Causes
what are the 3 main causes of heart failure?
ischaemic heart disease (35-40%)
cardiomyopathy (dilated) (30-34%)
hypertension (15-20%)
what is orthopnoea?
is shortness of breath (dyspnea) that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.
what adjustments could a HF patient make to improve their prognosis?
improve diet, exercise more, quit smoking, reduce alcohol intake, restrict fluid intake
Where is BNP released from and why?
released from ventricles in response to increased myocardial wall stress
(NT-proBNP is an inactive protein that is cleaved to release BNP, both are increased in HF patients, and levels correlate with severity)
How many people worldwide have HF?
how does ischaemic heart disease cause Heart failure?
caused by coronary artery artherosclerosis -> damage to myocardium —> scar tissue —> reduces contractility
what is anasarca?
is general swelling of the whole body that can occur when the tissues of the body retain too much fluid. The condition is also known as extreme generalized edema.
What are the non-pharmacological interventions for HF?
revascularisation, cardiac resynchronisation therapy, implantable cardioverter- defibrillator, cardiac transplantation
What is ejection fraction? and what % is the normal range and when is the cut off for HF?
50-70% is normal
<40% is HF
What is the incidence of HF in Scotland?
7.1/1000
How does hypertension cause heart failure?
harder for heart to pump —> hypertrophy (increased demand for Oxygen and squeezes coronaries —> weak contraction —> systolic HF
Give 4 symptoms of heart failure
extertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea (PND), fatigue
what classes of drugs are given to patients with heart failure and why?
ACEi to dilate the blood vessels, diuretics to reduce the fluid build up, beta blockers to reduce CO (started at low does and titrated up) , ARBs, aldosterone antagonists
what specific cells are present in the alveoli of patients with heart failure or pulmonary oedema?
Heart Failure cells: hemosiderin-containing macrophages
What is the cost of managing HF in the UK?
exceeds £1billion/year
What are the other less common causes of Heart failure?
cardiomyopathy (undilated), valvular heart disease, congenital heart disease (ASD, VSD) hyperdynamic circulation (anaemia, throtoxicosis, Paget's disease), right sided Hear failure, alcohol and drugs (imatinib, trastuzumab), arrthymias (AF, bradycardia), infections (Chaga's disease), pericardial disease
what are the signs of heart failure?
tachycardia, elevated JVP, cardiomegaly, 3rd and 4th heart sounds, bibasal crackles, pleural effusion, ankle oedema, tender hepatomegaly, ascites
What is class IV in the New York Heart Association (NYHA) classification?
symptoms of heart failure occur at rest and are exacerbated by any physical activity
(class I: No limitation. Normal physical exercise does not cause dyspnoea, palpitations or fatigue
class II: mild limitation. comfortable at rest but normal physical activity produces fatigue, dyspnoea or palpitations
Class III: marked limitation. comfortable at rest but gentle physical activity produces marked symptoms of heart failure)
what are some pathophysiological changes in heart failure
What is the most common cause of heart failure in Western countries?
coronary artery disease
What is the Frank-Starling mechanism? Draw it on the board
The law states that the stroke volume of the heart increases in response to an increase in the volume of blood in the ventricles, before contraction (the end diastolic volume), when all other factors remain constant.
As a larger volume of blood flows into the ventricle, the blood stretches the cardiac muscle fibers, leading to an increase in the force of contraction.
Define heart failure (according the European society of cardiology)
What tests can be done to diagnose HF?
blood tests (FBC, urea and electrolytes, LFTs, cardiac enzymes in acute HF, BNP/NT-proBNP and thyroid function)
CXR
ECG
Echocardiography
stress echocardiography
nuclear cardiology
Cardiac MRI
cardiac catheterisation
carhadc biopsy: diagnosing cardiomyopathies
cardiopulmonary exercise testing
ambulatory 24hour ECG monitoring
what would a CXR look like a patient with heart failure?
Kerley- B lines ( are seen as peripheral short 1-2 cm horizontal lines near the costophrenic angles.These lines run perpendicular to the pleura.)
blunt costophrenic angles, opacification radiating from the hila. prominent horizontal fissure due to fluid collection, cardiomegaly
What is the incidence of HF in the UK?
2/1000