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?

    <p>To form a closed delivery system for blood</p> Signup and view all the answers

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

    <p>Diuretic</p> Signup and view all the answers

    What is the primary cause of right heart failure?

    <p>Diastolic failure</p> Signup and view all the answers

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

    <p>To achieve target dose of medications</p> Signup and view all the answers

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

    <p>Fluid retention and vasoconstriction</p> Signup and view all the answers

    What is the aim of the management of myocardial infarction?

    <p>Decrease oxygen demand and increase coronary perfusion</p> Signup and view all the answers

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

    <p>Fluid retention</p> Signup and view all the answers

    What is one of the complications of myocardial infarction?

    <p>Stroke</p> Signup and view all the answers

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

    <p>Dual antiplatelet therapy with aspirin and clopidogrel</p> Signup and view all the answers

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

    <p>12-lead ECG with clinical interpretation</p> Signup and view all the answers

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

    <p>Statins</p> Signup and view all the answers

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

    <p>Coronary artery spasm</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

    What is the primary characteristic of congestive heart failure?

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

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

    <p>Right-sided heart failure</p> Signup and view all the answers

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

    <p>To assess left ventricular systolic and diastolic function</p> 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?

    <p>Acute heart failure</p> Signup and view all the answers

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

    <p>Neurogenic heart failure</p> 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?

    <p>Chronic heart failure</p> Signup and view all the answers

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

    <p>ECG</p> Signup and view all the answers

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

    <p>Brain natriuretic peptide (BNP)</p> Signup and view all the answers

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

    <p>Myocardial 'remodelling'</p> Signup and view all the answers

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

    <p>To decrease oxygen demand</p> Signup and view all the answers

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

    <p>Increases cardiac workload</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

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

    <p>To evaluate cardiac function</p> Signup and view all the answers

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

    <p>Dual antiplatelet therapy for 12 months</p> Signup and view all the answers

    What is the primary consequence of recurrent myocardial infarction?

    <p>Heart failure</p> Signup and view all the answers

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

    <p>Coronary artery spasm</p> 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?

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

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

    <p>To decrease fluid load in patients with heart failure</p> Signup and view all the answers

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

    <p>Blood vessels become less flexible and more prone to blockage</p> Signup and view all the answers

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

    <p>To prevent fluid overload and congestion</p> Signup and view all the answers

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

    <p>By reducing sympathetic tone</p> Signup and view all the answers

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

    <p>Ventricular arrhythmias</p> Signup and view all the answers

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

    <p>To decrease peripheral resistance</p> Signup and view all the answers

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

    <p>By increasing peripheral resistance</p> Signup and view all the answers

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

    <p>Gradual progression of cardiac dysfunction</p> Signup and view all the answers

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

    <p>Peripheral congestion</p> Signup and view all the answers

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

    <p>Diuretic and natriuretic effects</p> Signup and view all the answers

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

    <p>Decreased left ventricular ejection fraction</p> Signup and view all the answers

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

    <p>Platelet aggregation and vasoconstriction</p> Signup and view all the answers

    What is the primary underlying mechanism of acute heart failure?

    <p>Sudden decrease in the amount of blood pumped out from both ventricles</p> 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?

    <p>Hypertension</p> Signup and view all the answers

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

    <p>Pulmonary congestion</p> Signup and view all the answers

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

    <p>Arteriosclerosis</p> Signup and view all the answers

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

    <p>Detecting cardiac injury</p> Signup and view all the answers

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

    <p>Complete blockage of the vessel</p> Signup and view all the answers

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

    <p>Dyspnoea and fatigue at rest</p> Signup and view all the answers

    What is the primary goal of managing atherosclerosis?

    <p>All of the above</p> Signup and view all the answers

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

    <p>Dyslipidaemia</p> Signup and view all the answers

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

    <p>Thrombus formation and complete blockage of the vessel</p> Signup and view all the answers

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

    <p>Pain and disability in the lower limbs</p> Signup and view all the answers

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

    <p>Formation of lactic acid</p> Signup and view all the answers

    What is the primary cause of unstable angina?

    <p>Atherosclerosis</p> Signup and view all the answers

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

    <p>Cell death and scarring</p> Signup and view all the answers

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

    <p>Initial decrease, then increase</p> Signup and view all the answers

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

    <p>To replace necrotic tissue with scar tissue</p> Signup and view all the answers

    What is the primary effect of atherosclerosis on coronary arteries?

    <p>Decreased luminal diameter</p> Signup and view all the answers

    What is the primary characteristic of Prinzmetal's angina?

    <p>Caused by vasospasm</p> Signup and view all the answers

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

    <p>Decrease</p> 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.

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