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Heart Failure


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[Front]


Definition of Heart failure
[Back]


Cardiac output is unable to meet the metabolic requirements of the body despite adequate filling pressure

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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