M+T of CHF
What class of drugs reduces mortality in CHF by blocking the effects of adrenaline on the heart?
Beta blockers - reduce cardiac excitability and heart rate
What is the definitive treatment for severe symptomatic aortic stenosis?
Valve replacement - SAVR = surgical aortic valve replacement, an open-heart surgery, TAVR = transcatheter aortic valve replacement, less invasive procedure, uses a catheter to deliver and implant a new valve - used in >80yo as high surgical risk
What is the leading cause of congestive heart failure worldwide?
Ischaemic heart disease
Which cardiovascular risk factors accelerate calcific AS progression?
Hyperlipidaemia, hypertension, obesity - promote endothelial injury and calcific deposition
What percentage of Australians over 75 have moderate–severe aortic stenosis?
3-4%
It increases sharply with age
Which type of medication reduces afterload and is considered first line therapy in heart failure with reduced ejection fraction.
ACE inhibitors, they block renin-angiotensin system, lowering afterload and improving survival.
What type of murmur is characteristic of aortic stenosis?
crescendo–decrescendo - as blood is ejected from the left ventricle through the narrowed aortic valve, sound intensifies, peaking near mid-systole, and then fades as ejection slows
Name two lifestyle risk factors that contributes to CHF
Obesity, smoking, physical inactivity, high salt intake - increase cardiac workload and blood pressure
Which diseases accelerate aortic valve calcification?
Chronic kidney disease, diabetes mellitus, rheumatoid arthritis
Approximately how many Australians live with chronic heart failure?
Over 480,000 - Aging population! Proportion of elderly people up, proportion younger people down. Long term condition where heart muscle is too weak or stiff to pump blood to meet the body's needs. Not a sudden arrest but a gradual decline in heart function.
What device may be implanted to prevent sudden cardiac death in severe heart failure?
Implantable cardioverter-defibrillator (ICD), it detects and corrects life-threatening arrhythmias by delivering a shock to restore rhythm
Why are nitrates and ACE inhibitors used cautiously in severe AS?
They can cause hypotension due to fixed cardiac output
How does long-term hypertension lead to CHF?
Causes LV hypertrophy, so diastolic dysfunction leading to eventual systolic failure
What is the most common cause of AS in the elderly?
Degenerative (calcific) aortic stenosis - age related calcium buildup stiffens the valves, and that narrows them
CHF accounts for roughly what proportion of hospital admissions in Australia?
Around 2%.
Name two non-pharmacological lifestyle changes recommended for CHF patients
Salt restriction, fluid restriction, exercise as tolerated, weight monitoring - lowers volume overload, exercise maintains cardiac function/fitness
What pre-operative test/examination assesses aortic valve area and gradient?
echocardiogram
What heart valve disease can lead to congestive heart failure?
Aortic stenosis - Narrowed aortic valve makes it harder for the left ventricle to pump blood. Increasing pressure and workload causing left ventricular hypertrophy and heart failure.
What congenital condition predisposes to early AS?
Bicuspid aortic valve
What is the 5-year mortality rate after CHF diagnosis?
Around 50%. Even with treatment, CHF is a progressive condition with bad long-term prognosis.