided hypertrophy = death of myocardium = failure

Question 4

What causes oedema

Answer 4

increased pressure = extra fluid forced out of vessels = pools

decreased blood flow to kidneys = fluid retention and sodium retention = increased fluid = further swelling/oedema

Question 5

Pathophysiology of Left Sided Heart Failure

Answer 5

loses ability to efficiently pump oxygenated blood through the body

systolic dysfunction due to damage to myocardium

backflow = increased pulmonary pressure = capillary leak = pulmonary oedema = reduced gas exchange

Question 6

Symptoms of left sided heart failure

Answer 6

Dyspnoea
Orthopnoea
Crackles
Tachycardia
Confusion
Fatigue
Cyanosis
Pulmonary congestion

Question 7

Symptoms of right sided heart failure

Answer 7

Fatigue
Ascites
Hepatosplenomegaly
JVD
Peripheral oedema
Weight gain or anorexia

Question 8

How do the following contribute to heart failure:
Hypertension
Ischaemic Heart Disease
Damaged Myocardium
Infarct Muscle Tissue

Answer 8

Hypertension: greater arterial pressure = hypertrophy = myocardium needs more oxygen

Ischaemic Heart Disease: plaque in coronary arteries

Damaged Myocardium: less contractility = lower stroke volume = lower cardiac output

Infarct Muscle Tissue: tissue fibroused/toughened = reduced contractility = increased resistance

Question 8

Treatment of heart failure pre-hospitally

Answer 8

GTN (Systolic needs to be above 110) = decreased systemic resistance and pulmonary presssure

Furosemide = decreased sodium and water reabsorption = lower preload

Oxygen = increased gas exchange

Question 9

Define the Following:
Pre-load
After-load
Contractability

Answer 9

Pre-load: volume of blood left in the ventricles after diastole

After-load: resistance the ventricles must overcome to expel blood

Contractability: ability of muscles to contract

Question 10

Pathophysiology of cardiogenic pulmonary oedema

Answer 10

left ventricle failing = blood backs up into lungs = increases in pressure in the blood vessels of the lungs = fluid into alveoli

Question 11

Diastolic Heart Failure

Answer 11

abnormal filling of ventricles = reduced preload

Frank Starling Mechanism Affected: stroke volume of the heart increases in response to an increase in blood volume in the ventricles

Question 12

Ejection Fractions

Answer 12

below 40% = heart failure
40-50% = borderline systolic heart failure
50-70% = normal

Question 13

Key Points about LVADs

Answer 13

Need constant energy supply
Whirrs
No palpable pulse
Look for other signs of life
oxygen sats may not read
BP difficult
After transplant: atropine contraindicated (vagus nerve severed)