Clinical Features of Heart Failure

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Questions and Answers

What is the primary cause of blood 'back-up' in the systemic circulation?

Vascular constriction

Increased blood pressure

Diastolic failure

Poor ventricular contraction (correct)

Which of the following is a common complication of heart failure?

Alzheimer's disease

Myocardial infarction

Hypertension

Thromboembolism (correct)

What is the primary goal of non-pharmacological management in heart failure?

Reduce BMI through physical activity and healthy eating (correct)

Decrease blood pressure

Reduce fluid load

Improve cardiac function

What is the primary function of the vascular bed?

To form a closed delivery system for blood Signup and view all the answers

Which of the following medications is used to decrease fluid load in patients with heart failure?

Diuretic Signup and view all the answers

What is the primary cause of right heart failure?

Diastolic failure Signup and view all the answers

What is the primary goal of pharmacological management in heart failure?

To achieve target dose of medications Signup and view all the answers

What is one of the effects of Angiotensin II released in myocardial infarction?

Fluid retention and vasoconstriction Signup and view all the answers

What is the aim of the management of myocardial infarction?

Decrease oxygen demand and increase coronary perfusion Signup and view all the answers

What is the primary consequence of excessive salt intake in heart failure?

Fluid retention Signup and view all the answers

What is one of the complications of myocardial infarction?

Stroke Signup and view all the answers

What is used in the long-term management of acute coronary syndromes?

Dual antiplatelet therapy with aspirin and clopidogrel Signup and view all the answers

What is performed in the initial assessment of acute coronary syndromes?

12-lead ECG with clinical interpretation Signup and view all the answers

What is used to address dyslipidaemia in the management of myocardial infarction?

Statins Signup and view all the answers

What is one of the effects of catecholamine release in myocardial infarction?

Coronary artery spasm Signup and view all the answers

What is used in the management of myocardial infarction to decrease the work of the heart?

All of the above Signup and view all the answers

What is the primary characteristic of congestive heart failure?

Inadequate perfusion of tissues with oxygen and blood-born nutrients Signup and view all the answers

Which of the following is a type of heart failure that causes peripheral congestion?

Right-sided heart failure Signup and view all the answers

What is the primary purpose of an echocardiogram in diagnosing heart failure?

To assess left ventricular systolic and diastolic function Signup and view all the answers

What is the term for the sudden decrease in the amount of blood pumped out from both ventricles, reducing oxygen supply to the tissues?

Acute heart failure Signup and view all the answers

Which of the following is not a type of heart failure?

Neurogenic heart failure Signup and view all the answers

What is the term for the progression of heart failure that may have no symptoms in the early stages?

Chronic heart failure Signup and view all the answers

Which of the following is an investigation used to diagnose heart failure?

ECG Signup and view all the answers

What is the term for the peptide hormone that is elevated in heart failure?

Brain natriuretic peptide (BNP) Signup and view all the answers

What is the consequence of myocyte growth and fibroblast formation of collagen in myocardial infarction?

Myocardial 'remodelling' Signup and view all the answers

What is the primary goal of decreasing myocardial workload in the management of myocardial infarction?

To decrease oxygen demand Signup and view all the answers

What is the effect of vasoconstriction on cardiac workload in myocardial infarction?

Increases cardiac workload Signup and view all the answers

What is the role of Angiotensin II in the pathogenesis of myocardial infarction?

All of the above Signup and view all the answers

What is the primary purpose of echocardiography in the evaluation of myocardial infarction?

To evaluate cardiac function Signup and view all the answers

What is the long-term management recommendation for acute coronary syndromes?

Dual antiplatelet therapy for 12 months Signup and view all the answers

What is the primary consequence of recurrent myocardial infarction?

Heart failure Signup and view all the answers

What is the effect of catecholamine release on coronary arteries in myocardial infarction?

Coronary artery spasm Signup and view all the answers

What is the primary mechanism by which blood 'back-up' occurs in the lungs during left-sided heart failure?

Poor ventricular contraction causes blood to back-up in the pulmonary circulation Signup and view all the answers

What is the primary role of diuretics in the management of heart failure?

To decrease fluid load in patients with heart failure Signup and view all the answers

What is the primary consequence of atherosclerosis in the vascular bed?

Blood vessels become less flexible and more prone to blockage Signup and view all the answers

What is the primary reason why patients with heart failure are placed on fluid restriction?

To prevent fluid overload and congestion Signup and view all the answers

What is the primary mechanism by which beta blockers exert their therapeutic effect in heart failure?

By reducing sympathetic tone Signup and view all the answers

What is the primary complication of heart failure that can lead to sudden death?

Ventricular arrhythmias Signup and view all the answers

What is the primary role of ACE inhibitors in the management of heart failure?

To decrease peripheral resistance Signup and view all the answers

What is the primary mechanism by which hypertension contributes to the development of heart failure?

By increasing peripheral resistance Signup and view all the answers

What is the primary mechanism underlying the development of chronic heart failure?

Gradual progression of cardiac dysfunction Signup and view all the answers

Which of the following is a characteristic of right-sided heart failure?

Peripheral congestion Signup and view all the answers

What is the primary role of brain natriuretic peptide in heart failure?

Diuretic and natriuretic effects Signup and view all the answers

Which of the following echocardiogram findings is indicative of left ventricular systolic dysfunction?

Decreased left ventricular ejection fraction Signup and view all the answers

What is the primary consequence of endothelial injury in the pathophysiology of atherosclerosis?

Platelet aggregation and vasoconstriction Signup and view all the answers

What is the primary underlying mechanism of acute heart failure?

Sudden decrease in the amount of blood pumped out from both ventricles Signup and view all the answers

Which of the following risk factors is associated with an increased risk of coronary heart disease and cerebrovascular disease?

Hypertension Signup and view all the answers

Which of the following is a complication of left-sided heart failure?

Pulmonary congestion Signup and view all the answers

What is the term for the abnormal thickening and hardening of artery walls, often associated with lipid deposition?

Arteriosclerosis Signup and view all the answers

What is the primary role of cardiac enzymes in the diagnosis of heart failure?

Detecting cardiac injury Signup and view all the answers

What is the result of a thrombus forming in a partially obstructed artery?

Complete blockage of the vessel Signup and view all the answers

Which of the following is a characteristic of congestive heart failure?

Dyspnoea and fatigue at rest Signup and view all the answers

What is the primary goal of managing atherosclerosis?

All of the above Signup and view all the answers

What is the term for the metabolic disorder characterised by increased concentrations of plasma cholesterol and triglycerides?

Dyslipidaemia Signup and view all the answers

What is the consequence of an unstable plaque rupturing in an artery?

Thrombus formation and complete blockage of the vessel Signup and view all the answers

What is the clinical manifestation of peripheral artery obstruction in atherosclerosis?

Pain and disability in the lower limbs Signup and view all the answers

What is the primary consequence of anaerobic respiration in myocardial ischemia?

Formation of lactic acid Signup and view all the answers

What is the primary cause of unstable angina?

Atherosclerosis Signup and view all the answers

What is the primary result of ischaemia continuing in myocardial infarction?

Cell death and scarring Signup and view all the answers

What is the primary change in blood pressure in myocardial infarction?

Initial decrease, then increase Signup and view all the answers

What is the primary purpose of granulation tissue in myocardial infarction repair?

To replace necrotic tissue with scar tissue Signup and view all the answers

What is the primary effect of atherosclerosis on coronary arteries?

Decreased luminal diameter Signup and view all the answers

What is the primary characteristic of Prinzmetal's angina?

Caused by vasospasm Signup and view all the answers

What is the primary change in ejection fraction in myocardial infarction?

Decrease Signup and view all the answers

Study Notes

Right-Sided Heart Failure

Right heart failure is equivalent to diastolic failure
Clinical features include:
- Peripheral oedema
- Hepatosplenomegaly
- Pleural effusion
- Ascites

Left-Sided Heart Failure

Clinical features include:
- Pulmonary congestion and oedema
- Cough
- Dyspnoea/orthopnoea/PND

Pharmacological Management of Heart Failure

ACE inhibitors and beta blockers are used to manage heart failure
Diuretics like Furosemide are used to decrease fluid load in patients with HF
Anticoagulant and anti-arrhythmia medication are used in patients with HF with arrhythmias

Non-Pharmacological Management of Heart Failure

Moderate physical activity is recommended
Weight reduction through physical activity and healthy eating is recommended to reduce BMI
Reduction of salt intake is essential to prevent fluid retention
Careful monitoring of fluid intake is necessary to prevent fluid overload
Daily weight monitoring is recommended, with any sudden increase in weight reported and documented

Complications of Heart Failure

Renal failure
Hypokalaemia/hyperkalaemia
Hyponatraemia
Impaired liver function
Thromboembolism
Atrial and ventricular arrhythmias
Sudden death

Pathophysiology of Heart Failure

Heart failure can be acute or chronic
Often associated with systolic and diastolic congestion and with myocardial weakness
Acute HF involves a sudden decrease in the amount of blood pumped out from both ventricles, reducing oxygen supply to the tissues
Chronic HF involves a gradual progression of the disease, with early stages possibly having no symptoms of HF

Investigations for Heart Failure

ECG
Chest x-ray
Echocardiogram/Transesophageal echocardiogram
Cardiac enzymes
Brain natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) blood test

Echocardiogram

Non-invasive procedure using ultrasound waves
Provides a semi-quantitative assessment of left ventricular systolic and diastolic function
Valvular disorders can be accurately delineated and pulmonary artery systolic pressure can be estimated

Types of Heart Failure

Left heart failure (congestive heart failure) = systolic failure
Right heart failure = diastolic failure

Heart Failure

Right heart failure = diastolic failure
Clinical features of Right-sided heart failure:
- Peripheral oedema
- Hepatosplenomegaly
- Pleural Effusion
- Ascites
Clinical features of Left-sided heart failure:
- Pulmonary congestion and oedema
- Cough
- Dyspnoea/orthopnoea/PND

Pharmacological Management of Heart Failure

Ace inhibitors and beta blockers commenced at a low dose and titrated until target dose is achieved or tolerated dose is reached
Diuretic like Furosemide, used to decrease fluid load in patients with HF
Anticoagulant and anti-arrhythmia medication used in patients with HF with arrhythmias (e.g. AF)

Non-Pharmacological Management of Heart Failure

Moderate physical activity as the condition allows
Weight reduction through physical activity and healthy eating to reduce BMI
Reduction of salt intake is essential as excessive intake can cause fluid retention and lead to an exacerbation of cardiac problems
Careful monitoring of fluid intake prevents fluid overload
Patients may be placed on fluid restriction as directed on their care plan
Daily weight monitoring with any sudden increase in weight is reported and documented

Complications of Heart Failure

Renal failure
Hypokalaemia/hyperkalaemia
Hyponatraemia
Impaired liver function
Thromboembolism
Atrial and ventricular arrhythmias
Sudden death

Atherosclerosis and Hypertension

Vascular bed: blood vessels can dilate, constrict, pulsate and form a closed delivery system for the blood, which begins and ends at the heart
Abnormal heart sounds from ventricular dysfunction
Pericardial friction rub may occur from inflammation
Dullness in lung percussion and inspiratory crackles from pulmonary congestion may occur
Angiotensin II released and contributes to pathogenesis
Vasoconstriction
Fluid retention
Catecholamine release and coronary artery spasm
Myocyte growth and fibroblast formation of collagen, resulting in myocardial 'remodelling'

Evaluation for Myocardial Infarction

Chest x-ray
Cardiac enzymes
ECG
Angiography
Echocardiography

ECG Changes

[Image]

Complications of Myocardial Infarction

Arrhythmias
Death
Recurrent MI
Stroke
Heart failure

Myocardial Infarction Management

Oxygen and aspirin, sublingual glyceryl nitrate and IV morphine
Admission to coronary care unit
May give ACE-inhibitors or beta blockers
Coronary artery bypass graft
Thrombolytics or percutaneous angioplasty (PTCA) and stenting
Aim is to increase coronary perfusion and decrease myocardial workload and demand for oxygen
Decrease work of heart by decrease BP, HR, Contractility and end diastolic volume
Decrease blood clot formation
Address dyslipidaemia

Management of ACS -- Acute Coronary Syndromes

Initial assessment of ACS should involve a 12-lead ECG with clinical interpretation within 10 mins of first presentation
Care is guided by a suspected ACS assessment protocol
Cardiac-specific troponin concentration is measured on presentation and at defined periods thereafter
If appropriate, dual antiplatelet therapy with aspirin (100-150mg/daily) and either clopidogrel or ticagrelor for 12 months irrespective of whether coronary revascularisation was performed
Highest tolerated dose of statin should be initiated and continued indefinitely
Lifestyle education, cardiac rehab programs and chest pain action plans = long-term management strategy

Heart Failure Syndrome

Characterised by an underlying structural abnormality or cardiac dysfunction that impairs the ability of left ventricle (LV) to fill with or eject blood, particularly during physical activity
Symptoms of Congestive Heart Failure -- dyspnoea and fatigue can occur at rest or during physical activity
Pathophysiology of Heart Failure -- both ventricles can fail independently
Can be acute or chronic
Often associated with systolic and diastolic congestion and with myocardial weakness
Acute HF, sudden decrease in the amount of blood pumped out from both ventricles, reducing oxygen supply to the tissues
Chronic HF, progression of the disease is gradual and early stages may have no symptoms of HF
Right side of Heart fails = Right-sided heart failure (RSHF), causes peripheral congestion
Left side of Heart fails = Left-sided heart failure (LSHF), causes pulmonary congestion

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Description

This quiz covers the clinical features of right-sided and left-sided heart failure, including symptoms such as peripheral oedema, hepatosplenomegaly, pleural effusion, ascites, pulmonary congestion, cough, dyspnoea, and orthopnoea.