Podcast
Questions and Answers
What characterizes Systolic Heart Failure?
What characterizes Systolic Heart Failure?
- Increased heart muscle stiffness
- Reduced ejection fraction (EF < 40%) (correct)
- Inadequate filling of blood
- Preserved ejection fraction (EF > 50%)
Which type of heart failure is characterized by pulmonary congestion?
Which type of heart failure is characterized by pulmonary congestion?
- Right-Sided Heart Failure
- Chronic Heart Failure
- Left-Sided Heart Failure (correct)
- Acute Heart Failure Syndrome
What is the primary reason for developing Chronic Heart Failure?
What is the primary reason for developing Chronic Heart Failure?
- Sudden heart muscle weakening
- Inadequate filling of blood
- Rapid onset of symptoms
- Underlying cardiovascular diseases (correct)
Acute Heart Failure Syndrome (AHF) requires what kind of therapy?
Acute Heart Failure Syndrome (AHF) requires what kind of therapy?
What type of heart failure is associated with a preserved ejection fraction?
What type of heart failure is associated with a preserved ejection fraction?
What is the most common cause of Right-Sided Heart Failure?
What is the most common cause of Right-Sided Heart Failure?
Congestive Heart Failure (CHF) can affect which aspect of heart function?
Congestive Heart Failure (CHF) can affect which aspect of heart function?
Excessive body needs, such as those seen in anemia, can lead to which condition?
Excessive body needs, such as those seen in anemia, can lead to which condition?
What symptom would you expect to be elevated in congestive cardiac failure (CCF)?
What symptom would you expect to be elevated in congestive cardiac failure (CCF)?
Which characteristic of the pulse may suggest left ventricular failure?
Which characteristic of the pulse may suggest left ventricular failure?
What is a common symptom associated with right-sided heart failure?
What is a common symptom associated with right-sided heart failure?
What condition is associated with a diffuse apex beat?
What condition is associated with a diffuse apex beat?
Which of the following tests is NOT typically used to assess heart failure?
Which of the following tests is NOT typically used to assess heart failure?
Which type of heart sound is referred to as a gallop rhythm when combined with tachycardia?
Which type of heart sound is referred to as a gallop rhythm when combined with tachycardia?
What is the appearance of peripheral edema in heart failure?
What is the appearance of peripheral edema in heart failure?
What indicates a potential fluid retention issue in heart failure patients?
What indicates a potential fluid retention issue in heart failure patients?
Atrial septal defects are categorized under which condition?
Atrial septal defects are categorized under which condition?
Which of the following signs is typical for low cardiac output?
Which of the following signs is typical for low cardiac output?
What is a possible consequence of GIT congestion due to heart failure?
What is a possible consequence of GIT congestion due to heart failure?
Which symptom is commonly associated with pulmonary congestion due to left-sided heart failure?
Which symptom is commonly associated with pulmonary congestion due to left-sided heart failure?
Which laboratory test is used to assess the severity of heart failure?
Which laboratory test is used to assess the severity of heart failure?
What is a prominent feature of an echocardiogram in heart failure diagnosis?
What is a prominent feature of an echocardiogram in heart failure diagnosis?
Which symptom is not commonly linked to systemic congestion in right-sided heart failure?
Which symptom is not commonly linked to systemic congestion in right-sided heart failure?
What indicates the presence of left ventricular hypertrophy (LVH)?
What indicates the presence of left ventricular hypertrophy (LVH)?
What is the primary use of coronary angiography?
What is the primary use of coronary angiography?
Which medication is classified as a mineralocorticoid receptor antagonist (MRA)?
Which medication is classified as a mineralocorticoid receptor antagonist (MRA)?
Which condition is NOT treated with cardiac catheterization?
Which condition is NOT treated with cardiac catheterization?
What is the main effect of ivabradine on heart function?
What is the main effect of ivabradine on heart function?
What does RAS activation indicate in heart failure?
What does RAS activation indicate in heart failure?
What is a significant contraindication for digitalis use?
What is a significant contraindication for digitalis use?
Which new method is utilized for cardiac resynchronization therapy?
Which new method is utilized for cardiac resynchronization therapy?
What condition occurs when the heart muscle thickens abnormally, making it harder for the left ventricle to pump blood?
What condition occurs when the heart muscle thickens abnormally, making it harder for the left ventricle to pump blood?
Which condition is characterized by narrowing of the mitral valve that restricts blood flow into the left ventricle?
Which condition is characterized by narrowing of the mitral valve that restricts blood flow into the left ventricle?
Which type of cardiomyopathy leads to an enlarged and weakened left ventricle?
Which type of cardiomyopathy leads to an enlarged and weakened left ventricle?
What results from narrowing of the aortic valve that forces the left ventricle to work harder?
What results from narrowing of the aortic valve that forces the left ventricle to work harder?
How does a heart attack impact the heart muscle?
How does a heart attack impact the heart muscle?
Which condition increases pressure in the left atrium due to valve dysfunction, possibly leading to heart failure?
Which condition increases pressure in the left atrium due to valve dysfunction, possibly leading to heart failure?
What is the mechanism behind pulmonary hypertension affecting the right ventricle?
What is the mechanism behind pulmonary hypertension affecting the right ventricle?
Flashcards
What is Heart Failure?
What is Heart Failure?
A condition where the heart can't pump blood effectively to meet the body's needs due to a structural or functional problem.
What is Systolic Heart Failure?
What is Systolic Heart Failure?
A condition where the heart muscle is weak and can't pump blood effectively, leading to a reduced ejection fraction (EF < 40%).
What is Diastolic Heart Failure?
What is Diastolic Heart Failure?
A condition where the heart muscle is stiff and can't relax properly, leading to inadequate blood filling, but with a preserved ejection fraction (EF > 50%).
What is Left-Sided Heart Failure?
What is Left-Sided Heart Failure?
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What is Right-Sided Heart Failure?
What is Right-Sided Heart Failure?
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What is Congestive Heart Failure (CHF)?
What is Congestive Heart Failure (CHF)?
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What are some causes of Heart Failure?
What are some causes of Heart Failure?
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What is Acute Heart Failure Syndrome (AHF)?
What is Acute Heart Failure Syndrome (AHF)?
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Tricuspid Valve Disease
Tricuspid Valve Disease
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Ischemic Heart Disease
Ischemic Heart Disease
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Hypertension
Hypertension
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Diastolic Heart Failure
Diastolic Heart Failure
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High COP Failure
High COP Failure
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Low COP Symptoms
Low COP Symptoms
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Pulmonary Congestive Symptoms
Pulmonary Congestive Symptoms
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Pulsus Alternans
Pulsus Alternans
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Dilated Cardiomyopathy
Dilated Cardiomyopathy
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Hypertrophic Cardiomyopathy
Hypertrophic Cardiomyopathy
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Aortic Stenosis
Aortic Stenosis
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Aortic Regurgitation
Aortic Regurgitation
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Mitral Stenosis
Mitral Stenosis
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Mitral Regurgitation
Mitral Regurgitation
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Arrhythmias
Arrhythmias
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Pulmonary Hypertension
Pulmonary Hypertension
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Heart Failure
Heart Failure
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Orthopnea
Orthopnea
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Tachycardia
Tachycardia
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Right Upper Quadrant Pain
Right Upper Quadrant Pain
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Hepatomegaly
Hepatomegaly
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Congestive Splenomegaly
Congestive Splenomegaly
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Echocardiography
Echocardiography
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Electrocardiogram (ECG)
Electrocardiogram (ECG)
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Cardiac Catheterization
Cardiac Catheterization
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RAS inhibitors
RAS inhibitors
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Biventricular Pacing (CRT)
Biventricular Pacing (CRT)
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Implantable Cardioverter Defibrillator (ICD)
Implantable Cardioverter Defibrillator (ICD)
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Ivabradine
Ivabradine
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Enteresto (Sacubtril-valsartan)
Enteresto (Sacubtril-valsartan)
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Cardiac Transplant
Cardiac Transplant
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Diet and Activity Changes
Diet and Activity Changes
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Study Notes
Clinical Aspect of Heart Failure
- Heart failure (HF) is a common clinical syndrome with symptoms caused by impaired heart ability to pump blood at a rate proportional to the metabolizing tissues' needs. This is due to either a structural or functional cardiac disorder.
- Heart failure is a common end point for many cardiovascular system diseases.
- Acute Heart Failure Syndrome (AHF) is the rapid onset or worsening of heart failure symptoms, requiring urgent therapy. It may develop in patients with previously diagnosed heart failure or manifest as the initial presentation of heart failure.
- Chronic Heart Failure (CHF) is a long-term condition where the heart cannot pump blood efficiently to meet the body's needs. It develops slowly over time, often resulting from underlying cardiovascular diseases.
Pathophysiology
- Forward Failure: Characterized by low cardiac output.
- Backward Failure: Characterized by the heart's failure to accept venous return, leading to pulmonary and systemic congestion.
Types of Heart Failure
- Systolic Heart Failure (HFrEF): The heart muscle is weak and cannot effectively pump blood. Characterised by a reduced ejection fraction (EF < 40%). Commonly caused by conditions like coronary artery disease and heart attacks.
- Diastolic Heart Failure (HFpEF): The heart muscle is stiff and cannot relax properly, affecting the filling of blood. Ejection fraction is preserved (EF > 50%). Often associated with hypertension, aging, and diabetes.
Left-Sided vs. Right-Sided Heart Failure
- Left-Sided Heart Failure: The most common type of heart failure. The left ventricle cannot pump blood efficiently to the body, which leads to pulmonary congestion.
- Subtypes: Systolic failure (reduced ejection fraction), Diastolic failure (preserved ejection fraction).
- Right-Sided Heart Failure: The right ventricle fails to pump blood effectively to the lungs, leading to fluid retention in the lower extremities, abdomen, and other organs. Often a result of left-sided heart failure or pulmonary hypertension.
Congestive Heart Failure (CHF)
- CHF affects both sides of the heart and is characterized by fluid accumulation throughout the body.
Causes of Heart Failure
- Normal heart forced to do excessive work: Excessive pressure (hypertension), excessive volume (aortic regurgitation), and excessive body needs (anemia).
- Diseased heart muscle: Cardiomyopathy.
- Combined excessive work and heart muscle disease.
Causes of Left-Sided Heart Failure
- Coronary Artery Disease (CAD): The most common cause.
- Hypertension (High Blood Pressure): Chronic high blood pressure forces the left ventricle to work harder.
- Heart Attack (Myocardial Infarction): Blood flow blockage to part of the heart muscle.
Causes of Right-Sided Heart Failure
- Left-Sided Heart Failure: The most common cause.
- Pulmonary Hypertension: High blood pressure in the lungs' arteries.
- COPD (Chronic Obstructive Pulmonary Disease)
- Pulmonary Embolism
- Right Ventricular Myocardial Infarction
- Tricuspid Valve Disease
- Congenital Heart Disease
Signs of Left-Sided Heart Failure
- Low Cardiac Output Signs: Tachypnea, cyanosis, tachycardia, cool, clammy skin, intermittent claudication.
- Lung Congestive Signs: Dyspnea, paroxysmal nocturnal dyspnea, orthopnea, acute pulmonary edema, cough, recurrent winter bronchitis, hemoptysis.
Signs of Right-Sided Heart Failure
- Low COP Symptoms: Low cardiac output (general symptoms).
- Systemic Congestive Symptoms: Pain in the right upper abdomen (hepatic congestion), digestive issues (anorexia, nausea, vomiting, dyspepsia), CNS congestion (confusion, headache, insomnia, lack of memory and encephalopathy in advanced heart failure), edema in the lower limbs, ascites.
Examination of Patients with Heart Failure
- Cardiovascular System: Pulse (rapid, weak, thready), abnormal pulse character, blood pressure (normal, low, high). Jugular venous pressure, apex beat location and character. Heart sounds (third/fourth heart sound).
- Respiratory System: Cyanosis, bilateral basal fine end-inspiratory crepitations, pleural effusions, and expiratory wheeze (secondary to cardiac asthma).
Investigations of HF
- History and Physical Examination
- Blood Tests: CBC, Renal Function (Urea, Creatinine), Liver Function Tests, Thyroid Function, Electrolytes; B-type Natriuretic Peptide (BNP) and N-terminal pro-BNP (NT-proBNP)
- ECG
- CXR
- Echo/Doppler
- Coronary Angiography
- Cardiopulmonary Exercise Testing (CPET)
- Cardiac catheterization
Treatment of Heart Failure
- Pharmacological: Diuretics, RAS inhibitors, Digoxin, Beta-blockers, New drugs,
- Non-Pharmacological: Diet and activity changes (salt restriction, fluid restriction, daily weight monitoring, gradual exercise programs).
- Correction of Reversible Causes: Ischemia, valvular heart disease, thyrotoxicosis, arrhythmias
- Anticoagulation (coumadine): For atrial fibrillation, history of embolic episodes, and left ventricular apical thrombus.
- New drugs: Ivabradine, Sacubitril-valsartan
- New methods: Biventricular pacing, ICD (Implantable cardioverter-defibrillator), Cardiac transplant.
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