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WEEK 20:
Cardiac Failure
| Question | Answer |
|---|---|
| define heart failure | heart fails when it is unable to eject blood delivered to it by the venous system |
| most common type of heart failure | left sided heart failure (LHF) |
| types of heart failure | LHF, RHF, biventricular heart failure (LHF & RHF), and high output heart failure |
| systolic heart failure | low ejection fraction (EF <40%/50%) where EF equals the stroke volume divided by the left ventricular end diastolic volume (LVEDV) and normal range is 55%- 80% |
| end systolic volume (ESV) value | 50mL |
| how to find stroke volume (SV) | ESV - EDV |
| what is stroke volume | amount of blood transferred to arterial system during systole (>60mL in a healthy person) |
| how to get ejection fraction (EF) | SV / EDV (around 55%-75%) |
| what is EF | important measure of cardiac efficiency and health used to clinically assess cardiac status in patients with heart failure |
| diastolic heart failure (DHF) | normal EF (>60%) at rest with usually an S4 atrial gallop due to increased resistance to filling in late diastole |
| difference between diastolic and systolic heart failure | systolic heart failure is when heart cannot pump properly and diastolic heart failure is when heart cannot fill properly |
| LVF/ left systolic failure definition | LV cannot efficiently eject blood into aorta (problem emptying heart) which causes an increase in LVEDV leading to backup of blood into lungs producing pulmonary oedema |
| most common cause of diastolic heart failure (DHF) | concentric LV hypertrophy due to essential HTN |
| define RHF | RV cannot effectively pump venous blood into lungs (either because it cant pump or because it cant fill) where blood pools under pressure in venous system and builds up behind failed heart with increased afterload |
| left sided HF symptoms and signs | dyspnoea and pulmonary oedema |
| how does pulmonary oedema occur as a symptom/ sign of LVF | increase in LVEDV leads to increase in hydrostatic pressure in LV that is transmitted back into pulmonary capillaries |
| danger of pulmonary oedmea and symptoms | narrows airways and can produce expiratory wheeze (cardiac asthma), bibasilar inspiratory crackles, and pink frothy sputum |
| starling forces explanation | hydrostatic and oncotic pressures—that govern the exchange of fluid between blood plasma and the surrounding interstitial tissue across capillary walls |
| paroxysmal nocturnal dyspnoea | SOB at night when patient lying flat as there is no gravity to stop fluid from going from interstitial space to vascular compartment, which increases venous return to R and then to failed L leading to pulmonary oedema |
| paroxysmal relieved by | standing or placing pillows under the head, where number of pillows causes symptomatic relief should be quantitated |
| left sided S3 | can be normal in young people (due to sudden rush of blood entering a volume overloaded left or right ventricle) |
| s4 heart sound | pathological |
| BNP | cardiac neurohormone secreted in response to SNS activation from ventricles of the brain when there is volume overload |
| natriuretic peptides | involved in long term regulation of sodium and water balance, blood volume and arterial pressure |
| major actions of natriuretic peptides eg BNP | vasodilation (of veins which reduces venous return and hent ventricular preload and arteries reduced TPR with reduced NE release from SNS) and renal effect (leading to reduced renin + natriuresis (excrete sodium) + diuresis (pee more) |
| prominence of internal jugular veins can be a sign/ symptom of | right sided heart failure |
| backlog to limbs lead to | dependent pitting oedema (due to increase in venous hydrostatic pressure) |
| increased sympathetic activity leads to | peripheral vasoconstriction of afferent renal artery |
| tests to determine heart failure (4) | measure N-terminal pro-B-type natriuretic peptide level, arrange a 12 lead ECG, transthoracic echocardiogram, and CXR |
| 12 lead ECG most common finding is | LV hypertrophy |
| transthoracic echocardiogram shows | whether it is diastolic or systolic failure |
Created by:
kablooey
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