Heart Failure
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Heart Failure - Marcador
Heart Failure - Detalles
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| 🇬🇧 | 🇬🇧 |
| Definition of Heart failure | Cardiac output is unable to meet the metabolic requirements of the body despite adequate filling pressure |
| What are some causes of Heart failure | Hypertension Valvular stenosis → pressure overload Valvular regurgitation → volume overload Arrhythmias Coronary artery disease → MI Fibrosis → Diastolic dysfunction leading to restriction of filling |
| What are the 2 types of heart failure | Systolic Failure → Impaired Ventricular function --> Left Ventricular Ejection Fraction is less than 45% Diastolic Failure → Impaired filling --> Left Ventricular Ejection Fraction is more than 50% |
| What is congestive heart failure | Left heart failure leads to right heart failure |
| What are the different classes of New York Association Classification | Class I → No symptomatic limitation of physical activity Class II → Slight limitation of physical activity, Ordinary physical activity results in symptoms but no symptoms at rest Class III → Marked Limitation of physical activity, Less than ordinary physical activity results in symptoms but no symptoms at rest Class IV → Inability To carry out any physical activity without symptoms and symptoms at rest |
| What are some conservative management plans | Patient Education Lifestyle modification Reduce excess salt Reduce Alcohol Increase in aerobic exercise Optimise CV risk factors: decrease BP, statin, stop smoking |
| What drugs can you give for a heart failure patient | Beta blockers reduce heart rate by decreasing beta receptor activation and sympathetic drive Diuretics decrease fluid retention Angiotensin converting enzyme inhibitor decreases angiotensin II formation Angiotensin receptor blockers also stop the activation of the RAAS system Aldosterone antagonist decreases sodium and water retention |
| Surgical Managements for Cardiac failure | Implantable cardiac defibrillators Cardiac resynchronisation therapy Implantable pacemaker Left ventricular assist devices (LVAD) Heart transplant |
| What are the 2 compensatory mechanisms of the heart during LV failure | Decrease cardiac output leads to an increase in LVEDP which according to Starling Law leads to increase stretching of the myocytes and increase in cardiac output and also can lead to hypertrophy Neurohumoral compensation also takes place, and increases cardiac output which leads to increase in fluid retention and increase in central venous pressure which according to Starling Law leads to increase in cardiac output |
| What is the neurohumoral compensation | Myocardial damage leads to reduced CO and BP which activates the sympathetic NS This leads to the activation of the RAAS system , vasoconstriction, increase heart rate and contractility Vasoconstriction increases TPR which increases BP RAAS leads to increase fluid retention which leads to increase in cardiac output However in the long term the wall stress and increase oxygen demand leads to hypertrophy and decreased contractility |
| Briefly explain what the kidney does to compensate for decrease in CO | Sympathetic stimulation leads to vasoconstriction of the renal artery which leads to sodium and water retention This leads to increase in release of renin hence leading to production of angiotensin I and angiotensin II ( Angiotensin converting enzyme ) Angiotensin II causes more vasoconstriction and increases the TPR which increases blood pressure Angiotensin II also leads to release of Aldosterone which increases sodium and water retention This leads to increase in volume so it increases central venous pressure This hence leads to increase in end diastolic pressure And according to Starling's Law it leads to increase in CO Angiotensin II also leads to further sympathetic stimulation |