Questions and Answers
What condition is characterized by impaired left ventricular function resulting in a backlog of blood?
What defines heart failure with reduced ejection fraction?
Which of the following symptoms is associated with paroxysmal nocturnal dyspnoea?
What happens to the left atrium, pulmonary veins, and lungs due to impaired left ventricular function in chronic heart failure?
Signup and view all the answers
Which mechanism may explain paroxysmal nocturnal dyspnoea?
Signup and view all the answers
What physiological change occurs during sleep that affects the respiratory system?
Signup and view all the answers
Which of the following medications is part of the first-line medical treatment for chronic heart failure?
Signup and view all the answers
What is the purpose of cardiac resynchronisation therapy (CRT) in heart failure management?
Signup and view all the answers
Which heart failure classification system is used to grade the severity of symptoms?
Signup and view all the answers
What condition should be closely monitored in patients taking ACE inhibitors and aldosterone antagonists?
Signup and view all the answers
Study Notes
Chronic Heart Failure Overview
- Chronic heart failure affects the left ventricle's ability to pump blood, leading to impaired circulation.
- Causes a backlog of blood which increases volume and pressure in the left atrium, pulmonary veins, and lungs.
Symptoms and Clinical Features
- Pulmonary oedema occurs due to fluid leakage from the lungs, caused by elevated pressure.
- Ejection fraction is a critical measure of heart function, with normal levels above 50%.
- Two heart failure types:
- Reduced ejection fraction: less than 50%.
- Preserved ejection fraction: greater than 50%, often due to diastolic dysfunction.
Key Symptoms of Chronic Heart Failure
- Paroxysmal nocturnal dyspnoea (PND): patients wake suddenly at night feeling breathless, experiencing cough and wheeze.
- Potential mechanisms for PND include:
- Fluid accumulation in the lungs while lying flat.
- Decreased responsiveness of the brain's respiratory center during sleep.
- Lower adrenaline levels during sleep, reducing cardiac output.
Diagnosis and Assessment
- Diagnosis involves clinical evaluation and various investigations.
- New York Heart Association (NYHA) classification system is used to assess severity based on symptoms.
Management Principles
- Management follows NICE guidelines, using the “RAMPS” mnemonic for five key principles.
- Referral urgency is based on NT-proBNP levels, indicating heart failure severity.
Medical Treatment
- First-line options summarized by the “ABAL” mnemonic:
- Angiotensin receptor blockers (e.g., candesartan) as alternatives to ACE inhibitors if poorly tolerated.
- Aldosterone antagonists for patients with reduced ejection fraction when symptoms persist despite other treatments.
- Monitoring of renal function and electrolytes (U&Es) is critical due to risks of hyperkalaemia, particularly with diuretics and ACE inhibitors.
Additional Management Strategies
- Surgical interventions may address underlying valvular heart disease.
- Implantable cardioverter defibrillators provide shock therapy for life-threatening arrhythmias in high-risk patients.
- Cardiac resynchronisation therapy (CRT) optimizes heart function in severe heart failure (ejection fraction < 35%) through biventricular pacing.
- Heart transplantation may be an option for appropriate candidates with severe disease.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz explores the clinical features and mechanisms behind chronic heart failure, focusing on the impaired function of the left ventricle. Learn about the effects on blood flow, pressure in the heart, and the resulting fluid issues in the lungs and surrounding tissues.
