Lecture 5 LV Dysfunction and Heart Failure I Flashcards Preview

CDL301 Cardiovascular Pharmacology > Lecture 5 LV Dysfunction and Heart Failure I > Flashcards

Flashcards in Lecture 5 LV Dysfunction and Heart Failure I Deck (54)
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What is the NICE definition of heart failure

A complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired


What is the ESC definition of heart failure

An abnormality of cardiac structure or function which leads to failure of the heart to deliver oxygen at a rate commensurate with the requirement of the tissues despite normal filling pressures or only at the expense of increased filling pressures


How many patients per year in the UK experience heart failure

1 million


Heart failure will increase in incidence by 50% in the next 5 years T or F



What is the main risk factor of heart failure

Age – heart failure is a disease of ageing it is rare below 65 but extremely common in the over 85


Why is it thought that heart disease affects more men than women

Most likely underlying coronary artery disease which is more prevalent in males


What percentage of hospital admissions is accounted for by heart failure



Heart failure accounts for 2% of the NHS budget. Where is most of this cost incurred

70% of heart failures cost to the NHS is on hospital admission


What is the prognosis of heart failure

Heart failure prognosis is extremely poor with an overage 30% mortality within 1 year


What causes the majority of heart failure

Left ventricular systolic dysfunction (LVSD)


Other than LVSD what other category of heart failure is there

Heart failure with preserved ejection fraction (HFPEF)


How can problems with diastole cause heart failure

Relaxation of the heart in diastole isn’t passive it’s an active energy dependent process requiring ATP. Thus patients can have problems with this and hence have heart failure with preserved ejection fraction


How can we classify heart failure based on its onset

Acute heart failure is when a patient suddenly deteriorates whereas chronic heart failure is a creeping worsening state that gradually gets worse over time


Give an example of a structural cause of heart failure

Mitral valve rupture can sometimes cause heart failure


What is the most common cause of heart failure

Coronary artery disease


Discuss why treatments of heart failure don’t target the heart itself

Drugs that stimulate the heart when its poorly contracting increase the energy requirements by the heart. When a patient is in heart failure a neurohumoral response triggered in response to decreased cardiac output this is an attempt to support the circulation. However this response can be derogatory and increased the demands of the heart. So instead treatments are therefore aimed at the response not at the heart itself.


What is the main target in heart failure treatment

The main approach is a vasodilator therapy that acts via neurohormonal blockade. This includes blocking the renin-angiotensin-aldosterone system and the sympathetic nervous system.


What is the difference between left ventricular dysfunction and heart failure

LV dysfunction is something you can measure by measuring the ejection fraction whereas heart failure is the clinical syndrome observed


What are the two broad effects of heart failure

Reduced cardiac output and increased filling pressures/preload


What causes reduced cardiac output in patients in heart failure and how does this present

Reduced cardiac output is often due to decreased ejection fraction. Patients will present with fatigue and exercise intolerance


What causes the increased filling pressures/preload in heart failure

There is an increased back pressure upstream of the ventricles because the ventricles aren’t clearing as much blood. This means that the veins leading to the ventricles increase in pressure


What symptom is associated specifically with LVSD in heart failure

Pulmonary oedema due to increased pressure in the left atria backtracking to the pulmonary veins subsequently increasing pressure in those vessels. This causes fluid to leave the vessels and enter the lungs


How do patients with pulmonary oedema usually present

Patients are extremely uncomfortable and want to be sat up in order to decrease pulmonary pressure an used all respiratory muscles


What is the dominant symptom in patients with heart failure and how does this present

The dominant symptom is venous congestion which presents as breathlessness during minor exertion


What symptom is associated specifically with right ventricular dysfunction in heart failure and how does this present

Peripheral oedema due to increased pressure in the right atria backtracking to the all of the veins. This presents as swelling of the lower limbs and abdomen (Ascites)


What is meant by anasarca

‘Michelin man effect’ where oedema has travelled far up the body


Why is the increase in filling pressure that occurs in heart failure as a result of the ventricles diminished ability to clear blood of little benefit to patients

The steepness of the Frank-Starling curve is much shallower in these patients so therefore increases in preload/filling pressures wont increase cardiac output by any significant amount


What is synonymous with preload

Filling pressure left ventricular end diastolic pressure end diastolic volume


Diuretics and venodilators can cause hypotension in healthy patients why does this often not occur in patients in heart failure

Due to the much shallower Frank-Starling curve these drugs can shift patients out of pulmonary congestion with very little loss of cardiac output


What are the main broad effects of diuretics

Cause the body to lose Na+ and water