Slide 1

PALi Cardiology Revision: Heart Failure Lucille Ramani 0707070r@student.gla.ac.uk

Slide 2

a complex of signs and symptoms that occurs when the heart fails to pump adequate CO Heart Failure Definition Epidemiology Prevalence: 3-20 per 1000 5% emergency admissions by 50% in the next 25 years 50% dead by 5 years Mainly a disease of the older population (>65 years)

Slide 3

Aetiology CauseSpecific Examples Cardiovascular disease IHD; cardiomyopathies; HTN; myocarditis; valvular heart disease; congenital heart diseases Pulmonary disease Pulmonary HTN; pulmonary valve stenosis; PE; chronic pulmonary disease; neuromuscular disease Toxins Heroin; alcohol; cocaine; amphetamines; lead; arsenic; cobalt; phosphorus Infection Bacterial; fungal; viral (HIV); Borrelia burgdorferi (Lyme disease); sepsis Electrolyte imbalance calcium, phosphate, potassium, sodium Endocrine disorders DM; thyroid disease; hypoparathyroidism; phaeochromocytoma; acromegaly Systemic collagen vascular diseases SLE; RA; systemic sclerosis; polyarteritis nodosa; Reiters syndrome Drug-induced Adriamycin; cyclophosphamide; sulphonamides Nutritional deficiencies Thiamine; selenium; L-carnitine Pregnancy Peripartum cardiomyopathy

Slide 4

Aetiology: Chronic pulmonary disease cor pulmonale Left-sided heart failure Patent ductus arteriosus Isolated right-sided cardiomyopathy Tricuspid valve disease RV pressure backward failure systemic venous congestion Right Heart Failure (RHF)

Slide 5

Symptoms Fatigue Dyspnoea Anorexia, nausea Nocturia Signs JVP Smooth, tender hepatomegaly Ascites Pitting oedema (sacral, ankle) Hypotension Cyanosis, cool peripheries RHF: Clinical Features

Slide 6

Ischaemic heart disease Chronic systemic HTN Cardiomyopathy (usually dilated) Mitral / Aortic valve disease Mitral regurgitation: volume overload ( preload ) Aortic stenosis: pressure overload ( afterload) Consequence = pulmonary congestion LHF: Aetiology

Slide 7

Symptoms Fatigue Dyspnoea: exertional; orthopnoea; paroxysmal nocturnal Cough frothy pink sputum; haemoptysis Signs Few, but prominent at late stage Weight loss; muscle wasting Cardiomegaly Pulmonary oedema (creps) Hypotension; cool peripheries S3 and tachycardia: triple gallop rhythm LHF: Clinical Features

Slide 8

Compensatory mechanisms become overwhelmed and thus pathological (cardiac decompensation) Key concepts: CO is a function of preload and afterload Preload: end-diastolic wall stress (initial stretching of myocytes) Afterload: the resistance against which the heart has to pump Frank-Starling mechanism: change in SV in response to change in preload in preload via Rx is beneficial in workload and symptoms arising from venous congestion Pathophysiology

Slide 9

1. filling pressures to maintain SV 2.Dilation: increased wall tension ischaemia 3.Hypertrophy to balance pressure overload 4.Sinus tachycardia 5.Neurohormonal mechanisms Activation of RAAS - systemic vascular resistance - Aldosterone release (Na + and water retention) - ADH release (water retention) Sympathetic activity ( catecholamines) - HR, force of contraction and peripheral vasoconstriction Compensatory Changes

Slide 10

Diagnosis of HF (European Society of Cardiology Guidelines) Essential Features 1.Symptoms and signs of heart failure (e.g. SOB, fatigue, ankle oedema) 2.Objective evidence of cardiac dysfunction (at rest) Non-essential Features: in cases where there is diagnostic doubt 3. Response to treatment directed towards heart failure Diagnosis Bloods; cardiac enzymes/markers BNP (>100pg/mL = 95% specificity and 98% sensitivity ECG Transthoracic doppler ECHO: EF