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28 Cards in this Set
- Front
- Back
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Cardiac failure definition |
Abnormality of cardiac structure or function leading to failure of the heart’s function - can not maintain effective cardiac output and cannot meet demands of metabolizing tissue (OR CAN ONLY MEET REQUIREMENTS IF INCREASED FILLING PRESSURE) |
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Cardiac failure as a clinical syndrome pathophysiology |
Primary cardiac defect + Compensatory mechanisms |
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Clinical syndrome of CF |
Congestion (d/t failure) Inadequate perfusion (not meeting met demands) |
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Acute vs chronic CF |
Acute - pulm oedema and cardiogenic shock d/t MI Chronic - dilated cardiomyopathy, exertions dyspnoea and oedema (subclinical), valvular disease |
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Left vs right heart failure |
Left Pulmonary oedema PHTN: Orthopnea Dyspnoea PND S3 Bi-basal crackles
Right Peripheral oedema (venous congestion) - cor pulmonale Hepatomegaly Ascites Pleural effusion Elevated JVP
Bi ventricular HF = congestive HF |
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Overt vs subclinical HF |
Overt - signs and symptoms detectable, poor prognosis
Subclinical - at time of MI annoy see HF but over 6 months heart remodels as HF develops, management before it becomes overt |
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How can a heart struggling to perform its functions adapt to maintain SV? |
⬆️ contractility ⬆️ preload ⬇️ afterload
If dilate ventricle (⬆️ CO) - risk of congestive symptoms If prevent dilation (⬇️ CO) - risk of poor perfusion |
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Forward vs backward HF |
Forward - LHF causing brain and kidney impairment
Backward - LHF causing pulmonary oedema - RHF causing peripheral oedema and ascites |
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Systolic HF-REF vs diastolic HF-PEF |
Diastolic - inability to fill ventricle in diastole, ejection fraction preserved, pulm hypertension |
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CF in elderly |
Underdiagn: anorexia, depression and delirium
Overdiag: dyspnoea, oedema and crepitations
Causes - CAD, HT, AS, AF |
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CF in lung disease pt |
Dyspnoea “Orthopnea” Cyanosis Crepitations Pleural effusion
BUT HF causes ⬆️ BNP (only test in medical emergency) |
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CF aetiology |
HTN IHD Dilated cardiomyopathy Cor pulmonale RHD Valve lesions Cong heart diseases Myocarditis |
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Precipitants of HF |
Make more susceptible
Arrhythmia Anaemia Fever UTI Resp inf PE Renal failure Pregnancy |
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Hallmark symptom and rating of HF |
Dyspnoea (when exercise/fatigued at rest) (Orthopnea and PND - relief when sitting up points to cardiac and not resp pathology) NYHA - I -> IV |
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Symptoms of systolic HF |
Raised JVP Cardiomegaly |
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Congestion symptoms |
Oedema Ascites (abd discomfort) Liver discomfort (hepatomegaly - liver capsule has pain fibers) |
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Signs of HF in examination |
Oedema (sacral and ankle) Cardiac cachexia Peripheral cyanosis Jaundice Fever |
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Approach to CF |
FCP F failure C cause P precipitants |
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How to treat HF |
Treat cause! |
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If CV is primary aetiology |
Increased JVP Cardiomegaly |
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Causes of HF that don’t show cardiomegaly |
Acute HF (recent infarct) Restrictive cardiomyopathy Constrictive pericarditis MS HF-PEF |
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Signs of HF |
S3 Pulses alternans (very severe HF) Abnormal valsalva response |
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Dyspnoea differentiation |
Cardiac - will also have nocturnal dyspnoea, relieved by sitting up
Resp - relived by coughing (cough up phlegm obstructing vessels)
Check BNP if increase - cardiac Check ECG for LA enlargement Check therapeutic response - cardiac dyspnoea will improve with diuretics
More difficult to diagnose in elderly, COPD pts and obese pts |
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CXR signs |
Cardiac enlargement ⬆️ perfusion to upper lobes Interstitial oedema (Kerley B lines) - PND, pulm HTN (eg. MS) Alveolar oedema (pulm oedema) |
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ECG signs |
Helps ID underlying cause (doesn’t give diagnostic) Importance in excluding CF - not likely to be CF if ECG normal (esp in acute setting) Reveals underlying precipitants - AF, bradycardia Can impact tx - ECG if LBBB |
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Echo signs |
Shows ejection fraction Can see LA enlargement (distinguish between pulmonary and cardiac disease) |
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Brain natriuretic peptides (BNP) signs |
To Dx or eliminate CF If BNP high - can suspect CF Can be used to monitor efficacy of tax or to determine Px |
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Blood test signs |
Hb - anaemia is bad prognostic sign (anaemia causes ⬆️ output) U&E (renal failure - possible precipitant) Trop I or T Thyrotoxicosis |
