What may cause heart failure?
- Coronary artery disease
- Valvular heart disease
- Arrhythmias
- Cardiomyopathies
Name some causes of cardiac myopathy
- Inherited - dilated cardiomayopathy
- Thyrotoxicosis
- Alcohol
- Drugs - chemo agents
- Pregnancy
- Pericardial effusions
Right heart failue will cause congestion ____________
Systemically
Left heart failure will cause congestion in the ________
Lungs
Pulmonary oedema will lead to what?
Orthopnoea
Paroxysmal dyspnoea
Chronic right heart failure may lead to what?
- Hepatomegaly
- Ascities
- GI distress
What is PND, and what causes it specifically?
Paroxysmal nocturnal dyspnoea
Left heart failure
Pulmonary oedema is associated with which type of sputum?
A cough with frothy sputum
What is orthopnoea and what sided heart failure is associated?
Breathlessness when lying flat
Left sided heart failure
Why does left sided heart failure often present with cyanosis?
Pulmonary oedema is often present which impairs gas exchange meaning oxygen cannot enter as easily into the bloodstream
Whta are signs of right sided heart failure?
- Elevated JVP
- 3rd heart sound - early systole caused by blood flowing quickly into a failing heart
- Murmur
- Peripheral oedema
- Hepatomegaly
- Ascities
- Tachycardia
In relation to the different times during a heart cycle that heart failure can manifest, what are the two heart failure classifications?
Systolic - the heart fails to pump sufficiently
Diatolic - the heart fails to relax sufficiently - often as a result of hypertension
What are the two types of chronic heart failure?
- Compensated - stable - patient appears well and in control
- Decompensated - unstable
Blood pressure is often very ____ in patients with decompensated heart failure
Low
What investigations should be taken for suspected heart failure?
- FBC
- U+Es
- LFTs
- Lipids
- Thyroid function
- BNP - B-natriuretic peptide (not in Tayside)
What causes B-natriuretic peptide to rise?
Can be released due to atrial stretch
It is not specific to heart failure
Yet is is high in heart failure, so a normal result will rule out heart failure
Which tests should be done for suspected heart failure?
- ABGs
- ECG
- CXR
- ECHO
- Troponin I - only when ACS is suspected
What can be seen on a CXR for heart failure?
- Cardiomegaly
- Alveolar oedema
- Prominent upper lobe vessels
- Kerley B lines
What is the gold standard investigation for heart failure?
ECHO
What is the first step in treating heart failure?
Treat cause
- Stop alcohol
- Control AF
- Valve replacement
- Reduce BP
- Revascularisation
How may you treat a patient to make them feel better during heart failure?
- Fluid balance
- Diuretics if overloaded and breathless (furosemide)
How can heart failure be treated pharmacologically to remove symptoms?
- ACEI (or ARB)
- Beta blocker
- Aldosterone antagonist
Which ACEI could be used to treat heart failure?
- Lisinopril
- Enalapril
ACEI have what side effects?
- Angioneurotic oedema (rapid swelling of the dermis, subcutaneous tissue, mucosa and submucosal tissues - similar to urticaria (hives))
- Dry cough
- Renal impairment
-
Physiology184
-
Atheroma25
-
Peripheral Vascular Disease21
-
Cardiomyopathy, Myocarditis and Pericarditis59
-
Anatomy - Cardiovascular Theory94
-
Hypertension31
-
Stroke12
-
Endocarditis49
-
Arrhythmias91
-
MI and Ischaemic Heart Disease74
-
Venous Thromboembolic Disease58
-
Valvular Heart Disease70
-
Cardiovascular Disease21
-
Cardiac Arrest15
-
Cardiovascular Drugs38
-
ECG16
-
Heart Failure37
-
Pharmacological Treatment of Cardiovascular Conditions62
-
Pharmacology 1 - Drugs Affecting Vasculature and Blood Pressure90
-
Pharmacology 2 - Drugs Modifying Cardiac Rate and Force100
-
Pharmacology 3 - Anti-Arrhythmic Drugs77
-
Pharmacology 4 - Lipid Metabolism and Cardiovascular Disease75
-
Pharmacology 5 - Anti-platelet, Anticoagulant and Thrombolytic Drugs96
-
Aneurysm0
